The Supreme Court is scheduled to consider for the first time on Wednesday a law restricting transition-related health care for minors, and legal experts say the court's decision will affect transition-related health care nationwide for both minors and adults for decades to come. It states that access to related medical care may be affected.
A key legal question the court will consider is whether a Tennessee law banning puberty blockers, hormone therapy, and surgery for transsexuals constitutes discrimination on the basis of sex.
The American Civil Liberties Union and Lambda Legal argue that such care is prohibited because it is prohibited only as a treatment for gender dysphoria. The law makes exceptions for minors who need treatment for other reasons. For example, puberty blockers can be used to treat children who experience precocious or early puberty, and doctors may also perform surgery on infants born with sexual characteristics that fall outside of the standard male or female binary. You can.
In April 2023, just days after the ACLU filed a lawsuit against Tennessee's law, the Department of Justice intervened, saying it discriminates against transgender youth based on gender and transgender status and requiring a constitutional amendment. It filed its own complaint against the law, alleging a violation of Article 14 equal protection. clause. The Supreme Court granted the Biden administration's appeal of a 6th U.S. Circuit Court of Appeals ruling that upheld Tennessee's law. The court will not consider parts of the law prohibiting surgeries that were not subject to lower court injunctions.
In a prepared response to the Supreme Court, Tennessee Attorney General Jonathan Scumetti said the law does not discriminate on the basis of sex, but rather “provides protection against minors seeking sex-change drugs and for other medical purposes.” “We are drawing a line between minors seeking drugs.” Boys and girls fall on both sides of that line. ” The attorney general's office also argues that there is uncertainty about the risks and benefits of transitional care for minors and that states are permitted to pass legislation aimed at protecting minors. There is.
Harley Walker, a 17-year-old transgender girl from Auburn, Alabama, said she worries about how the court's decision will affect her future. Since Alabama's ban on transition-related care for minors went into effect in January, Walker and his father, Jeff, have had to travel 200 miles to another state, and Walker has had to travel 200 miles to another state for telehealth visits. Sometimes I sit in my car or in a hotel room. That way, she can continue taking estrogen.
Walker plans to attend college out of state. Because Alabama's law applies to people under the state's legal age of majority, 19, Walker cannot receive care in the state until he is in second grade.
“Every time this bill has been introduced in state legislatures in Alabama or across the country, it has obviously been a big shock and created a lot of security and uncertainty, but I still feel safe under the umbrella umbrella of the United States of America. I knew it was. , and they could have gone to another state that was more lenient about transgender people and access to health care, but Trump got elected and this Supreme Court decision… this is going to change access to health care for transgender people. It's scary what it can do to transgender adults,” Walker said. “It's scary to think that I won't be safe in this country for the rest of my life. I hope that doesn't happen.”
Transgender youth, their families, and transition-related caregivers told NBC News that state regulations for such care have led to a confusing patchwork of laws across the country, leaving many families unable to provide care. He says he has had to leave his home state because of this. As a result, legal experts believe the court's decision could affect access to such care for minors as well as adults in the coming years due to some of the policies proposed by President-elect Donald Trump. states that it is possible to decide.
“The reason medical care for transgender people is currently protected under the Affordable Care Act is that there is widespread recognition that denying it constitutes illegal sex discrimination under the Affordable Care Act. Because there is,” said Shannon Minter, the national center’s legal director. Lesbian rights, LGBTQ legal advocacy group. “So if the court says no, that this exclusion from care is not discrimination, that would really jeopardize our coverage under the Affordable Care Act.”
Legal situation leading up to the lawsuit
Last year, three transgender young people, their parents, and a doctor told the U.S. Supreme Court that, effective July 2023, doctors would have to wean the young people off their medication for nine months until March 31, 2024. It sought an injunction to block a Tennessee law that includes a provision allowing
One of the plaintiffs, a 15-year-old transgender girl referred to in the lawsuit as LW, fought the law last year because she “knows how important this care is to tens of thousands of transgender youth like me.” said.
“The thought of losing the medicine I need is scary. If this law continues, my family may have to leave Tennessee, where I have lived and loved all my life,” she said, adding that she doesn't know. added. Given how many states have passed similar bills, where can her family go?
In their petition to the Supreme Court, the ACLU and Lambda Legal noted that circuit courts are divided on this restriction. The Eighth Circuit blocked the Arkansas law from taking effect, but the Sixth and Eleventh Circuits allowed the Tennessee, Kentucky, Alabama, and Florida laws to go into effect.
Twenty-three states restrict puberty blockers, hormone therapy, and surgery for trans minors. According to the Movement Advancement Project, an LGBTQ think tank, 18 of these measures are being challenged in court.
As of April, an estimated 113,900 transgender youth lived in states that restrict access to transition-related care for minors, according to the Williams Institute at the UCLA School of Law.
Many families with transgender children have had to work around caregiving restrictions to continue caring for their children. Some families have left their home state entirely. Some, like Walker, travel hundreds of miles to receive care.
Dr. Izzy Lowell, founder and director of the telemedicine clinic QueerMed, serves transgender teens and adults across the country. She said her clinic has seen an increase in underage patients, especially since restrictions on transitional care started taking effect across the South. She estimates the clinic has 800 to 1,000 minor patients, 80% to 90% of whom live in states with restrictions on minor care.
Lowell said patients in states with travel restrictions who can afford to travel can go to states without such laws for telemedicine appointments at the clinic, and they can be assured that the patient will not be physically present during the appointment. The laws of the state in which you are located apply.
“A lot of my work now is as a travel agent,” Rowell said. She discusses with nearly all of her patients where they live, what states they can and cannot travel to, and the possibility of vacations or layovers at airports in other states. For example, she said the clinic saw a patient who was in transit at Boston Logan International Airport.
She said the impact of care restrictions was extremely difficult for patients.
“I think medical science in general underestimates the really serious health risks of stress, which are 10 times more severe than stress,” she says. “People are being openly hated and discriminated against. People are scared and really afraid of losing access to treatments that are devastating and life-threatening to them and to others.”
She said the presidential election and Trump's pledge to ban transgender medical care to minors nationwide and ban Medicaid from covering transgender medical care increased those concerns, she said. The number of new patient registrations at the clinic increased from an average of 10 to 15 per week to 250 on Nov. 6, the day after the election, and 150 on Nov. 7, the clinic said. The following week saw an average of 50 new registrations per day.
Regardless of the outcome of the Supreme Court case, Rowell said he will never stop providing transition-related care “as long as it is legal,” even as the backlash grows.
Last year, Lowell's Georgia-based clinic was destroyed by an arsonist, and the FBI is investigating the incident as a hate crime, she said.
“The only way to plan ahead for this is to continue to do everything we can for people as long as we can,” she said. “We won't stop until it's absolutely necessary.”
