Pivotal gender-affirming care case reaches SCOTUS

• The arguments follow an election that emboldened Republicans to pursue more restrictions on trans rights — not just with respect to medical care but in matters like accessing bathrooms and youth sports.
• Medical groups including the American Medical Association and the American Academy of Pediatrics endorse gender-affirming care for minors diagnosed with gender dysphoria, and research shows it lowers depression and suicidality.

What they're saying: "It makes this case even more high stakes than it was before ... because really what we're going to find out is whether the court will provide a check on government actions that target trans people," said Gabriel Arkles, interim legal director of the Transgender Legal Defense and Education Fund.

State of play: The Biden administration says Tennessee's law preventing minors from accessing medical treatments for gender dysphoria violates the Constitution's Equal Protection Clause.

• The 6th U.S. Circuit Court of Appeals last year rejected a request from families and medical providers to block the law. Plaintiffs represented by the American Civil Liberties Union will argue that because the law classifies minors based on gender, the matter has to be reviewed with heightened scrutiny.
• "We are just asking the court to look at the text of this law which bans treatment based on an individual's sex and say — as the court has said for 50 years — that when the government does engage in those types of distinctions, that heightened scrutiny applies," said Chase Strangio, an ACLU lawyer who will present arguments for the plaintiffs.
• Justices could decide the law does classify minors based on sex and send the case back to lower courts for review. Or they could apply the standard themselves and rule on its constitutionality.

The other side: Tennessee Attorney General Jonathan Skrmetti will argue that the Constitution gives state officials responsibility for protecting public health in their state. That power has "always come [with] wide discretion to regulate medical practices," he wrote in a brief to the court.

• The state law doesn't discriminate based on sex and creates exclusions for minors requiring hormone therapy or other drugs covered by the ban for other medical purposes, Skrmetti argues.
• "While the government is free to favor its transition-first, ask-questions-later approach, the Constitution does not bind Tennessee to that same choice," the brief reads.

What we're watching: Conservative Justices Neil Gorsuch and John Roberts sided with the court's more liberal justices in a 2020 decision that concluded employers cannot discriminate against employees for being gay or transgender.

• "There's certainly hope that because they were able to see the clarity of sex discrimination in that context, they'll be able to see it here too," Arkles said.

A ruling is expected in June. But regardless of the outcome, it probably won't be the last word on gender-affirming care bans.

• If the court rules against Tennessee, the Trump administration and individual states could impose other restrictions, like ending Medicaid coverage for gender-affirming care procedures.
• And even if the court says Tennessee's ban can't stand, there could be additional legal fights over other state restrictions.

The bottom line: Allowing the ban to stand would effectively leave in place a patchwork of laws on gender affirming care for minors, with different states permitting different levels of access to care, KFF policy experts wrote last month.

• "Under this scenario, where a young person lives will continue to dictate the access they have to gender affirming care and the number of those with limited access could increase," they wrote.

Tina Reed contributed.