In a 6-3 decision, the Supreme Court has upheld Tennessee’s blatantly discriminatory ban on gender-affirming care for transgender people in the case of United States v. Skrmetti. The court’s Republican majority deliberately sidestepped fundamental constitutional questions, choosing instead to reopen a dangerous loophole from the Jim Crow era to permit medical discrimination.
The Court’s rationale for enabling this gender-based medical discrimination revives the legal tactics once employed to uphold interracial marriage bans, voter disenfranchisement, and segregation—a disturbing regression in constitutional interpretation.
This decision effectively green-lights medical care bans across the country, immediately threatening the lives and well-being of transgender and gender non-conforming Americans, and paving the way for legalizing medical discrimination, aligning with the broader Project 2025 agenda to “roll back the 20th century.”
The Jim Crow blueprint
The Court’s majority opinion, penned by Chief Justice Roberts, asserts that it doesn’t need to determine whether discrimination against transgender people is also sex discrimination. This is a preposterous legal maneuver, designed solely to avoid applying “heightened constitutional scrutiny”—the legal standard that has consistently compelled lower courts to invalidate similar anti-trans laws.
The majority contends that Tennessee’s prohibition on gender-affirming healthcare for transgender youth—known as SB1—is based on “gender dysphoria,” bizarrely treating this medical diagnosis as somehow irrelevant to a person’s transgender identity.
Their convoluted reasoning constructs a legal fiction: the notion that a state can ban medical treatments predominantly sought by a specific group without actually discriminating against that group.
According to the majority opinion:
“SB1 prohibits healthcare providers from administering puberty blockers or hormones to minors for certain medical uses, regardless of a minor’s sex…. By the same token, SB1 does not exclude any individual from medical treatments on the basis of transgender status. Rather, it removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions.”
This tactic bears an unsettling resemblance to historical arguments used to justify other forms of legally sanctioned discrimination.
Justice Sonia Sotomayor, in a powerful and urgent dissent, dismantled the majority’s convoluted logic, exposing its inherent contradictions and the grave consequences for transgender youth and all freedom-loving Americans.
She wrote:
“Consider the mother who contacts a Tennessee doctor, concerned that her adolescent child has begun growing unwanted facial hair. This hair growth, the mother reports, has spurred significant distress because it makes her child look unduly masculine. The doctor’s next step depends on the adolescent’s sex. If the patient was identified as female at birth, SB1 allows the physician to alleviate her distress with testosterone suppressants…. What if the adolescent was identified male at birth, however? SB1 precludes the patient from receiving the same medicine.”
This compelling comparison lays bare the fact that Tennessee’s law makes access to options for medical care dependent on a minor’s sex assigned at birth, denying a male adolescent treatments that a female adolescent could receive. This is, unequivocally, sex discrimination.
Confederate rallying cry revived
The core of the Supreme Court’s ruling reanimates a historical justification for discrimination: the “states’ rights” argument. Roberts declares, “We leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
While Roberts shrewdly avoids directly referencing the neo-confederate rallying cry of “states’ rights,” the decision truly does revoke the supremacy of the U.S. Constitution in order to grant the State of Tennessee the right to discriminate.
For generations, the cry of “states’ rights” has been the anti-constitutional rallying cry for those seeking to uphold systems of oppression. It was the shield behind which Southern states defended racial segregation, voter suppression, and bans on interracial marriage.
Sotomayor points out that in 1967, Loving v. Virginia, the legal brief for the Jim Crow State of Virginia, explicitly invoked this doctrine, arguing that “it is the exclusive province of the Legislature of each State to make the determination for its citizens as to the desirability of a policy of permitting or preventing [interracial marriage].”
By allowing Tennessee to impose discriminatory medical bans, the Supreme Court’s conservative majority is resurrecting the legal framework that once empowered states to deny fundamental constitutional rights based on race.
As Sotomayor warns: “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.”
Her words highlight the consequence of allowing basic human rights to be subjected to the ever-shifting “political whims” of individual states, a danger the Fourteenth Amendment was specifically designed to prevent.
This judicial action is not isolated; it functions as a crucial piece of a larger, coordinated effort, outlined in Project 2025, which aims to systematically dismantle civil rights and environmental protections and to significantly expand executive power in a future conservative administration. Project 2025 explicitly calls for stripping federal nondiscrimination protections for LGBTQ+ people to give states the right to discriminate.
This decision underscores the necessity for a renewed, unyielding defense of LGBTQ+ rights. We must build an America that champions inclusion and secures fundamental rights for absolutely everyone, regardless of who they are, whom they love, or how they identify. This means fiercely resisting Project 2025’s discriminatory agenda at every turn, in every branch of government, and in every community.
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