WASHINGTON — The ongoing United States v. Skrmetti case is expected to have deep ramifications for families of children who are transgender and their doctors in traditionally conservative states, experts say.
Lawyers for both parties presented their arguments on gender-affirming care at the U.S. Supreme Court in December. The issue has become decidedly divisive across the country in recent months. The case will determine whether Tennessee Senate Bill 1 — a provision that would eliminate all medical treatments that align with a transgender minor’s asserted gender — is able to move forward.
Advocates argue that the bill violates the constitutionality of the 14th Amendment and will drastically harm families with children who are transgender. The Biden administration urged the Supreme Court to review the constitutionality of the bill.
Under President Donald Trump, however, the Department of Justice sent a letter to the court in February, saying that “the government’s previously stated views no longer represent the United States’ position.” The Supreme Court is expected to deliver a response in the coming months.
John Patrick Elwood, a lawyer for the American Bar Association, said the Supreme Court is likely to allocate this responsibility to the states and, if it does, it will cause a ripple effect for families with children that rely on gender-affirming care.
“States that are inclined to do so are going to be permitted to prohibit gender affirming care,” Elwood said. “So, people who have a child who has gender dysmorphia may have to relocate if they want their child to be able to live in accordance with or at least to have gender-affirming care.”
For some families, that’s already happened changing attitudes toward LGBTQ+ communities, said Kara Ingelhart, founding director of LGBTQI+ Rights Center and a clinical assistant professor of law at Northwestern University.
“Certain folks have chosen to move to other states, like where I live in Illinois where there’s statutory protections for gender-friendly care for young people,” Ingelhart said. “There are statutory protections for abortion care not only for the patient but for the provider providing it. That’s what the immediate effect is on these families. They have to decide how to get this medically necessary care for their children, and what they’ll do is cross state lines to get to care or move themselves.”
This decision will also serve as an indicator of what’s to come for other constitutional rights, foreshadowing how states can leverage their power.
“People who live in states where there are these kinds of policies who don’t have trans children or don’t have gender-affirming health-care needs also may be encouraged to migrate across state lines,” Ingelhart said. “This does feel like the first piece of the domino where other people’s liberty interests could be at issue or equal protection rights could be an issue.”
Ingelhart also explained that doctors will most likely not be trained to care for individuals who are transgender if the bill is successful, which could result in a declining number of admissions at medical schools in largely conservative states.
“It has a negative impact on the health-care industry at large because that means that people who are training to become health-care professionals in the state of Tennessee can’t get training on this standard practice,” she said.
Some universities have already had to adjust their curriculum in accordance with similar legislation.
In July 2024, the Medical University of South Carolina announced that it would no longer provide transition-related medical care after the passing of H.B. 4624, a bill that prohibits public funding from being used to support gender-affirming treatment. It’s one of 17 anti-LGBTQ+ bills that South Carolina has passed.
“MUSC Health funds are public funds. We are prohibited from providing gender-transition services to all patients,” Dr. Patrick Cawley, MUSC’s chief executive officer, said in a statement to the SC Daily Gazette.
MUSC was not available for comment.
“Other people in Tennessee who may need this care in future won’t get that help,” Ingelhart said. “Health-care providers for adults may not be getting training on this and not provide good care, but also the future of the health-care industry. Young people in nursing school, in PA school and in medical school will probably seek at a higher rate – and we have already seen this — to pursue their degrees and education elsewhere.”
If so, health-care options in the state will diminish — a combined result of having a smaller pool of medical professionals that know how to administer comprehensive care and lower enrollment numbers at state medical schools.
“Just all together health-care quality will decrease,” Ingelhart said.
Lauren Nutall and Afia Barrie are reporters for HUNewsService.com.
