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Supreme Court Case on Transgender Youth Medical Care May Impact Schools

The U.S. Supreme Court on Monday agreed to decide whether a state law that bars medical treatment for gender dysphoria in transgender adolescents violates the U.S. Constitution’s equal-protection clause. The court’s decision will likely hold implications for equal-protection claims for transgender and other LGBTQ+ students in schools.

Separately, the justices turned away the appeal of two groups and several parents who sued over Connecticut’s 2021 decision to end religious exemptions to vaccination requirements for students to attend school.

In the transgender-care case, United States v. Skrmetti, the court agreed to hear the appeal of the Biden administration, which had intervened in lawsuits challenging a 2023 Tennessee law that forbids puberty blockers, hormones, or surgeries for the purpose of “enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or “treating purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

The case marks the first time the justices will take up on the merits of the issue of medical care for transgender youth. The Tennessee law, one of 21 similar state measures across the country, was challenged by three transgender teenagers, along with their parents and one doctor who treats gender dysphoria.

A federal district court blocked the law, ruling that it likely violates the equal-protection clause because it discriminates based on sex. But in a 2-1 ruling last September, a panel of the U.S. Court of Appeals for the 6th Circuit, in Cincinnati, rejected the equal-protection claim. The Tennessee law “regulates sex-transition treatments for all minors, regardless of sex,” the court said.

The court said transgender people were not entitled to have laws targeting them subjected to a higher degree of scrutiny because they did not have “immutable” characteristics that defined them as a discrete group and they were not politically powerless.

“The novelty of these treatments also undercuts any claim of animus,” the court said.

The 6th Circuit majority also rejected arguments that the Supreme Court’s 2020 decision in Bostock v. Clayton County governed the analysis of the Tennessee law. In Bostock, the high court held that the main federal job-discrimination law’s prohibition on sex discrimination covered bias on the basis of sexual orientation and gender identity.

The Biden administration and the private plaintiffs appealed to the Supreme Court, as did a group challenging a similar Kentucky law that was upheld in the same 6th Circuit opinion.

“The 6th Circuit’s decision implicates multiple circuit conflicts about the application of the equal-protection clause to laws that target transgender individuals,” U.S. Solicitor General Elizabeth B. Prelogar said in the government’s brief.

She noted that the 6th Circuit decision conflicted with rulings by the U.S. Courts of Appeals for the 4th and 7th circuits that held that school district policies restricting the choice of restroom by transgender students violated the equal-protection clause. And she said the U.S. Court of Appeals for the 9th Circuit, in San Francisco, relied on Bostock last year in a decision that blocked an Idaho law that bars transgender women and girls from female school athletics.

Tennessee, in urging the court not to take up the case, said some of the school cases relied alternatively on Title IX of the Education Amendments of 1972, which bars sex discrimination in federally funded schools.

The Supreme Court “does not take cases to opine about broad social issues, such as gender identity,” the state said. “Tennessee acted rationally, reasonably, and compassionately to protect its children, and the act survives any level of review.”

The court granted review of the Biden administration’s appeal after considering it at six consecutive private conferences. The court did not grant review in the appeals by the private challengers to the Tennessee and Kentucky laws, each of which included a claim that the state laws violated the rights of parents to direct the medical care of their children. That is a bit of a twist on the parental-rights claims asserted by those who have challenged some school district policies that support transgender students. But the high court is not taking up that question, and it held the other appeals in abeyance for now.

The court will hear arguments in the case in the next term.

Justices decline review on religious exemptions to school vaccinations

The court declined a review of We the Patriots USA v. Connecticut Office of Early Childhood Development, which involved the challenge to the state’s removal of religious exemptions for its school vaccination requirement.

Like most if not all other states, Connecticut has long required students to be vaccinated for such communicable diseases as measles and pertussis as a condition of school enrollment. The state added a medical exemption in 1923 and a religious exemption in 1959. But after a nationwide measles outbreak in 2018, the state in 2020 ended the religious exemption, except for “legacy” students who had claimed the exemption and were allowed to keep it until they left the state school system.

“The number of claimed religious exemptions rose to the point that many schools fell below the herd immunity threshold, with many more in jeopardy of following suit,” the state said in its Supreme Court brief.

The state became the fifth to cease allowing religious exemptions for school vaccinations, joining California, Maine, Mississippi, and New York.

The decision was challenged by several parents and two groups as a violation of their First Amendment free exercise of religion rights. Some of the parents objected to the use of fetal tissue in vaccine products, while a Muslim family objected on religious grounds to the use of pork products in some vaccines.

A federal district court dismissed their claims, and the U.S. Court of Appeals for the 2nd Circuit, in New York City, affirmed, noting that it was joining a “consensus” among state and federal appellate courts holding that “the absence or repeal of a religious exemption” does not make a school vaccination law unconstitutional.

In their Supreme Court appeal, the challengers argued that the absence of a religious exemption made the state’s vaccination rule not neutral and generally applicable, and thus problematic under the free-exercise clause.

In its response, the state said there was no true circuit split on any issues in the case, and the medical exemption is claimed by only a “negligible number” of children.

“So eliminating the religious exemption gave the state the best chance to vindicate its interest in improving student and community health by safeguarding herd immunity,” the state said.

The Supreme Court declined the challengers’ appeal without comment.

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