Supreme Court lifts broad injunction against Idaho ban on gender-affirming care for minors

The Supreme Court on Monday allowed Idaho to begin broadly enforcing a new state law barring many forms of gender-affirming care for minors, at least for now.

The high court, which sharply reined in a lower court decision that had blocked Idaho from enforcing the law, left in place protections for such treatments for two anonymous teenagers whose families filed suit to block it.

The impact of the ruling for other transgender minors seeking treatment but who aren’t plaintiffs in the challenge is murky, because they could potentially try to join the pending lawsuit or file suits of their own.

The court’s three liberal justices dissented from the high court’s ruling, while all the court’s conservatives except Chief Justice John Roberts wrote or joined opinions explaining their views.

The law, which Republican Gov. Brad Little signed in April 2023, sought to ban medical professionals from providing gender affirming care, including transition surgeries, puberty blockers or hormone therapy for those under 18. Doctors could face up to 10 years in prison for providing such services under the law. The high court's ruling, while not a final one on the legality of bans on gender-affirming treatment, could reverberate among the legal challenges in other states that have passed similar bans.

The opinions the justices issued Monday explaining the court’s decision in the case, however, made little reference to the issue of whether such laws aimed at transgender people are or are not constitutional.

Instead, the Supreme Court’s members duked it out over a long-simmering question of whether and when individual judges have the power to block enforcement of a law broadly even though only one or a small number of plaintiffs have stepped forward to challenge it.

While the justices spilled 34 pages on that issue Monday, they did not resolve it since no opinion garnered a majority of the court.

At oral arguments in various cases, Justice Neil Gorsuch has repeatedly aired his skepticism about broad injunctions, and he led the charge Monday.

“In recent years, certain district courts across the country have not contented themselves with issuing equitable orders that redress the injuries of the plaintiffs before them, but have sought instead to govern an entire State or even the whole Nation from their courtrooms,” Gorsuch wrote in an opinion joined by Justices Clarence Thomas and Samuel Alito.

“As in so many other recent cases, the district court’s universal injunction effectively transformed a limited dispute between a small number of parties focused on one feature of a law into a far more consequential referendum on the law’s every provision as applied to anyone,” Gorsuch added.

Justices Brett Kavanaugh and Amy Coney Barrett took a somewhat different tack which expounded on some of the factors the high court considers or should consider, but did not stake out the same hostility to broad injunctions that Gorsuch evinced.

Justices Ketanji Brown Jackson and Sonia Sotomayor explicitly declined to join in Gorsuch's generalizations about statewide and nationwide injunctions and said the court order here appeared aimed at protecting the anonymous plaintiffs rather than impacting other parties.

“The questions raised by ‘universal injunctions’ are contested and difficult. I would not attempt to take them on in this emergency posture, even in a case that actually raised the issue,” Jackson wrote in a dissent joined by Sotomayor.

Jackson and Sotomayor also suggested that the Supreme Court should generally defer to appeals courts on such emergency requests, although Gorsuch and Kavanaugh said such a presumption would not always be wise.

While Kagan indicated she would’ve rejected Idaho’s request to begin enforcement of the law, she did not join Jackson’s opinion, nor did Kagan offer any explanation of her stance.

The Idaho measure was supposed to take effect on Jan. 1 but was temporarily blocked by U.S. District Judge B. Lynn Winmill, an appointee of former President Bill Clinton, in December after families of two unnamed transgender girls sued the state in May. The 9th Circuit Court of Appeals upheld that decision in January. Idaho officials submitted an emergency application in February to Justice Elena Kagan, who oversees that judicial circuit, to let the state enforce the ban.

At the Supreme Court, Idaho elected not to challenge the lower court’s ruling with respect to the two minor plaintiffs, while fighting the broader impact.

“Every day Idaho’s law remains enjoined exposes vulnerable children to risky and dangerous medical procedures and infringes Idaho’s sovereign power to enforce its democratically enacted law,” Alan Hurst, Idaho’s solicitor general, wrote in the state’s application. “These procedures have lifelong, irreversible consequences, with more and more minors voicing their regret for taking this path.”

Attorneys for the plaintiffs said in a response to the emergency application that “because this is a law that has no constitutional applications, the harms to Pam, Jane, and their parents are just the tip of the iceberg,” referring to the unnamed girls.

“Many Idaho families would confront the painful choices facing the Poes and Does, assuming they have the resources to travel or move,” the attorneys wrote. “For those families that don’t have those options, a stay would mean they would have to watch their children’s mental health and well-being deteriorate as care is withdrawn or withheld.”

Little said the ban — known as the Vulnerable Child Protection Act — aims toward “protecting minors from surgeries or treatments that can irreversibly damage their healthy bodies.” Medical organizations such as the American Academy of Pediatrics have come out in support of gender transition care and say that gender-affirming care for children rarely, if ever, includes surgery.

The case is part of a larger effort to limit access to gender-affirming care for minors in some states with Republican-led legislatures. At least 20 states have passed bans or restrictions on such care, though in at least four of those states, the bans have been placed on hold by federal courts. Other states such as Illinois, Colorado and Minnesota have passed bills protecting health care for transgender youth.

The Supreme Court has largely stayed out of cases relating to gender-affirming care for minors, but pressure has been mounting on the high court to weigh in as judges across the United States have ruled differing opinions on whether these bans violate the equal protection and due process clauses of the 14th Amendment of the Constitution.

In November, families and health care providers in Tennessee and Kentucky asked the Supreme Court to block similar state laws that prevent children from receiving gender-affirming care.