Supreme Court allows Idaho to enforce ban on gender-affirming care for nearly all transgender minors for now

Washington — The Supreme Court on Monday agreed to allow Idaho officials enforce a ban on gender-affirming medical care for nearly all transgender minors statewide, granting a request from state officials to narrow the scope of a lower court's order that blocked the law from taking effect.

The court's conservative majority granted the state's request for a stay over the objections of the three liberals, Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson. The stay does not apply to the two transgender teenage plaintiffs in the case and the care they are seeking, but blocks the more expansive portions of the lower court's decision.

"The district court's order promised to run for the life of this lawsuit, thus preventing Idaho from executing any aspect of its law for years. Meanwhile, the plaintiffs face no harm from the partial stay the State requests," Justice Neil Gorsuch wrote in an opinion that was joined by Justices Clarence Thomas and Samuel Alito.

Jackson, in a dissent joined by Kagan, argued that the court should decline to intervene at this stage.

"This Court is not compelled to rise and respond every time an applicant rushes to us with an alleged emergency, and it is especially important for us to refrain from doing so in novel, highly charged, and unsettled circumstances," she wrote, adding that "caution is especially warranted" in this case.

The American Civil Liberties Union and the ACLU of Idaho, which is representing two families that challenged the law, denounced the Supreme Court's order in a 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 groups said. "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."

The Idaho case

The legal battle involves Idaho's Vulnerable Child Protection Act, or H.B. 71, which was signed into law by GOP Gov. Brad Little last year. The measure bars health care providers in the state from providing certain medications or surgeries "for the purpose of attempting to alter the appearance of or affirm the child's perception of the child's sex if that perception is inconsistent with the child's biological sex." Among the restricted treatments are puberty blocking-drugs, hormone therapy and surgeries. Violators of the law may face up to 10 years in prison and fines.

Parents to two transgender girls sued the state over the law, arguing it violates the Constitution. The two, identified in court filings by the pseudonyms Pam Poe and Jane Doe, were diagnosed with gender dysphoria and have taken puberty blockers and estrogen therapy. In addition to challenging the constitutionality of the law, the families asked a federal district court to block enforcement of the law while their case proceeds.

The district court granted their request in December 2023, finding in part that the law is likely unconstitutional. The lower court also ruled that prohibiting gender-affirming care would have "serious consequences" for Pam Poe and Jane Doe, including "severe psychological distress." 

"Transgender children should receive equal treatment under the law," U.S. District Judge B. Lynn Winmill wrote in his decision. "Parents should have the right to make the most fundamental decisions about how to care for their children."

The injunction reached statewide, in part because Winmill found that because Pam Poe and Jane Doe used pseudonyms, it would be difficult to provide them relief without compromising their anonymity. The judge also said that if the injunction applied only to the plaintiffs, there would likely be follow-on lawsuits, which would "create needless and repetitive litigation."

State officials asked the U.S. Court of Appeals for the 9th Circuit to pause the district court's order or narrow its scope to cover just Pam Poe and Jane Doe, but the request was denied. Idaho then sought emergency relief from the Supreme Court while the 9th Circuit considers the appeal, asking the justices to limit the injunction to apply only to Pam Poe and Jane Doe. The high court agreed in its order on Monday.

In their request to the justices, Idaho officials, represented by the conservative legal group Alliance Defending Freedom, criticized the scope of the district court's injunction as "exorbitant" and said it reached too far by blocking enforcement of the law "in all circumstances against all parties."

Relief specific to the teenagers involved in the case was "easy to conceive," they said, as an injunction could prohibit enforcement against those who provided Pam Poe and Jane Doe with the treatments they've sought.

"Plaintiffs only seek estrogen hormone therapies, yet the district court issued a universal injunction against the law in its entirety, stopping enforcement even in situations where Plaintiffs' experts agree medical intervention is not appropriate," Idaho officials wrote. "Those applications involve the most extreme surgical treatments and the most vulnerable minors, who will lose the protections of Idaho's law and will instead be governed by an injunction obtained by others who do not and cannot speak for them."

They went on to claim that the "overbroad" injunction would allow doctors to experiment on minors with "dangerous" surgeries, such as mastectomies for patients with gender dysphoria. 

But the American Civil Liberties Union, which is representing the family, warned the Supreme Court that allowing the state to enforce the law would cause severe harm to Pam Poe and Jane Doe.

Granting the request from Idaho officials would jeopardize "their ability to continue receiving the medical care that they, their parents, and their doctors all agree is medically necessary for their health and well-being"  and require them to "give up their anonymity as transgender plaintiffs in this case to try to access that care," ACLU lawyers wrote in a filing.

They also noted that because the law imposes criminal penalties on doctors and pharmacists who provide gender-affirming care to minors, harm to Pam Poe and Jane Doe cannot be remedied without an injunction shielding health care providers from prosecution so they can continue treating them.  

Additionally, because Pam Poe and Jane Doe are receiving ongoing medicare care, Idaho's ban would disrupt that treatment, and a narrowed injunction would jeopardize their access to care. 

"The preliminary injunction maintains the status quo — that the decision about whether to pursue gender-affirming medical care for adolescents with gender dysphoria is made by their parents, in consultation with the children's doctor," the ACLU lawyers wrote. "With the advice of their doctors, parents weigh the risks and benefits of treatment just as they do for other medical decisions."

More than 20 states have imposed bans on gender-affirming medical care for minors, though laws in some states have been blocked by courts, according to the Human Rights Campaign.