Solomon Center Panel Discusses the Legal Battleground for Gender-Affirming Care

Gender-affirming care has become one of the most contentious legal battlegrounds in the United States, a topic addressed in depth by a recent expert panel titled “United States v. Skrmetti: The Legal Battleground for Gender-Affirming Care,” hosted by the Solomon Center for Health Law and Policy on Nov. 12.

The panel featured experts including Joshua Block ’05, senior attorney from the ACLU’s LGBTQ & HIV Projects; Katie Eyer ’04, professor at Rutgers Law School; and Julie Veroff ’15, deputy solicitor general at the California Department of Justice.

Solomon Center Senior Fellow Michael Ulrich, associate professor of health law, ethics, and human rights at Boston University, and Hannah Terrapin ’26 served as co-moderators.

The plaintiffs in United States v. Skrmetti contend that a Tennessee law banning gender-affirming care violates the Equal Protection Clause of the U.S. Constitution. The 6th U.S. Circuit Court of Appeals, in an opinion by Chief Judge Jeffrey S. Sutton, held that the law is not unconstitutional. 

Although the U.S. Supreme Court held in Bostock v. Clayton County that Title VII of the Civil Rights Act’s prohibition on sex discrimination extends to discrimination based on gender identity, the 6th Circuit concluded that discrimination based on gender identity is different than discrimination on the basis of sex. If the court had concluded that they were the same, it would have had to apply heightened scrutiny to the Tennessee law, as sex is considered a “suspect” classification. Because the court concluded they were different, it applied the lowest form of scrutiny — rational basis review. 

Block set the stage with a historical perspective on the recent surge in legislation targeting gender-affirming care. He emphasized that after the Supreme Court’s decision in Dobbs overturned Roe v. Wade, many states moved ahead with bans on gender-affirming care, despite earlier injunctions. Block explained that gender-affirming litigation risks fundamentally altering legal protections against sex discrimination — including what kinds of laws receive heightened review. 

Eyer focused on the historical parallels between the current fight for transgender rights and earlier civil rights movements. 

“If ever there were a circumstance where [heightened scrutiny] was implicated, it is the rights of transgender youth today,” Eyer said. 

Eyer also highlighted the volume of anti-transgender legislation, noting that 664 bills targeting transgender rights were introduced in 2024, illustrating the scope of the challenge ahead for advocates.  

Veroff, participating in her personal capacity, discussed the potential outcomes of Skrmetti and the broader implications for state regulation of medical practice. Veroff explained that “one option is that we get a decision affirming the 6th Circuit’s application of rational basis,” which would mean that discrimination on the basis of gender identity would not trigger heightened scrutiny. 

The panel concluded with reflections on the broader cultural and legal significance of Skrmetti. Ulrich reinforced insights on the broader medical and ethical implications of state-level restrictions on gender-affirming care. He warned about the possible consequences if states are permitted to selectively ban specific treatments, regardless of established medical consensus. This practice could lead to a chilling effect on healthcare beyond even LGBTQ+ rights. 

“We’ve already seen this argument with mifepristone,” Ulrich said, referring to the ongoing legal battles surrounding the abortion medication.  

The event was co-sponsored by the Yale Health Law and Policy Society (YHeLPS), Yale Law Women+ (YLW+), If/When/How: Lawyering for Reproductive Justice: Yale Law School Chapter, Trans @ Yale Law School (T@YLS), Disabled Law Students Association (DLSA), and OutLaws.