UPDATE, February 5, 2020, 4:26 p.m.: Attorneys general from six states and Washington, D.C. have filed a lawsuit against the Trump administration for its rule designed to complicate abortion coverage in Affordable Care Act plans.

The Trump administration issued a rule Friday designed to create administrative burdens for insurance plans on the Affordable Care Act (ACA) exchanges that include abortion care, in a move that imperils coverage of abortion care for more than 3 million people.

A year after first proposing it, the Centers for Medicare and Medicaid Services issued a final rule that will complicate the process of billing and payment for ACA insurance plans that include abortion coverage. People who have health care through a state exchange will have to submit a separate premium payment for abortion coverage, an added administrative requirement that could result in lost coverage for those who fail to follow the administration’s regulation.

The new rule for plans through the ACA, also known as Obamacare, “will likely result in plan decisions to eliminate abortion coverage from their policies in order to avoid additional administrative requirements, placing the costs of abortion care directly on women enrollees and potentially limiting their access to these services,” according to a December 2018 analysis published by the Kaiser Family Foundation after the rule was first proposed.

The separate billing requirement will go into effect on June 27, 2020. Other parts of the rule will go into effect in 60 days.

The impact of the rule will be felt in at least 16 states and Washington, D.C.: five states that require ACA exchange plans cover abortion care, and the other states that offer at least one exchange plan that includes abortion coverage. U.S. Health and Human Services Department (HHS) estimates the rule will affect more than 3 million people across the country.

Twenty-six states prohibit ACA marketplace health plans from including abortion services, according to the National Women’s Law Center.

Jacqueline Ayers, vice president of government relations and public policy at Planned Parenthood Federation of America, said with the new HHS rule, the Trump administration is “trying to make safe, legal abortion even harder to access.”

“This rule won’t just require separate payments, it further splits off abortion from other reproductive health care and puts up massive barriers to access,” Ayers said in a statement. “Everyone deserves reproductive health care coverage that meets their needs, including abortion, without shame or stigma.”

The rule’s financial effect on those who have health coverage through the state ACA exchanges will be considerable.

Mary Alice Carter, senior advisor at watchdog group Equity Forward, said HHS Secretary Alex Azar, who helped undermine the Title X family planning program, “has once again put the wishes of the anti-abortion lobby ahead of what is best for the health and well-being of people in America.”

“Everyone should be able to make decisions about abortion with dignity and respect, without financial or political interference,” Carter said in a statement. “This regulation will build yet another barrier to abortion access.”

HHS has waged administrative war on the ACA since Trump took office in 2017. In April 2018, the administration expanded the list of ACA “hardship exemptions,” which waive fines for lacking health insurance coverage, to include those who object to abortion care.