On June 18th, 2025, the Supreme Court decided to green-light Tennessee’s ban on gender-affirming care for trans youth, opening the door to a state-by-state battle over fundamental medical rights and bodily autonomy.
In this column, I will briefly review what opinions the Justices held, the immediate implications, and some potentially far greater impacts.
Note from Author: This read will be a bit heavy on legal terminology and the understanding of Constitutional Law, so I will provide a small glossary of terms:
- Majority Opinion: The official ruling of the Court, joined by at least five Justices, explains both the outcome of the case and the legal reasoning that binds lower courts.
- Concurring Opinion: A separate opinion written by one or more Justices who agree with the result reached by the majority but for different or additional reasons.
- Strict scrutiny: The highest level of judicial review; the government must prove a law is narrowly tailored to serve a compelling interest and is the least restrictive means available.
- Rational-basis review: The most deferential review; a law will be upheld if it is reasonably related to a legitimate government interest, with the burden on the challenger to demonstrate that it is not.
- Equal Protection Clause: The part of the Fourteenth Amendment that bars states from denying any person “the equal protection of the laws,” requiring like treatment for those similarly situated.
- Suspect or Quasi-Suspect Class: Groups (e.g., race as “suspect,” sex as “quasi-suspect”) that have faced historical discrimination; laws that single them out trigger heightened scrutiny rather than mere rational-basis review.
What the Court Said
Writing for the majority opinion was Chief Justice John Roberts, a George W. Bush appointee. In the opinion he wrote, some mental gymnastics and liberties were taken to arrive at the opinion. Justice Roberts opined that SB1 was framed as a neutral diagnosis and treatment rule. Thus, a boy or a girl who seeks puberty blockers or hormones to live as a different gender is barred, so the law “does not classify by sex.” The Court decided not to treat transgender people as a protected class or status category, and Tennessee only needed to show a “rational” reason for the ban. Justice Roberts interestingly relied on past precedent in his opinion as well, leaning on Geduldig v. Aiello (1974).
Geduldig’s Ghost: Why Sex-Equality Scholars Are Alarmed
This past week, I was listening to the Strict Scrutiny podcast, which features law professors Leah Litman, Kate Shaw, and Melissa Murray. It’s a personal favorite of mine, and I highly recommend it if you’re interested in the inner workings of the Supreme Court. In their most recent episode, I found it both interesting and alarming that they discussed Geduldig and the emphasis placed on past precedent. Geduldig v. Aiello (1974) was a highly criticized case that said that pregnancy discrimination is not sex discrimination because it merely separates “pregnant” from “non-pregnant” people. Justice Roberts applied the same logic to Skrmetti.
Using his logic, “minors seeking treatment” from “minors who are not,” no sex classification is involved. The women on the Strict Scrutiny podcast were highly critical of this, as they were all in agreement that it reopens the door to every legislature effectively writing women-specific burdens out of the Equal Protection Clause. In plainer terms, if pregnancy and gender dysphoria can be walled off from sex discrimination analysis, then any health policy that targets conditions unique to one’s sex could escape heightened scrutiny. We are talking about future attacks on issues like contraception and in-vitro fertilization, which are most likely. The majority opinion effectively has rewritten the rulebook for all sex-based equality claims.
Barrett’s History Test and the Vanishing of Trans Discrimination
Justice Amy Coney Barrett, a Trump appointee, wrote a separate concurrence that joined the majority opinion but went a bit further. I found the opinion to be highly troubling. Listening to the oral arguments in December, I felt almost hopeful that Justice Barrett might side with the liberal justices in this case; however, she did the opposite.
In her opinion, she laid out a strikingly narrow view of who counts as a “suspect” or even a “quasi-suspect” class. She borrowed heavily from past precedent language, specifically regarding race and sex. Justice Barrett wrote that such heightened scrutiny protection should only be reserved for groups with a “long and undisputed history of purposeful state-sponsored discrimination and political powerlessness.” She writes that transgender people cannot meet the bar of being a “suspect” or “quasi-suspect” class because recent policy disagreements do not equate to entrenched legal discrimination that would be akin to those faced by cisgender women or racial minorities. Using her logic, litigants would be required to prove not just present-day hostilities, such as bathroom and sports bans, but possibly decades or even centuries of subordination before the Equal Protection Clause would even look their way.
If you’re feeling a bit bewildered, you’re not alone. Upon reading her opinion, I found myself going through a laundry list of state-sponsored systemic discrimination against transgender Americans. We have been excluded from military service, denied passports, fired under “moral turpitude” rules, and criminalized for wearing clothing that “did not match our sex” well into the 1980s. Contemporary data shows disproportionate rates of poverty, homelessness, and assault. By any empirical measure, the notion that there is no settled historical discrimination against the transgender community is erasure.
Why does Barrett’s groundwork here matter? Because lower courts often treat concurrences as road maps. If judges in lower courts begin to adopt her version of a “history test,” future plaintiffs, from a trans worker suing over job discrimination to a non-binary student contesting bathroom bans, could be doomed to the same deferential rational-basis box that Skrmetti fell victim to. Justice Barrett has effectively written a doctrinal wall that says, “Hey, come back after another century of oppression, and then maybe we’ll talk.”
The Immediate Impact
Twenty-seven states have enacted similar statutes or regulations restricting gender-affirming care for trans youth. Judges in Arkansas and Montana have struck down specific rulings, but the rest of those state statutes and regulations are based on state constitutions and may be appealed. It should be noted that every single one of those laws has been enacted within the last five years, underscoring how rapidly devolving our situation is as it has moved from legislative hearing rooms to the nation’s highest Court.
Because Skrmetti treats these statutes as ordinary health and safety regulations, they now will stand on significantly firmer federal legal ground. Unless a future case comes before the Court and persuades them to apply stricter scrutiny, transgender people are going to have to win based on other legal theories or unique state constitutional provisions.
This effectively is going to lead our community into a patchwork of survival, where there are states like Minnesota and Colorado with ‘Trans Refuge’ laws and states that have outright bans on care. Chase Strangio, the ACLU lawyer who argued Skrmetti before the Court, appeared briefly on the Strict Scrutiny podcast, where he explained that the ruling is a devastating loss but reminded listeners that it does not erase other precedents that protect the community and that there is still hope.
Where Does the Legal and Political Fight Go Next?
I expect there to be many state suits brought forward based on parental autonomy, challenging the blanket bans that crush parental rights, which may be a more sympathetic argument to our conservative Supreme Court.
There will likely be legal battles over the Affordable Care Act again. In this case, I would expect providers in states where there are bans to be faced with the choice of following state law to drop their gender-affirming care programs or lose their Medicare and Medicaid funding.
The Supreme Court will likely revisit this case if a lower court splits and strikes down the ban on due-process grounds, and it may need to clarify further whether Geduldig is truly back from the dead.
The political terrain is just as precarious. The Democrats have little to no power in Congress, as they are also grappling with whether or not to keep transgender rights on their platform going into the 2026 Midterm Elections. There have been multiple state leaders of states with bans who have promised to enforce enhancements after the decision, including audits of insurance claim records and seeking penalties for out-of-state prescriptions shipped into a banned state.
There are multiple swing-state legislatures, namely Michigan, Pennsylvania, and Arizona, that will confront shield-law bills in the next session that are similar to the ones enacted in Minnesota and Colorado. These legislatures may flip control after the 2026 Midterm Elections, so time is of the essence.
The Long Arc Remains Hopeful
Remember: Bowers v. Hardwick (1986) once declared that gay people could be jailed for intimacy, and only seventeen years later, Lawrence v. Texas (2003) erased that insult to the privacy of gay people. Constitutional law is a pendulum, not a straight line. Skrmetti was a grievous blow, but it will not be the last word.
The Bottom Line
If you live in a ban state, I implore you to call both your state and federal representatives today. Ask your insurers how they intend to handle cross-state prescriptions. Donate any frequent flyer miles or gas rewards you may have to advocacy groups to help families with travel expenses. Above all, share your story; misinformation thrives in silence. We need to control the narrative in the future.
