US v Skrmetti: Viewpoints from Tennessee
The Supreme Court considers Tennessee’s ban on healthcare for trans youth. What’s at stake?
By Allison Peters
Now that Donald Trump has taken office for a second term, MAGA forces are pulling out all the stops to fan the flames of their culture wars and increase attacks on transgender people. On January 20th, Trump signed executive orders declaring that there are “two sexes” and halting diversity programs. On January 27th, he signed another order to ban transgender troops from serving openly in the military. And just yesterday, he signed yet another order that seeks to restrict, if not end, gender-affirming healthcare for youth under the age of 19.
These executive orders build on right-wing attacks on queer and trans people, which legislators in red states have brought forward. One such attack has been on gender-affirming care for transgender youth. On December 4, 2024, the Supreme Court of the United States heard a consequential case challenging Tennessee’s blanket ban on gender-affirming care for transgender youth.
Given Liberation Road’s commitment to queer and trans liberation, it is important to analyze how these bans, hate campaigns, and attacks represent an existential threat to trans people, and how Liberation Road can fight on the terrain of gender against the New Confederacy’s attempts to enforce cis hetero gender norms and the nuclear family with Project 2025.
Background on US v Skrmetti
The US Supreme Court case, US v Skrmetti, involves the families of Tennessee trans youth and a Tennessee doctor who provides gender-affirming healthcare. Tennessee is one of 26 states that have passed such bans on life-saving medical treatment for trans youth. Upholding S.B. 1 in Tennessee also opens the door to denying gender-affirming care to trans adults. These bans echo backlash to gender-affirming care during World War II in Germany, as well as in the 1970s in the US. MAGA forces are using attacks on trans people as a frontier in culture wars for enforcing gender norms.
The Tennessee families are represented in the case by Chase Strangio, a lawyer from the ACLU, who is the first trans attorney to argue a case at the Supreme Court. The state of Tennessee is represented by Tennessee Attorney General Jonathan Skrmetti. Many states have targeted trans people in other ways besides the youth healthcare bans, ranging from sports team bans, restrictions on drivers’ licenses and state identification, bathroom bans, and bans in various public spaces (schools, government buildings, and other public settings). Healthcare has been restricted for trans adults in various ways, including threats to state-funded insurance like Medicaid.
Access to healthcare is a vital need for trans people, and gender-affirming care is evidence-based and has shown to have hugely positive impacts on the health and well-being of trans people. Access to healthcare is one of the primary things that allows trans people to exist in public space, and a wealth of research supports the safety and efficacy of this care. Every major US medical association advocates for transgender youth to have access to meticulously tailored, developmentally appropriate gender-affirming care—proven to reduce suicide risk and improve mental health. Nevertheless, twenty-six states have enacted bans on this life-saving care, ignoring scientific evidence and codifying discrimination.
Attacks
The types of restrictions on healthcare in the Skrmetti case, as well as the other bans referenced, deeply infringe on the ability of trans people to be in public space and to exist. Take for example bathroom access: if a person can't use public restrooms, how can they go about daily life at work, school, or in public spaces?
Healthcare bans for trans teens obstruct the decision making of parents and doctors by the state intervening. And attacks on trans youth have often paved the way to attacks on trans adults. The same treatments that Tennessee has banned for trans teens such as hormones and hormone blockers are allowed and frequently prescribed to cis children to treat precocious puberty. This suggests that the state is okay with these treatments as long as they are being used to uphold a normative version of gender. This intervention is politically motivated and goes against evidence-based recommendations for gender affirming care.
Republicans’ attacks are clearly not about the well-being of these children. The restrictions represent a targeted attack on trans youth and trans people more broadly. Because the laws impact trans youth and their mental health, even to the point of suicide, and because of the potential for targeted violence towards trans individuals, this can be characterized as a death wish for trans youth and trans people, if not an outright genocidal threat to trans people’s existence. Skrmetti’s appointment as the Tennessee Attorney General to be an activist at the federal level also shows the political motivation of this agenda. In 2023, the Tennessee state legislature accorded the Attorney General’s office a 10-person “strategic litigation unit” with a $2.25 million dollar budget.
Implications
If SCOTUS upholds Tennessee’s ban, it would open the door to many other state-level attacks on trans people. A decision upholding the ban would follow in the footsteps of the court’s decision on Dobbs and further undermine the 14th Amendment Equal Protection Clause. A wide range of civil rights are derived from past court decisions based on the 14th Amendment, including same sex marriage, which was decided in Obergefell v Hodges; interracial marriage (Loving v Virginia); and school desegregation (Brown v Board of Education). During the oral arguments in Skrmetti, Supreme Court Justice Ketanji Brown Jackson raised fears that a ruling upholding the Tennessee law could upend these key decisions. “I’m worried that we’re undermining the foundations of some of our bedrock equal protection cases,” Jackson said.
What to Expect Next
The first potential development of the case may happen as soon as January. The Biden administration supported the plaintiffs, thus the name of the case “US v Skrmetti.” Now that Trump has taken office it is possible, even likely, that the US government will no longer support the plaintiffs in the case. This would be an unusual development; in the past, incoming administrations have largely held to the positions of their predecessors in pending cases, but during Trump's first term he vacated a number of cases that the previous administration had supported. If the Trump administration vacates the case, the court would have to decide whether to take up the case from the ACLU and continue with a judgment or drop the case. We would then expect a decision in late June.
Trump’s executive order declaring that there are only “two sexes” represents a direct attack on transgender people (and may even open the door to “fetal personhood”). While there are still questions about how this might hold up legally and in terms of enforcement, it incites hatred and violence and opens the door wider to infringement on the basic rights of trans people.
We are already beginning to see attacks on those who have spoken out, including Episcopalian bishop Mariann Edgar Budde who requested mercy from Trump for people who are scared, including gay, lesbian, and trans children in families of all different politics, Democrat, Republican, and Independents. We must continue to speak out in our communities by defending existing protections for trans people and employing resistance strategies against attacks.
Strategy
What are the tasks at hand for leftists and those committed to trans liberation?
1. Struggle within our mass organizations and left organizations to support trans people, which can take many forms:
Through our unions, we can fight to ensure that trans healthcare is covered by health insurance and trans members are protected from workplace discrimination. An injury to one is an injury to all, and in this moment standing by our trans coworkers is of paramount importance. We must recognize these struggles not as a siloed issue but as the same fight for basic dignity and respect which we all are fighting.
Among left organizations we must build unity to fight together against attacks on trans people. We must continue to build the broadest possible united front and a leading left trend which can push back against the entirety of the MAGA agenda and in particular against the pointed attacks on vulnerable populations including trans people and immigrants.
Churches, synagogues, masjids, and other spaces of worship can play a crucial role in providing safe refuge and respite, both physical and spiritual. Now as white Christian nationalist organizations spearhead these attacks, the support of faith organizations is even more crucial. Religious groups are in a unique place to speak out and powerfully counter the twisted logic of hate that so many are adopting.
Mass organizations, whether unions, independent political organizations, PACs, or C4s, can join in supporting legislation to protect the basic rights of trans people and to fight against legislative and political attacks on trans people.
2. Struggle in the legislative/civic arena:
Support legislation to protect the basic rights of trans people. While MAGA-led states have passed legislation criminalizing trans people, a number of states have fought back by passing legislation to protect trans people. These states include Colorado, Illinois, Maryland, New Mexico and Minnesota, which have provided legal protections and healthcare coverage and access. Those in states or cities with progressive leadership should take every opportunity to pursue and support similar legislation. These safe havens will be crucial, especially as roughly half of states enact increasingly aggressive anti-trans policies.
Fight back against the introduction of new legislation that singles out and attacks transgender people. We expect the Trump administration to continue to aggressively attack trans people, roll back any federal protections, and go after states that have passed laws to protect trans people. At the state level, we expect MAGA-controlled states to aggressively pursue anti-trans legislation to attempt to criminalize every aspect of trans existence. We also expect to see local school boards attacking the rights of trans students.
Speak out in your community as these decisions are being made: at school board meetings, at city councils, in the legislature, in your local newspaper. It is powerful when trans people and the parents of trans youth speak out, but it is even more powerful when they are surrounded by a community speaking out with them.
Support electeds who are campaigning against the MAGA agenda. In 2025 there will be local elections in many cities, two gubernatorial races, and special elections to fill Congressional seats vacated by appointees to the Trump administration. And already it is time to begin building the infrastructure to fight MAGA in the 2026 midterms.
3. Provide personal support to trans friends and comrades:
Mutual aid is crucial, especially for those living in red states where trans people are thinking about their basic safety, access to healthcare and medication, securing identification with current name and gender marker, and the possible need to move. Support takes many forms: emotional support to weather the storm; financial support including jobs and healthcare costs; food and housing.
Be aware of the vulnerabilities that trans people face, along with their families and professionals who work with them. Respect trans people’s privacy and do not out someone as trans without their explicit permission - always good advice, and even more so in these heightened times.
In particular, trans youth are a target and are especially vulnerable to the changes MAGA is pushing forward in schools. Parents of trans youth will be carrying tremendous responsibilities and need support from their communities. Teachers and doctors, as well as other school and healthcare workers, will also play a critical role and will face attacks and heightened scrutiny of their work.
Likewise, those at the intersections of multiple vulnerabilities will need support. Trans immigrants face attacks from multiple fronts, including those who have fled their home countries because of anti-trans and anti-LGBT laws and face the possibility of being forced to return to unsafe conditions.
4. Support the organizations on the front lines:
Many of the Trump administration’s actions will be challenged in court, with organizations like the ACLU and Lambda Legal leading the charge.
Student organizations and teachers’ unions will be on the front lines defending trans youth.
LGBTQ+ community organizations and mutual aid funds will need more support than ever as they play a crucial role in supporting community members.
At the local level, many of these organizations will be looking for volunteers to support them as they carry out their work.
If you know of organizations that are doing good work in this time, we invite you to add their names in the comments.
Allison Peters is a member of Liberation Road and its Oppressed Gender Work Team.
This is quite good. It makes the struggle concrete, i.e., what is happening to real people in real life. Many working class people know trans people, but have mixed feelings about them, not being familiar with the issue as framed here. So this is helpful on that front. I have only one quibble: 'nuclear family' is connected to negatives. 'Patriarchal family' would be better. Not all nuclear families are patriarchal or even, of necessity, male-dominated. I think, like all of the institutions of civil society, they are a terrain of struggle, debate, and reform. But that may be a discussion for another day.