Millions could lose their health insurance as a result of Trump's action and be forced to rely on the emergency room as their primary health provider. Here, Keanya Swaby, a patient access employee in the emergency room at Jersey City Medical Center, inputs information for Michele Marion, 44, in September 2014. | Julio Cortez / AP

WASHINGTON—Unions and women’s rights groups protested and 19 state attorneys general sued to stop Republican President Donald Trump’s scheme to yank health insurance coverage from at least six million people.

Trump’s plan, unveiled in an executive order on October 12, would stop approximately $7 billion in annual subsidies, called cost-sharing reductions (CSRs), to insurers to help them keep premiums affordable for people earning up to $30,000 yearly.

Many, if not most, of the people who would get hurt are women enrolled in the individual insurance market, the National Partnership for Women and Families noted.

The Affordable Care Act mandates insurers offer policies, at the same “silver level” average coverage they offer to everyone else, to lower-income people. But when the insurers pointed out they would lose tons of money, Congress started voting for the subsidies. Trump is stopping them. He claimed the ACA did not explicitly enact the subsidies, and his administration won’t defend them in court.

As a result of his move, the insurers will get stuck with the bill and various analysts calculated Trump’s ruling could drive premiums up by 20 percent, or drive some insurers immediately out of the market, leaving whole counties in the U.S., most of them rural, with no coverage at all.

Trump also used his executive order to boost what he called an alternative—association health plans—that small firms and individuals could use to gain coverage. But those plans, first unveiled more than a decade ago, have largely failed to provide adequate coverage, or any at all, analysts say.

The Service Employees and the American Federation of Teachers spoke out against Trump’s dump of the health coverage. California Attorney General Xavier Becerra, New York’s Eric Schneiderman, and Maryland’s Brian Frosh led the charge of 18 state AGs, plus the Attorney General for Washington, D.C., into U.S. District Court in San Francisco. Becerra called Trump’s executive order part of his “sabotage” of the ACA.

“Undermining the Affordable Care Act has been Donald Trump’s and many Republicans’ plan for a long time. It’s long past time President Trump learned he doesn’t get to just pick and choose which laws he’ll follow, and which bills he’ll pay,” Becerra said.

“Hundreds of thousands of New York families rely on the Affordable Care Act’s subsidies for their health care—and again and again, President Trump threatened to cut off these subsidies to undermine our healthcare system and force Congress to the negotiating table. That’s unacceptable,” said Schneiderman. “I will not allow President Trump to once again use New York families as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost.”

Frosh called Trump’s halt of the CSR subsidies “reckless, destructive, and illegal.” He said it would jeopardize health care coverage for 400,000 Marylanders and force people into choosing “between having health coverage and buying groceries.”

It is estimated that Trump’s move would cost the federal government some $200 billion over the next decade, Frosh said, citing the non-partisan Congressional Budget Office.

Union leaders were upset, too. One, the Teachers’ Randi Weingarten, said her 1.4-million-member union would support the states’ suit. AFT includes health care workers, and specifically school nurses, in its ranks.

“President Trump’s one-two punch yesterday targeting the financial underpinning of the Affordable Care Act is designed to gut the ACA. And his proposed replacement? Empty words,” Weingarten said.

“While his words are empty, the president’s actions will make America sicker, poorer, and worse off—for individuals who will have fewer and fewer insurance options, and for states whose budgets will worsen as more people will be unable to afford insurance and will revert to using emergency room medicine. Trump owns this unconscionable situation and bears responsibility for the harm it will cause.”

Gayle Batiste, whose Service Employees Local 121 in the Sacramento area includes registered nurses, told local media that Trump’s executive order was an “execution order” for people who depend on the ACA. “It is a cruel, callous, and calculated move to reverse the progress we’ve made under the ACA, harming millions of people who are counting on this care,” she added.

The head of California’s health care exchange explained the premiums—already rising by 12 percent next year—would jump monumentally in the Golden State, the nation’s most-populous, in 2019.

Becerra’s lawsuit says Trump’s withholding cost-sharing subsidies violates an ACA mandate, but Trump gleefully tweeted: “The Democrats Obamacare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”

Debra Ness, executive director of the National Partnership for Women and Families, said Trump’s cutoff would hurt low-income women the most. “How low will he go?” she asked. She called it “the latest in a series of outrageous actions” to destabilize health coverage for millions.

“This is a dagger aimed directly at vulnerable low and middle-income women and families. Its impact will be heartbreaking. It will drive up costs, create chaos, harm health, and take lives. There is absolutely no reason the Trump administration cannot continue making these essential payments. This is a petulant act by a president whose agenda has been rejected by the public and Congress. The Affordable Care Act is the greatest advance for women’s health in a generation, yet Trump is hell-bent on destroying it in order to appease his base.”