WASHINGTON -The U.S. Supreme Court threw out on Monday judicial decisions that favored transgender people in cases from North Carolina, West Virginia, Idaho and Oklahoma, including in legal challenges to state health insurance programs that deny coverage for patients seeking gender-affirming medical treatment.

Acting in appeals by officials in North Carolina and West Virginia, the justices ordered lower courts to reconsider their decisions siding with the challengers to the insurance policies in light of the Supreme Court’s major June 18 ruling that upheld a Republican-backed ban in Tennessee on treatments such as puberty blockers and hormones for minors experiencing gender dysphoria.

The Supreme Court decided that Tennessee’s ban on youth transgender care did not violate the U.S. Constitution’s 14th Amendment promise of equal protection, as challengers to the law had argued. The court’s conservative justices were in the majority and liberal justices in dissent in the 6-3 decision.

Gender dysphoria is the clinical diagnosis for significant distress that can result from an incongruence between a person’s gender identity and the sex assigned at birth.

Supreme Court Routinely Orders Lower Courts to Revisit Cases

The Supreme Court routinely orders lower courts to revisit certain cases that were on appeal in order to apply new case standards and legal interpretations from the nation’s top judicial body.

The case from North Carolina involved the state employee health plan, which excludes medical and surgical treatment “leading to or in connection with sex changes or modifications and related care.” In West Virginia, Medicaid – the state-federal health insurance program covering low-income Americans – has denied coverage for “transsexual surgery” since 2004. Medicaid is managed primarily by state governments.

In a similar case, the Supreme Court on Monday ordered reconsideration of a lower court’s ruling that allowed a lawsuit to proceed against an Idaho official accused of denying surgical care to transgender Medicaid beneficiaries in that state, also taking into account the June 18 ruling.

The justices also ordered reconsideration in a lower court’s decision that revived a lawsuit challenging Oklahoma’s policy barring transgender people from changing their birth certificates to match their gender identity.

The Tennessee Dispute

As in the Tennessee dispute, the plaintiffs had asserted that the policies violate the 14th Amendment and other laws.

The justices did not immediately act in three other pending appeals involving state laws in West Virginia, Idaho and Arizona that would ban transgender athletes from female sports teams at public schools. Thursday is the next day when the Supreme Court acts on whether or not to take up pending appeals.

The issue of transgender rights is a flashpoint in the U.S. culture wars. President Donald Trump during his 2024 election campaign promised to impose restrictions on gender-affirming care and sports participation, and since returning to office in January has taken aim at transgender rights.

The Supreme Court in May permitted Trump’s administration to implement his ban on transgender people in the U.S. military.

Trump also has signed an executive order targeting what he called “gender ideology” and declaring that the federal government would recognize only two sexes: male and female. Trump also rescinded orders by his predecessor, Democrat Joe Biden, combating discrimination against gay and transgender people.

The Supreme Court’s ruling in the Tennessee case could bolster efforts by states to defend other measures targeting transgender people.

Tennessee’s law, passed in 2023, aimed to encourage minors to “appreciate their sex” by prohibiting healthcare workers from prescribing puberty blockers and hormones to help them live as “a purported identity inconsistent with the minor’s sex.”

The Supreme Court’s ruling, written by Chief Justice John Roberts, highlighted the “ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones,” and found that the state law directly responds to that uncertainty.

The ruling, however, left some room for future legal challenges and for lower courts to apply tougher legal scrutiny and potentially find unlawful discrimination involving other curbs on transgender rights.

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(Reporting by Andrew Chung; Editing by Will Dunham)