A coalition of Democratic state attorneys general sued the Trump Administration on Monday, seeking to block next month’s implementation of a rule overturning Obama-era protections for transgender people against sex discrimination in health care.

New York Attorney General Letitia James, leading the group of 23 states, said the change affecting the Affordable Care Act’s anti-discrimination section would give health care providers and insurance companies carte blanche to refuse treatment based on factors such as gender identity.

James also raised concerns that women could be denied access to abortion under the revision, which takes effect Aug. 18, and that non-English speakers will be deprived of information through a change to requirements that insurers print materials in a variety of languages.

“This is just the latest attempt by President Trump and his administration to unlawfully chip away at health care for Americans after failing to repeal the ACA time after time,” James told reporters in a conference call announcing the lawsuit.

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The lawsuit, filed in Manhattan federal court against the Department of Health and Human Services, secretary Alex Azar and civil rights chief Roger Severino, seeks an injunction to stop the rule from taking effect. The attorneys general argue it violates the Fifth Amendment’s equal protection clause.

A message seeking comment was left with a spokesperson for the department.

The Trump Administration pushed ahead with the rule change even after a Supreme Court ruling last month barring workplace sex discrimination against LGBT people, moving to show Trump’s religious and socially conservative supporters that he remains committed to their causes ahead of the November election.

Under the change, Health and Human Services said it will enforce sex discrimination protections “according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.” That rewrites an Obama-era regulation that sought a broader understanding shaped by a person’s internal sense of being male, female, neither or a combination.

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The lawsuit brought by the attorneys general is part of an expected flurry of lawsuits challenging the lawsuit, including one filed last month by the LGBT civil rights organization Lambda Legal. Such groups say explicit protections are needed for people seeking sex-reassignment treatment, and even for transgender people who need care for common illnesses such as diabetes or heart problems.

California Attorney General Xavier Becerra and Massachusetts Attorney General Maura Healey, both frequent Trump foes, assisted James in crafting the lawsuit. Becerra said implementing the rule while coronavirus continues to rage across the country is especially cruel.

“This is a mean and unconstitutional rule in any context,” Becerra said. “But authorizing discrimination in our health care system at this time, when our nation is suffering through a pandemic, is unbelievably immoral.”