Supreme Court allows Idaho to enforce ban on gender-affirming care for minors

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The Supreme Court. (Photo: Adobe Stock)

The U.S. Supreme Court has taken the unusual step of reversing and superseding a lower court ruling on a state ban on gender-affirming medical care for minors in Idaho. The court’s decision allows Idaho to enforce a ban on the healthcare for trans minors while the case continues to make its way through the lower courts, which had temporarily stayed the ban. 

The April 15 order means Idaho can activate the Idaho Vulnerable Child Protection Act, a 2023 law banning such care. The Idaho law would make it a crime for any physician to provide cross-sex hormones, puberty blockers or other gender-affirming care such as surgeries to anyone under age 18. Those doctors and specialists would be subject to up to a decade in prison for providing such care to trans kids. 

Five of the court’s conservative justices either wrote or joined opinions agreeing with the court’s decision on the state’s request. Two liberal justices, Ketanji Brown Jackson and Sonia Sotomayor, dissented from the ruling. Without making a statement of her own, Justice Elena Kagan indicated that she also would have denied the state’s request. Chief Justice John Roberts did not publicly indicate how he had voted, although he is known for being the court’s swing voter.

Idaho Attorney General Raúl R. Labrador lauded the court’s ruling in a statement.

“Denying the basic truth that boys and girls are biologically different hurts our kids,” Labrador said. “No one has the right to harm children, and I’m grateful that we, as a state, have the power and duty to protect them.”

The case, Poe v. Labrador, was initiated after Idaho GOP Gov. Brad Little signed the bill into law. Two anonymous teen plaintiffs — two trans girls — and their parents sued Idaho and requested the law be blocked while their lawsuit made its way through the courts. 

In a lawsuit filed in May 2023, the two Idaho families assert that HB 71, signed into law by Little, violated the rights of transgender youth and their parents under the U.S. Constitution.

U.S. District Judge B. Lynn Winmill, a Bill Clinton appointee, found the families likely to succeed in their challenge and blocked enforcement of HB 71 while the case went forward, issuing a preliminary injunction and the ban was temporarily blocked in December.

The SCOTUS ruling does allow these two unnamed trans teens who sued to challenge the law to continue their estrogen treatments without punishment to their medical teams or their families.

The Supreme Court has not previously weighed in on the issue of transgender care, which has become a flashpoint among conservatives and Republican lawmakers, particularly in red states where dozens of laws have been proposed and many passed regarding such care. 

At issue in the original case ruled on in the district court is whether such a ban of medical care is constitutional. But the Supreme Court did not address that — the court only addressed whether the law could be in effect now while the merits of the case continue to be adjudicated in the lower courts, which could take some time.

The trajectory of the case thus far is that the state appealed Judge Winmill’s ruling, but the U.S. Court of Appeals for the 9th Circuit refused to stay Winmill’s action. It was in response to this that Idaho petitioned the Supreme Court to restrict the lower courts’ injunction to just the two plaintiffs. This would then allow the ban to take effect in Idaho, prohibiting any other trans youth from accessing even the most rudimentary gender-affirming care.

In their petition, attorneys for Idaho asserted that “Plaintiffs suffer no harm at all, let alone irreparable harm, if the injunction applies to them but not to others.”

The response to that by the plaintiffs’ attorneys was to argue that such a restriction would be tantamount to outing the two trans girls whose lawsuit it was. The assertion is that since the law stipulates there will be criminal charges brought against doctors providing such care, the girls could only receive such care by outing themselves as the people who had filed the lawsuit to anyone working for their doctors’ offices or at their pharmacies.

The justices were not swayed by that eventuality.

In a 13-page brief, Justice Neil Gorsuch wrote, “The plaintiffs face no harm from the partial stay the State requests.” 

Gorsuch was joined by Justices Clarence Thomas and Samuel Alito. He wrote, “Even with it, the district court’s preliminary injunction will operate to prevent state authorities from taking any action to interfere with their ability to access the particular drug treatments they seek.”

Gorsuch also wrote that it is “a welcome development” that the court is “reining in an overly broad” lower court order.

Justices Brett Kavanaugh and Amy Coney Barrett wrote separately in another 13-page brief that they agreed with the decision to temporarily block the lower court ruling while the lawsuit continues to be addressed by the lower courts on the merits.

Justice Jackson wrote that the court should have resisted “micromanaging” the lower courts and in an eight-page brief in which she was joined by Justice Sotomayor, wrote that the issue of gender-affirming medical care for transgender minors is a “a serious and consequential matter, which, indeed, raises the profile of this case and the stakes of our intervention, for the law at issue here will have a significant practical impact on everyone it affects.”

The American Civil Liberties Union and the ACLU of Idaho issued a joint statement: “While the Court’s ruling today importantly does not touch upon the constitutionality of this law, it is nonetheless an awful result for transgender youth and their families across the state.”

The statement continued, “Today’s ruling allows the state to shut down the care that thousands of families rely on while sowing further confusion and disruption. Nonetheless, today’s result only leaves us all the more determined to defeat this law in the courts entirely, making Idaho a safer state to raise every family.”

When the ACLU filed the case last spring, they described the plaintiffs, named Pam Poe and Jane Doe for the purposes of the lawsuit. 

“Pam Poe is an Idaho native and a transgender teenager receiving gender-affirming medical care criminalized by HB 71. She has a part-time job and loves engineering, programming and math. Pam lives with her parents Penny and Peter Poe who are also plaintiffs in the lawsuit challenging HB 71.”

The ACLU continued, “Jane Doe is a lifelong resident of Idaho and a transgender teenager receiving gender-affirming medical care criminalized by HB 71. When she is not at school, she likes to play video games, listen to music and go on walks. She is interested in computer science and coding, and she plans to go to college after she graduates high school. She lives with her parents, Joan and John Doe, who are also plaintiffs in this case.”

As the ACLU explained in the case, “gender-affirming medical care is widely accepted to treat gender dysphoria, helping alleviate the distress of gender dysphoria and significantly improving patients’ mental health and well-being. Such treatment is supported by leading medical experts and all major U.S. medical organizations, including the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics.”

Gender dysphoria is defined as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.

In November, the ACLU and Lambda Legal asked the Supreme Court to review a September 2023 decision by the 6th Circuit that upheld laws that bar transgender children in Tennessee and Kentucky from accessing puberty blockers and hormones.

The court has yet to say whether it will consider that case.

The states that have enacted laws restricting or banning gender-affirming medical care for transgender minors are Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah and West Virginia.

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