This Wednesday, the U.S. Supreme Court will have to deal with a Pandora’s box it opened in 2022 with the Dobbs v. Jackson Women’s Health ruling when it hears oral arguments in a case focused on healthcare for transgender youth.
These arguments for US v. Skrmetti will aim to answer whether Tennessee Senate Bill 1 violates the Equal Protection Clause of the Fourteenth Amendment. SB1 prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”
According to an October press release from the American Civil Liberties Union, Tennessee filed a brief that relies on the Supreme Court’s 2022 ruling in Dobbs. That ruling overturned decades of protections on reproductive healthcare, including abortion, in the U.S.
“The brief cites to Dobbs at least 10 times in sweeping arguments to justify government sex discrimination,” said the ACLU. Amy Howe explained in her blog “Howe on the Court” that Tennessee has argued that the legislation “does not classify based on sex,” but instead “distinguishes between minors who want puberty blockers and hormone therapy for gender-affirming care and minors who would use them for other purposes.”
In April 2023, the U.S. Department of Justice filed a complaint challenging the bill. In a press release, the DOJ said that SB1 “denies necessary medical care to youth based solely on who they are.” It stressed that the legislation banned potential treatment options recommended by major medical associations for consideration.
For example, the American Medical Association in 2021 slammed prohibitions on “medically necessary gender transition-related care for minor patients,” and called attempts to do so “a dangerous intrusion into the practice of medicine.”
“In a letter to the National Governors Association (NGA), the AMA cited evidence that trans and non-binary gender identities are normal variations of human identity and expression, and that forgoing gender-affirming care can have tragic health consequences, both mental and physical,” said the association.
According to the Williams Institute at UCLA, transgender people who need and receive gender-affirming medical care have a lower prevalence of suicide thoughts and attempts than those who need it but have not received it. While receiving this care can help reduce suicidality for people with gender dysphoria, anti-transgender legislation can have a negative impact. Research from the Trevor Project found that 48 anti-transgender laws were enacted in the U.S. across 19 different state governments from 2018 to 2022, leading past-year suicide attempts among transgender and nonbinary youth to increase by as much as 72%.
Per the Human Rights Campaign, US v. Skrmetti, the “first ever case addressing the constitutionality of bans on medical care for transgender youth,” and its consequences could be far-reaching. Statistics from the Williams Institute indicate that, in the U.S., about 0.5% of adults and 1.4% of teens, ages 13 to 17, identify as transgender.
“At its heart, this case is about human dignity. Transgender youth are not political pawns – they are children who deserve compassion, medical care and the same opportunities to thrive as all youth, and their parents deserve the same rights to support their needs as all other parents,” Human Rights Campaign President Kelley Robinson said. “No politician should ever be able to interfere in the decisions best made by families and doctors – but that’s exactly what these discriminatory bans allow.”
Despite legal challenges from the ACLU and others, SB1 was enacted last year. Howe noted that it argues that the state has a “compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty.”
While Tennessee claims that the legislation does not classify people based on sex, the [President Joe] Biden administration contends that it does.
“They reason that SB1 distinguishes between medical care that is permitted or barred based on the sex of the patient as assigned at birth: A trans male teenager, for example, cannot receive puberty blockers or hormones, but a boy who is not transgender can,” Howe explained. The federal government thinks the case should go back to the court of appeals – where it could receive a higher level of scrutiny than previously applied – or for the Supreme Court to decide that the legislation fails “heightened scrutiny because the law is not substantially related to an important government interest.”
How said a decision in the case is expected by next summer.