U.S.A.: Understanding the Supreme Court case on trans healthcare
September 9, 2024Since 2021, hormone therapy for trans youth with gender dysphoria has been banned in 24 states in the U.S.A.. This has prompted opposition from leading medical organisations, including the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics. As a result, thousands of families have had to travel to access necessary medical care or endure their child's suffering due to a lack of access.
In July 2023, the Sixth Circuit Court of Appeals denied a request from families and medical providers to stop a Tennessee law prohibiting gender-affirming medical care. Some plaintiffs, including a Nashville-based couple with their trans teenage daughter and a medical provider, joined others challenging a similar ban in Kentucky to petition the Supreme Court on the constitutionality of these laws.
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According to ‘ACLU Oregon’, this year, the Supreme Court agreed to hear the case, U.S.A. v. Skrmetti. The Tennessee case plaintiffs are represented by the American Civil Liberties Union, the ACLU of Tennessee, Lambda Legal, and Akin Gump. This legal challenge targets provisions in Tennessee's ban concerning hormone therapies like hormone replacement therapy and puberty blockers, excluding surgical care. The ACLU provides insights into the case, its ramifications, and ways to safeguard gender-affirming care and support transgender rights.
Impact of Skrmetti v. U.S. on Trans Health Care:
The central issue is whether Tennessee’s prohibition of gender-affirming hormone therapies for transgender minors breaches the Equal Protection Clause of the U.S.A. Constitution. Tennessee's ban, like others recently enacted, allows these hormones when used in ways the state deems “consistent” with a person's sex assigned at birth. For example, a cisgender teenage girl could receive an oestrogen prescription for any clinical diagnosis, but a trans girl with gender dysphoria could not.
The ACLU contends that Tennessee’s ban exemplifies discrimination based on sex and transgender status, violating the 14th Amendment’s Equal Protection Clause. A similar argument succeeded in 2020 when the Supreme Court ruled 6-3 in favour of LGBTQ+ workers, stating that discrimination for being homosexual or transgender inherently involves sex discrimination under Title VII, the federal law against employment sex discrimination.
In recent years, district courts have universally blocked similar bans in Arkansas, Alabama, Florida, Georgia, Indiana, Kentucky, and Tennessee. However, the Sixth, Seventh, and Eleventh Circuit Courts of Appeals have allowed some bans to stand. The Supreme Court's decision will determine if states can restrict medical treatment for transgender youth with gender dysphoria but not if they must. A constitutional ruling on Tennessee's law would limit the impact on access to these treatments to states where bans are active.
Effects on Other Health Care, Including Birth Control:
States enacting bans similar to Tennessee’s heavily reference the Supreme Court’s opinion in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and permitted states to ban abortion. U.S.A. v. Skrmetti will test the court’s willingness to extend Dobbs to ban other healthcare areas. The decision’s outcome could lay the groundwork for further restrictions on access to abortion, IVF, and birth control.
The case will now be heard by the country’s top court in October.
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