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Dissenting Justice Sonia Sotomayor wrote that "there is no constitutional justification" for the decision, and access to gender-affirming care "can be a question of life or death."
LGBTQ+ advocates decried Wednesday's U.S. Supreme Court decision upholding Tennessee's prohibition on gender-affirming medical treatments for minors as a dangerous green light for states to violate personal privacy and ban healthcare that many transgender people say saved their lives.
Writing for the 6-3 majority in U.S. v. Skrmetti, Chief Justice John Roberts stated that S.B. 1, Tennessee's 2023 ban on gender-affirming care for people under age 18, does not violate the equal protection clause of the 14th Amendment. The majority concurred with a lower court's ruling that S.B. 1 is not subject to heightened scrutiny, a standard of judicial review also known as intermediate scrutiny used to determine a law's constitutionality, especially in cases involving classifications based on sex or gender.
"The Supreme Court is green-lighting the eradication of trans people from society."
"This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field," Roberts wrote. "The voices in these debates raise sincere concerns; the implications for all are profound. The equal protection clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best."
"Our role is not 'to judge the wisdom, fairness, or logic' of the law before us... but only to ensure that it does not violate the equal protection guarantee of the 14th Amendment," the ruling adds. "Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process."
BREAKING: In a 6-3 Roberts decision, the Supreme Court has ruled that Tennessee's ban on gender affirming care is not subject to heightened scrutiny. This decision will strip millions of trans people off their constitutional rights.www.supremecourt.gov/opinions/24p...
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— Alejandra Caraballo (@esqueer.net) June 18, 2025 at 7:17 AM
Roberts was joined in the majority by right-wing Justices Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. Liberal Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson dissented.
Sotomayor wrote in her dissent that "there is no constitutional justification" for the decision, which "does irrevocable damage to the equal protection clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight. It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them."
She continued:
Transgender adolescents' access to hormones and puberty blockers... is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death. Some transgender adolescents suffer from gender dysphoria, a medical condition characterized by clinically significant and persistent distress resulting from incongruence between a person's gender identity and sex identified at birth. If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality. Suicide, in particular, is a major concern for parents of transgender teenagers, as the lifetime prevalence of suicide attempts among transgender individuals may be as high as 40%. Tragically, studies suggest that as many as one-third of transgender high school students attempt suicide in any given year.
S.B. 1—introduced by Tennessee state Sen. Jack Johnson (R-23)—who was also behind the state's public drag ban—prohibits minors from undergoing hormone therapy or taking prescribed puberty blockers. Three transgender teens and their parents, as well as a Tennessee doctor who treats trans youth, challenged the law, claiming it violated the equal protection clause.
The plaintiffs were joined by the Biden administration along with the national and state ACLU, Lambda Legal, and the law firm Akin Gump Strauss Hauer & Feld LLP in asking the Supreme Court to review the ban after the 6th U.S. Circuit Court of Appeals upheld it in September 2023.
Responding to Wednesday's ruling, Allison Scott of the Campaign for Southern Equality—which manages the Trans Youth Emergency Project (TYEP)—said: "I am heartbroken today. No one should be forced to leave their home state to access healthcare—and it is outrageous to see the U.S. Supreme Court uphold these bans and continue to allow the government to interfere with the personal medical decisions of families."
Scott was alluding to the argument often made by proponents of bans on not only trans healthcare but also abortion and other reproductive rights that people seeking such care are free to go where it is legal—even as some states pass laws banning such travel.
There are approximately 300,000 people aged 13-17 and 1.3 million adults in the United States who identify as transgender, according to the Williams Institute at the University of California, Los Angeles School of Law, which notes that more than two dozen states have passed laws similar to S.B. 1.
(Image: Human Rights Campaign Foundation)
Transgender activist Alejandra Caraballo, a civil rights attorney and instructor at the Harvard Law School Cyberlaw Clinic, said on the social media site Bluesky, "I can't begin to tell you just how incredibly fucked trans people are here."
"This will pour gasoline on the Trump administration's attacks on trans people and they will get even harsher and more cruel," Caraballo added. "The Supreme Court is green-lighting the eradication of trans people from society."
Caraballo and others including the ACLU and trans rights activist Erin Reed noted that the decision is somewhat limited because it leaves previous rulings against anti-trans laws intact. However, Caraballo warned that "while the decision didn't explicitly say heightened scrutiny doesn't apply to all contexts involving trans people, it held that it was on the basis of medical diagnosis."
Therefore, "the government could just do whatever it wants to trans people based on gender dysphoria," she wrote. "For instance, they could strip everyone with gender dysphoria of security clearance in the government. Declare everyone with gender dysphoria a national security threat and purge them from the government entirely. The trans military ban will be upheld under this."
"Most importantly, states can now just ban gender-affirming care for everyone, including adults," Caraballo added. "We'll likely see that coming soon in addition to federal government efforts to eliminate access for all trans people."
"This will pour gasoline on the Trump administration's attacks on trans people."
U.S. President Donald Trump has renewed and expanded his first-term attacks on transgender people, including by issuing a day one executive order declaring that only two genders exist, another order advocating action against educators who "facilitate the social transition of a minor," and yet another directing the Department of Education—which he has vowed to abolish—to notify school districts that allowing transgender girls and women to compete on female teams violates Title IX, the federal law prohibiting discrimination on the basis of sex in education.
Trump also appointed a transphobe to head the Justice Department's civil rights office, ordered the removal transgender people and issues from federal agency websites, and reinstated his first-term ban on new military enlistment by trans people, who—according to the White House—cannot lead an "honorable, truthful, and disciplined lifestyle."
"Every day I speak with families of transgender youth who are worried about the future," TYEP patient navigator Van Bailey said after Wednesday's ruling. "Many are panicking, unsure of where or when they'll get the medicine that their child needs to continue leading a healthy, happy life. These laws are cruelly thrusting families into impossible choices, and it is deeply unfair."
As we wait for legal guidance from our partners at @aclu.org and @lambdalegal.org, we want to share what we already know:The Supreme Court’s decision in U.S. v. Skrmetti is devastating, and we will not stop fighting.
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— Christopher Street Project (@christopherstreet.bsky.social) June 18, 2025 at 8:34 AM
ACLU LGBTQ & HIV Project co-director Chase Strangio—the first openly trans attorney to argue before the Supreme Court—said that "today's ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution."
However, Strangio also noted that "the court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful."
"We are as determined as ever to fight for the dignity and equality of every transgender person and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve," he added.
Jennifer Levi, senior director of transgender and queer rights at GLAD Law, said in a statement that "the court today failed to do its job."
"When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution's backbone," Levi added. "Instead, it chose to look away, abandoning both vulnerable children and the parents who love them. No parent should be forced to watch their child suffer while proven medical care sits beyond their reach because of politics."
"When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution's backbone."
National Center for LGBTQ Rights legal director Shannon Minter asserted: "The court's ruling abandons transgender youth and their families to political attacks. It ignored clear discrimination and disregarded its own legal precedent by letting lawmakers target young people for being transgender."
"Healthcare decisions belong with families, not politicians," Minter added. "This decision will cause real harm."
Sasha Buchert, counsel and director of the Nonbinary and Transgender Rights Project at Lambda Legal, called the ruling "heartbreaking" and contended it will make it "more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive."
"But we will continue to fight fiercely to protect them," Buchert added. "Make no mistake, gender-affirming care is often lifesaving care, and all major medical associations have determined it to be safe, appropriate, and effective. This is a sad day, and the implications will reverberate for years and across the country, but it does not shake our resolve to continue fighting."
The Supreme Court’s Skrmetti decision is a pivotal moment in our fight for LGBTQ+ equality. Here are three ways to TAKE ACTION:
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— Human Rights Campaign (@hrc.org) June 18, 2025 at 9:26 AM
Human Rights Campaign (HRC), Lambda Legal, and other advocacy organizations are planning to hold a "decision day" rally at noon Wednesday outside the Supreme Court in Washington, D.C.
HRC lamented that Skrmetti "sets a dangerous precedent and threatens access to care for trans people across the country."
"We are showing up loud and clear: We will not go back," HRC said. "We will not be erased."
"Uber, Lyft, and Metro Nashville Airport Authority are engaging in an inappropriate and malicious alliance to destroy dozens of livelihoods," said the Tennessee Drivers Union.
A Tennessee union announced Monday that 34 Uber and Lyft drivers received messages "informing them that they had been permanently banned" from working at Nashville's airport after joining scores of workers for a peaceful caravan there last month to support a state bill that would impact the companies.
The Tennessee Drivers Union (TDU) said in a statement that some participants, "including those in the passenger's seat not driving," were banned from providing rides at Nashville International Airport following the February 14 action, during which "participating Uber and Lyft drivers had their apps turned off."
In a message to one Uber driver obtained by Common Dreams, the company said that "Nashville International Airport (BNA) notified us that you conducted a pickup on the arrivals level of the terminal. Please note that all pickups must occur in the Uber-designated zone."
"Due to the nature of the incident, the airport is restricting certain driver-partners from accepting rides or dropping passengers off at BNA permanently, pursuant to the terms of Uber's agreement with the airport," Uber continued. "Your account appeared on the list. For that reason, your account has been permanently blocked from operating at BNA. Contact the airport for more information."
A message to a Lyft driver similarly said that "it has been reported that you were conduct detrimental to the orderly operation of the airport. That being said, at the request of the airport, you are prohibited from operating on BNA airport property indefinitely."
"To prevent future suspensions, carefully review the BNA rules and regulations," Lyft added. "Please note, citations may be given if you operate on BNA property during your suspension, and you will be responsible for paying them."
Lyft and Uber have not responded to Common Dreams' requests for comment on the bans, which come as working people face high costs and a billionaire-led assault on the federal government.
TDU said Monday that "Uber, Lyft, and Metro Nashville Airport Authority are engaging in an inappropriate and malicious alliance to destroy dozens of livelihoods. The airport is one of the only opportunities for ride-share drivers to make barely above minimum wage."
"This is an attack against dozens of workers, their families, and their communities," the union continued, noting the millions of dollars in fees the airport gets from drivers and Metro Nashville Airport Authority CEO Doug Kreulen's $600,000 salary.
As Common Dreams reported last year, TDU has sounded the alarm about working conditions for drivers at BNA. Union members kicked off Labor Day weekend in 2024 with a strike to draw attention to demands including a cap on the number of ride-share drivers in the area, an expansion of their airport lot, and clean, working bathrooms on-site.
TDU said Monday that "this retaliation isn't a mistake," arguing that "Uber and Lyft are threatened" by Tennessee House Bill 879/Senate Bill 818, introduced last month by state Rep. Rush Bricken (R-47) and Sen. Joey Hensley (R-28).
The bill text begins by highlighting that "Tennessee is the only state in the Southeast that allows out-of-state ride-hail drivers to operate within the state, while Tennessee ride-hail drivers may not work in surrounding states."
"Tennesseans who live and work in our communities, contributing directly to our local economy, struggle to compete with an oversaturated market of out-of-state drivers," the legislation explains, calling for "a basic licensing regime."
The bill would require ride-hail drivers operating in the state to have a "transportation network license," which would require a Tennessee driver's license, or proof of residency in DeSoto County, Mississippi, or Crittenden County, Arkansas.
Companies that allow drivers to provide rides without a Tennessee-issued transportation network license would be hit with a $1,000 penalty per violation and could ultimately be banned from operating in the state.
"Summer can be the hungriest time for children," said one anti-hunger advocate.
A dozen states are poised to walk away from a combined $1.14 billion in federal funding that would help alleviate hunger for nearly 10 million children next summer, according to Food Research & Action Center, or FRAC, a nonprofit that addresses poverty-related hunger.
The 12 states, all of which are GOP-led, face a January 1 notice of intent deadline to participate in the Summer Electronic Benefit Transfer (EBT) Program, also known as SUN Bucks. Under the food assistance program, families with eligible school-age children can get $120 per summer to buy food.
"Summer can be the hungriest time for children," said Crystal FitzSimons, FRAC's interim president, in a Monday statement. "This funding is an opportunity for states to ensure children have access to the nutrition they need to grow, thrive, and return to school ready to learn. No child should have to go hungry during the summer months, especially when solutions like Summer EBT exist."
Currently, Idaho, Alaska, Wyoming, South Dakota, Iowa, Oklahoma, Texas, Mississippi, Tennessee, Georgia, South Carolina, and Florida are set to potentially not participate in the program for this coming summer, according to FRAC. All other U.S. states, Washington, D.C., all U.S. territories, as well as the Cherokee Nation and the Chickasaw Nation are participating this coming summer.
The Summer EBT Program is one of multiple Summer Nutrition Programs administered through the U.S Department of Agriculture. Last summer, the SUN Bucks "bridged the gap" for some 21 million children in 37 states, as well as D.C., all U.S. territories, and multiple Native American tribes, per FRAC.
While the Summer EBT Program, or SUN Bucks, doesn't have widespread name recognition, a poll conducted by Data for Progress this past summer found that once voters read a description of the policy, it enjoyed strong bipartisan support from voters.
The governor of Tennessee has indicated that he will not renew the Summer EBT Program for the state, according to NBC News, despite the fact that FRAC estimates that hundreds of thousands of children would be eligible for the benefit this coming summer. According to FRAC, the program would result in approximately $77.2 million in benefits for struggling families in Tennessee.
FRAC and at least one other group are urging the governor to change course. According to NBC's reporting, advocates say Tennessee presents a particularly acute need for the program because the state's topography can make it hard for families to reach food banks or other meal distribution sites. Also, some communities in the eastern part of the state that struggle with hunger and poverty were also impacted by Hurricane Helen earlier this year.