1 year ago
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The Supreme Court upheld Tennessee’s law banning gender-affirming healthcare for transgender minors, delivering a major blow to access to care for trans people as the Trump administration seeks to end federal recognition of trans people entirely.
The high court’s 6-3 decision written by Chief Justice John Roberts is expected to have nationwide impacts, after more than two dozen states enact similar bans on access to hormone therapy and other gender-affirming healthcare for trans people under 18.
All three liberal justices dissented.
“This case presents an easy question,” Justice Sonia Sotomayor wrote in her dissenting opinion.
At issue is whether Tennessee’s law banning certain healthcare constitutes a form of sex discrimination that violates the Constitution’s 14th Amendment.
“Because sex determines access to the covered medications, it clearly does. Yet the majority refuses to call a spade a spade,” she wrote.
“Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down [the law], or categorical healthcare bans like it,” she added. “The Court’s willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight.
The conservative majority’s ruling “also authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” she added.
Justices were asked to decide whether states that ban transgender children from medically recommended healthcare qualifies as unconstitutional sex discrimination under the 14th Amendment’s equal protection clause.
During December’s oral arguments in United States v Skrmetti, several conservative justices suggested they would leave a decision on standards for trans healthcare up to individual states, echoing similar arguments from the landmark ruling that revoked a constitutional right to abortion care.
The justices heard more than two hours of wide-ranging arguments and questions on whether trans people can be constitutionally protected from discrimination during oral arguments last year.
Justice Samuel Alito grilled ACLU attorney Chase Strangio, the first-ever openly trans attorney to present at the high court, to repeatedly cast doubt on whether being transgender is “immutable” and thus protected by anti-discrimination laws.
“I think that the record shows that the discordance between a person’s birth, sex and gender identity has a strong biological basis and would satisfy an immutability test,” Strangio replied.
In 2020, medically necessary gender-affirming healthcare was available to transgender young people in every state. Within the years that followed, that same healthcare was outlawed in nearly half of states, after hundreds of bills targeting LGBT+ young people flooded statehouses on a wave of anti-trans rhetoric that dominated campaign messaging into the 2024 presidential election.
South Dakota was the first state to introduce an outright ban. Arkansas was the first to make one law. By the end of 2024, 26 states made affirming care for trans minors illegal. Nearly 40 percent of trans youth aged 13 to 17 — roughly 119,000 children — are living in those states, according to the Human Rights Campaign.
One week after his inauguration, Trump signed an executive order directing federal agencies to rescind policies that support or acknowledge gender-affirming healthcare for transgender Americans.
He also issued an executive order effectively ending federal recognition of trans people across the government, forming the basis for several other orders focused exclusively on trans people, their healthcare and whether they can serve in the U.S. military.
His sweeping order on gender-affirming care targets the prescription of puberty blockers, hormone therapies and affirming surgeries for anyone under 19 years old — an age group that includes adult Americans.
Major medical organizations including the American Academy of Pediatrics, the American Medical Association, American Academy of Child and Adolescent Psychiatry and American Counseling Association, among others, agree that such care is clinically appropriate for trans youth experiencing gender dysphoria. Medical guidelines generally say that affirming surgeries should only be approved for people ages 18 and older, and they are rarely, if ever, performed.
This is a developing story
