United States v. Skrmetti (teaching reference) (Unspecified)
The Facts
Tennessee enacted SB 1, prohibiting healthcare providers from administering puberty blockers or cross-sex hormone therapy to minors for the purpose of gender transition. Families of transgender minors and a physician sued Tennessee Attorney General Jonathan Skrmetti, arguing the law discriminated on the basis of sex and transgender status. The Sixth Circuit upheld the law, reversing a preliminary injunction. The United States joined the case as a plaintiff, challenging the law under the Equal Protection Clause of the Fourteenth Amendment.
The Issue
• Does Tennessee's SB 1, which restricts gender-affirming medical care for minors, violate the Equal Protection Clause of the Fourteenth Amendment by discriminating on the basis of sex? • Does the law's distinction based on a minor's natal sex in determining access to hormone therapies constitute sex discrimination requiring heightened scrutiny? • Whether categorical bans on gender-transition treatments for minors, while permitting identical treatments for other purposes, can survive constitutional equal protection review.
The Rules
No state shall deny to any person within its jurisdiction the equal protection of the laws. The central constitutional provision at issue, used to challenge whether SB 1's sex-based classifications require heightened judicial scrutiny.
Prohibits healthcare providers in Tennessee from administering puberty blockers or cross-sex hormone therapy to minors for the purpose of gender transition, while permitting the same treatments for other medical purposes.
Sex-based government classifications must satisfy heightened (intermediate) scrutiny and be supported by an exceedingly persuasive justification. Cited by dissent to argue SB 1's sex-based distinctions required more than rational basis review.
The Application
Under Virginia and Bostock, SB 1's restriction raises sex-discrimination concerns because it effectively bars only transgender minors from accessing treatments available to others, potentially relying on sex-based generalizations about gender identity. The Supreme Court, however, applied rational basis review by characterizing the law as regulating medical treatment by purpose, gender transition, rather than by sex, and found Tennessee's interests in protecting minors and regulating experimental medical treatments sufficiently important to justify the differential impact. The dissenters argued Bostock required heightened scrutiny, viewing the law as discriminating against transgender minors, a proxy for sex, regardless of its formal neutrality. The majority's choice of rational basis thus allowed the restriction despite its disparate impact on the basis of sex and gender identity.
The Conclusion
**The Supreme Court upheld Tennessee's SB 1 in a 6-3 decision authored by Chief Justice Roberts, holding that the law does not facially discriminate on the basis of sex under the Equal Protection Clause because it applies equally to all minors regardless of sex.** The Court applied rational basis review, finding Tennessee's asserted interests in protecting minors and regulating experimental medical treatments sufficient. Justices Sotomayor, Kagan, and Jackson dissented, arguing the law discriminates based on sex and transgender status and should receive heightened scrutiny. The decision leaves states broad authority to regulate or ban gender-affirming care for minors.
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