The Supreme Court ruled on Wednesday that state laws banning gender-affirming health care for transgender youth are constitutional.
In a 6-3 opinion, the justices decided that issues around regulating gender-affirming care for minors should be up to “the people, their elected representatives, and the democratic process” — evoking the court’s 2022 Dobbs v. Jackson decision.
“This carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field,” wrote Chief Justice John Roberts in the court’s opinion on U.S. v. Skrmetti. “The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”
“Our role is not ‘to judge the wisdom, fairness, or logic’ of the law before us … but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process,” Roberts concluded in the court’s opinion.
The court upheld a Tennessee law that prohibits health care providers from providing gender-affirming care — specifically hormone therapy, puberty blockers and surgery — to trans minors. If a health provider violates the law, they can be sued by the minor, a parent of the minor, or the Tennessee attorney general. Additionally, the provider risks losing their state medical license.
The plaintiffs in the case, three transgender teens, argued that the Tennessee law violates the equal rights protection clause of the 14th Amendment because it bans puberty blockers and hormone therapy only for trans people, and not for cisgender people. As a result, the plaintiffs said, the law “imposes disparate treatment on the basis of sex.”
Roberts and five other justices disagreed with that argument, concluding that the law does not discriminate on the basis of sex and, therefore, is not subject to “heightened review” — a legal form of evaluating a case that would have made it harder for Tennessee to defend the law that is usually reserved for race- and sex-discrimination cases.
The justices concluded that the law merely “classifies on the basis of age” and “on the basis of medical use.”
“In the medical context, the mere use of sex-based language does not sweep a statute within the reach of heightened scrutiny,” Roberts wrote.
Justice Sonia Sotomayor wrote the dissenting opinion, joined by her liberal colleagues, Justices Ketanji Brown Jackson and Elena Kagan (the latter joined only in part).
“Tennessee’s law expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny,” Sotomayor wrote. “The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee’s categorical ban on lifesaving medical treatment so long as ‘any reasonably conceivable state of facts’ might justify it.”
“Thus, the majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent,” Sotomayor continued.
Under the Biden administration, the federal government was initially involved in the case, U.S. v. Skrmetti, arguing that the Tennessee law violated the Fourteenth Amendment. However, in a February letter, the Trump administration changed course.
“The Department has now determined that [the law] does not deny equal protection on account of sex or any other characteristic,” wrote Deputy Solicitor General Curtis Gannon. “Accordingly, the new Administration would not have intervened.”
However, the Trump administration argued that the court should not dismiss the case because the Supreme Court’s decision will “prompt resolution of the question presented will bear on many cases pending in the lower courts.”
Over half of U.S. states have enacted laws to ban gender-affirming care for trans youth and there are at least 17 lawsuits challenging different state bans, according to data from the Movement Advancement Project. (The ruling does not impact state laws that protect access to gender-affirming care.)
The Supreme Court decision comes amid a wave of attacks against trans people from the Trump administration, which opposes gender-affirming care, and Republicans in Congress, who are considering a bill that bans Medicaid from covering gender-affirming care.
Transgender rights advocates immediately denounced the Supreme Court’s decision.
“The Court’s ruling abandons transgender youth and their families to political attacks. It ignored clear discrimination and disregarded its own legal precedent by letting lawmakers target young people for being transgender,” National Center for LGBTQ Rights Legal Director Shannon Minter said in a statement. “Healthcare decisions belong with families, not politicians. This decision will cause real harm.”
The court abandoned “both vulnerable children and the parents who love them. No parent should be forced to watch their child suffer while proven medical care sits beyond their reach because of politics,” said GLAD Law Senior Director of Transgender and Queer Rights Jennifer Levi.
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Oriana González is a reporter at NOTUS.