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Transgender advocates protest outside the US Supreme Court building during oral arguments of the United States v. Skrmetti case regarding gender affirming care, Washington, DC, December 2024
The justices are expected to issue rulings on the most controversial cases of the term imminently.
The U.S. Supreme Court could issue rulings as soon as Thursday in two cases that could upend LGBTQ+ health care and preventive services nationwide, handing new power to the Trump administration and Republican state governments to restrict access to evidence-based care.
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The ruling, expected on any opinion day before the end of the Court’s term in late June or early July, centers on U.S. v. Skrmetti and Kennedy v. Braidwood Management. Together, they could determine whether transgender youth are allowed to access gender-affirming care—and whether tens of millions of Americans will keep their no-cost access to services like PrEP, STI screening, contraception, and cancer prevention under the Affordable Care Act. The Supreme Court has not indicated any opinion days beyond June 12.
Related: Key LGBTQ+ Supreme Court decisions to watch this term and what you need to know
Related: 7 takeaways from the Supreme Court hearing on Tennessee’s ban on gender-affirming care for youth
In Braidwood, the justices are considering whether the U.S. Preventive Services Task Force—an independent panel of health experts—has the legal authority to recommend services that insurers must cover without charging patients a fee. The plaintiffs, backed by far-right attorney Jonathan Mitchell, argue that the task force is unconstitutional and object specifically to the ACA’s PrEP mandate, claiming it “encourages homosexual behavior.”
What’s at stake goes far beyond PrEP. If the Court sides with the plaintiffs, it could open the door for the Trump administration to gut ACA mandates, roll back LGBTQ-inclusive coverage, and replace science-backed guidelines with ideological restrictions, experts warn.
Related: Justices Kavanaugh & Barrett signal they may uphold access to PrEP and preventive care protections
“Even if the Court rules against the plaintiffs, the Trump administration could be granted the ability to overturn health experts’ evidence-based recommendations regarding which preventive services insurers must cover,” Protect Our Care said in a statement ahead of the ruling. “This would leave existing coverage at risk, given the Trump administration’s open embrace of pseudoscientific treatments and track record of embracing junk plans that are not required to cover evidence-based services—not to mention their longtime goal of repealing the ACA altogether.”
Health advocates also point to Health and Human Services Secretary Robert F. Kennedy Jr.’s removal of the CDC’s vaccine advisory panel as a warning of what’s to come. After committing not to do so during his confirmation hearings, HHS announced a blanket dismissal this week.
In U.S. v. Skrmetti, the Court will decide whether Tennessee’s law banning gender-affirming care for minors—such as puberty blockers and hormone therapy—is constitutional. The law prohibits treatments only when used to support gender transition but allows them for other conditions for cisgender children. LGBTQ+ legal groups argue the law is a clear instance of sex discrimination, singling out trans youth while ignoring medical consensus.
A ruling in favor of Tennessee would embolden other states to escalate attacks on trans health care. Several have already introduced legislation to restrict gender-affirming care for adults, block Medicaid funding, and criminalize supportive parents. Georgia Republican Congresswoman Marjorie Taylor Greene sponsored a bill that made it out of committee earlier this week that would criminalize gender-affirming care for minors.
The Court’s pending decisions come just one week after it unanimously ruled in Ames v. Ohio that majority-group plaintiffs—like straight or white workers—should not face higher legal hurdles when bringing discrimination cases. While some far-right voices claimed the decision struck a blow to Diversity, Equity, and Inclusion policies, the ruling’s author, Justice Ketanji Brown Jackson, focused on ensuring equal legal standards for all.
Related: Supreme Court will decide if insurance companies must cover PrEP for HIV prevention, cancer screenings
The broader context is clear: under the Trump administration’s second term, attacks on LGBTQ+ health care are accelerating. From attempts to repeal the ACA through tax legislation to eliminating key public health advisory panels, the infrastructure that protects queer and trans communities is under siege.
“Free preventive care services are a lifeline that Americans cannot afford to lose,” said Leslie Dach, chair of Protect Our Care. “This lawsuit is just the latest in a long line of targeted attacks designed to rip away affordable health care, and it’s everyday Americans who will pay the price. Unfortunately, the threat doesn’t stop with the Supreme Court. Given the Trump administration’s ongoing attacks on health care, we must remain vigilant.”
Decisions in both Braidwood and Skrmetti could be released as early as 10 a.m. ET Thursday.
