How Supreme Court Trans Health Care Ruling Will Affect Kids

The U.S. Supreme Court has upheld a Tennessee law banning gender-affirming care for minors in the case US v. Skrmetti. In a 6–3 decision by the conservative supermajority, the court ruled that the state law, called Senate Bill 1 (SB1), does not violate the Equal Protection Clause of the Constitution by discriminating on the basis of sex—despite the fact that the law forbids certain medical treatments for young people based on their assigned sex at birth.
Why This Matters
The ruling is a major blow to transgender Americans' rights and protections, which have been under attack at the state and federal level. The challenge to Tennessee's SB1 had been brought by three transgender adolescents, their families and a doctor. 'This might seem like a small issue to others but it affects my whole world,' wrote one of the plaintiffs, a then 12-year-old transgender boy, in a declaration submitted to the district court. 'I've gone through a lot to finally get to the happy, healthy place where I am and I desperately hope that doesn't all get taken away from me.'
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For anyone under the age of 18, SB1 banned medical treatments that aim to alleviate the symptoms of gender dysphoria—a feeling of misalignment between someone's perceived gender and their assigned sex at birth. The law bans gender-affirming medical treatments, including puberty-blocking drugs and hormone therapies. There's no evidence of serious negative effects of these medications, though long-term use of puberty blockers may limit the buildup of bone mineral density.
Such medications have also long been used by nontransgender adolescents and children to treat a variety of conditions. Their use for gender dysphoria is currently supported by the American Medical Association, the American Association of Pediatrics, the American Psychological Association and other important medical institutions.
Research has shown that young people who experience gender dysphoria are at a high risk of depression and suicide. Those who receive care have better mental health outcomes, including decreased suicidal ideation, multiple studies have found. In contrast, between 2018 and 2022, when states enacted antitransgender laws, suicide attempts among transgender young people increased by as much as 72 percent. In the U.K., a ban on puberty blockers for transgender youth led to a sharp decline in mental health among this group, including increased depression, social isolation, and suicidal ideation, a recent study found.
The Decision
In the Supreme Court's majority decision, Chief Justice John Roberts pointed to 'fierce scientific and policy debates about the safety, efficacy, and propriety' of the treatments. Many of those debates have largely been political, not scientific, however.
The Court was tasked with deciding whether the law constituted sex discrimination under the Equal Protection Clause and should thus be subject to a higher level of judicial scrutiny. Plaintiffs argued that SB1 prohibits established medical treatments for some people and allows them for others based on individuals' assigned sex at birth. For example, in Tennessee, a teenager who had been assigned female at birth could not receive testosterone therapy, but a teenager who had been assigned male at birth could.
'The Equal Protection Clause does not resolve these disagreements,' Roberts wrote in the majority opinion. 'Nor does it afford us license to decide them as we see best. Our role is not 'to judge the wisdom, fairness, or logic' of the law before us ... but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.'
In dissent, Justice Sonia Sotomayor wrote, 'Tennessee's law expressly classifies on the basis of sex and transgender status.... The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee's categorical ban on lifesaving medical treatment.... By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.'
What the Experts Say
The Court's decision means that Tennessee's SB1 and any similar state laws do not merit heightened scrutiny from the judicial system to ensure they are appropriate. 'This is unfortunate because the evidence base regarding gender-affirming care is overwhelming supportive of access to the care,' says Elana Redfield, a LGBTQ+ policy expert at the Williams Institute at the University of California, Los Angeles. 'However, the legislature disregarded this evidence and relied instead on misinformation and conjecture when it passed the law—and, one can argue, bias against transgender people.'
Redfield notes that the case's outcome doesn't prevent states from passing laws to protect access to gender-affirming care—as 14 states and Washington, D. C., have chosen to do. She adds that the ruling also does not prevent future challenges to antitransgender laws from being brought before the Court on different grounds.
Lawrence Gostin, co-faculty director of the O'Neill Institute for National and Global Health Law at Georgetown University Law Center, has decried the Court's decision. 'It's jaw-dropping to see a majority of Supreme Court justices turn a blind eye while transgender minors are flatly denied access to health services in consultation with their doctors,' Gostin said in a recent press release. 'The Court is greenlighting red state laws that will deeply affect the lives of marginalized and victimized people seeking healthcare, social acceptance, and dignity. This decision paves the way for additional restrictions on other essential but politically fraught services, notably within sexual and reproductive health.'
Last December Scientific American spoke with health policy experts about what was at stake in the US v. Skrmetti case.
In January a study of 315 trans youth found that they had better emotional health after taking hormones.
See our answers to the questions ' What Are Puberty Blockers, and How Do They Work? '
Explore ' What the Science on Gender-Affirming Care for Transgender Kids Really Shows.'
IF YOU NEED HELP
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• USA Today

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Yahoo

24 minutes ago

• Yahoo

The national 'emergency' that is hitting Canadians where it hurts — in their paycheques

Frances Donald was either having a highly productive morning or a disastrous finish to her workweek, depending upon one's definition of disasters in relation to getting stuff done. Royal Bank of Canada's chief economist dropped off her kid at daycare and was down to work before 8 a.m. on June 6, which was not quite a 'Super Bowl' magnitude day for economists, she said, but more along the lines of the 'playoffs,' since Statistics Canada was about to release its labour force survey for May and that's the kind of thing economists get fired up about. The unforeseen twist came shortly before 9 a.m., when the daycare called to say she needed to pick up her child because of an upset tummy. Sometimes pulling off the work/life juggle just does not go according to plan. As Donald's morning proved, however, most Canadians aren't a bunch of lazybones kicking back on the couch watching Netflix all day, but a bunch of grinders hard at work and at life. Yet that doesn't jibe with Canada's well-known issues with productivity, especially compared to the United States and other countries. That flagging productivity over the past couple of decades has added another layer of angst for policymakers, economists and others who think about this country's future and how to make it better. 'Even as a mainstream economist, I am shifting away from simply pulling apart the statistics because if you just look at the statistics, you're not seeing the whole picture,' Donald said. 'The question is, how do we create an innovative, scalable, resilient economy?' It is a great question, underscored with an even greater urgency than ever to answer since some, such as Bank of Canada's senior deputy governor Carolyn Rogers in March 2024, have said Canada is in the grips of a productivity 'emergency,' not a term central bankers throw around lightly. Equally mind-blowing, perhaps, is to learn that Canada during its centennial year in 1967 was considered the world's third-most prosperous nation, behind only the United States and Switzerland. Global productivity rankings were not a thing back in those days, but Canada today is 18th best, sandwiched between Italy and Spain — the nation that made taking an afternoon nap famous — while Ireland is tops, begging the question: what in the name of James Joyce has been going on around here? 'Most people don't understand and probably couldn't care about productivity, but there's a very close link between your productivity and your income,' Philip Cross, the former chief economic analyst at Statistics Canada, said. Productivity, he said, boils down to how fast you can do your work and do it correctly. The faster the work gets done — accurately — the more time there is to do other things such as hanging out with friends, volunteering or taking care of business at home. Converted into dollars and cents, productivity measures the amount of output per hour worked. Forty years ago, Canadians generated 88 per cent of the value of Americans per hour worked, but that dropped to 71 per cent by 2022. That's something all Canadians should care about since Americans generate US$91.50 per capita per hour worked versus US$71.90 for those north of the border. In other words, labour productivity is not an abstract statistic, but the fundamental economic measure of a country's prosperity. 'Increased productivity is a win,' Cross said. 'It is a gift that keeps giving.' A more productive Canada would be home to locals flush with additional cash and the means to buy better cars, houses and other things, but it could also provide better roads, hospitals, public schools and transit, and give the country a better chance of retaining its homegrown talent, which is key to maintaining future productivity. 'When you talk about productivity, too many Canadians think, 'Does that mean I am supposed to work harder, because I'm already working as hard as I can and I'm juggling my family and I am coaching the minor hockey team,' and so on,' John Manley, the one-time deputy prime minister and current chair of investment banking firm Jeffries Canada, said. 'Productivity is not about working harder; it is about working smarter.' Manley is 75, but views retirement as a quaint relic of the 20th century and wishes the same were true for Canada's productivity crisis. It is a subject he first publicly addressed in a 1999 speech at the Empire of Canada Club in Toronto. In case there were any skeptics in the Bay Street crowd that day, he pointed out Ontario was about as productive as 'Mississippi'; per capita income in the U.S. at the time was 30 per cent higher than in Canada, and this country had the lowest rate of productivity growth among the G7 during the preceding 25 years. Time has marched on, but times have not changed when it comes to the productivity challenges bedevilling the country. These include, in no particular order, internal trade barriers, businesses sitting on their wallets instead of making capital investments, matching immigrants to jobs that use their skills, government red tape, a lack of access to capital, prosperity-killing corporate tax policies, a lack of competition in certain parts of the economy, not enough innovation and not enough willpower to do anything to solve the problem. One of the trickiest mountains to climb, Manley said, is that Canada is not a complete productivity disaster and is still a relatively prosperous country. 'Canadians tend to have this attitude of if you don't have to fix something because it is hard to fix, then why would you fix it?' he said. But Manley knows firsthand Canadians are more than capable of making tough fixes. In the 1990s, a Wall Street Journal headline proclaimed that Canada was an 'honorary member of the Third World.' The country's credit rating had been downgraded, the deficit was ticking past half a trillion dollars and 34 cents of every tax dollar collected was going toward servicing the debt. It was an existential fiscal crisis, and Jean Chrétien's government needed to take drastic action, not necessarily because they loved the idea of making change, but because the country no longer had a choice. Back in those days, Manley was industry minister. He oversaw a department that cut back to nine programs from 54 and laid off 25 per cent of its staff. Transfer payments to the provinces were slashed. It was an ugly time, he said, but by February 1998, the government delivered Canada's first balanced budget in 30 years. Crisis solved. The moral of the story? Change is difficult, but it is not impossible. Among the changes that currently need to be made is a widespread shift in opinion about extractive industries such as oil and gas, mining and forestry. 'We sometimes don't like to admit it, but it is our natural resources that pay the bills in Canada,' Manley said. 'We should not be ashamed of that.' But the productivity challenges confronting the energy sector, for example, are much more complex than most people in urban centres think. Once upon a time in the oilpatch, Scott Saxberg, the founder and former chief executive of Crescent Point Energy Corp., now known as Veren Inc., said there was plenty of investor capital to go around. Canada was the place to be when he initially got into the game in the early 2000s. He did not know any of the 'rules,' but what he found was a regulatory environment that, year over year, grew increasingly dense. There always seemed to be a new regulation being layered on top of an old regulation and that brought on increased uncertainty. Investors, he said, hate uncertainty. The Americans delaying and eventually quashing the Keystone XL pipeline was another blow, and the bruises eventually began to add up. Saxberg remembers meeting a potential investor in Scotland and feeling confident about reaching a deal right up until the gentleman looked down at his phone, looked back up and said he was not going to invest because it appeared Keystone XL was not going to fly. Without the new pipeline, any energy company producing in Canada would be at a 'cost disadvantage compared to producers in the U.S.' End of meeting. 'Capital is competitive; it moves around the globe,' he said. 'So when you hear the word competitiveness, what that means is you want to create a country with an environment that attracts capital and out competes other countries for that capital because capital looks at an industry on a macro basis and it goes, 'Well, you're not going to be a good long-term investment, so we are going to look elsewhere.'' Alberta's oilsands had the added disadvantage of being a more costly product to produce, as well as being next door to the U.S., which underwent a fracking craze and completed five new pipelines in 2024 alone, according to the U.S. Energy Information Administration. Meanwhile, several international players, including TotalEnergies SE, BP PLC, ConocoPhillips and Shell PLC, have exited the province in recent years. Wooing them back, Saxberg said, is going to require streamlining regulations, increasing capacity to move oil and natural gas to market (hello pipelines) and a recognition that Alberta and Saskatchewan are not the bad guys, but key drivers of Canadian prosperity. The government-owned Trans Mountain Pipeline is a poster child of productivity. It requires about 750 people to operate, gives Canadian oil producers better access to overseas markets and is expected to produce $2.8 billion in tax revenues by 2043. 'That pipeline produces a product that goes into international markets and the money comes back to Canada and we put it into health care, education, roads, bridges, tunnels and whatever else,' Manley said. 'Imagine what we could do with more of the above.' Dreaming of a future full of new pipelines can steal attention away from some of the more upbeat and unsung productivity stories in the present day. If Canada were to appoint a chief storyteller to convey these yarns, Linda Hasenfratz, chair of auto-parts manufacturing giant Linamar Corp., should get the nod. She's the type of person who can look at a 'drop of water in a glass and see it as half full,' one person who knows her well said. Hasenfratz is also the type of executive who uses charts and graphs to hammer home points during an interview. Topping her list of key takeaways is that Linamar has boosted its productivity by 100 per cent over the past 15 years. Over the same timeframe, the Canadian manufacturing sector as a whole improved its productivity by about 50 per cent, which, perhaps surprisingly, outpaced the U.S. sector's gains. Linamar has 75 plants worldwide and ranks its Canadian ones as its most productive. Toyota Motor Corp.'s Canadian plants are its best performers, according to auto industry analyst J.D. Power, and General Motors Co.'s facility in Oshawa, Ont., consistently ranks as its top factory in North America. In other words, Canadian operations are competing and appear to be crushing it. But one obstacle to that dynamic showing up on Canada's bottom line is government, Hasenfratz said. Nearly one per cent of all Canadians are federal employees. Between 2010 and 2023, the government's headcount grew by 26 per cent. More than 2.5 million Canadians worked for not-for-profit organizations in 2023, according to government statistics. Combined, Hasenfratz said that means far too many well-educated Canadians are working in areas that do not make a dime. 'We need to get more people into revenue-generating businesses and that would have an enormous positive impact on productivity,' she said. Hasenfratz also pointed out that the stories we choose to tell about ourselves matter. 'When you hear things like Canada is not productive, that is not very inspiring, and it doesn't make you think, 'Damn, I'm going to get in there and be more productive tomorrow,'' she said. 'But if you see an example of a company that has doubled its productivity over the past 15 years and in doing so has gained business, grown profit and realized a great return on investment, then you'll be like, 'I want to do that,' because that is inspiring.' Trevor Tombe, a University of Calgary economics professor, recognizes Canada is awash with unrealized potential, but said there are issues in trying to realize those gains. Let's imagine Hasenfratz and her manufacturing sector pals, oil producers and agriculturists are all able to generate more of what the world wants for export — especially to destinations other than the U.S. All that stuff would need to get loaded into massive container ships at the ports of Vancouver, Montreal and Halifax. But the Port of Vancouver is already the largest on the North American West Coast and is handling record levels of cargo. An expansion that has been in the works since 2013 will not be completed until sometime in the 2030s. Montreal got the ball rolling on its port expansion in 2018, but it's still in progress and a long ways away. 'If you want to sell a good to another country beyond the United States, you are not doing it by truck or rail; you're doing it by port because there's an ocean in the way,' Tombe said. 'Right now, we don't have any excess port capacity that would allow us to trade much more with other countries, and in terms of a construction timeline in Vancouver, it is plausibly 20 years from start to finish.' If Canada is unable to get its goods moving, diversify its trade partners, grow exports to China, Japan, South Korea, India and so on, the U.S. is left as the only option. That is not a great position to be in when negotiating a new trade deal with Donald Trump. One option is to build ports elsewhere, such as the Arctic. There currently isn't a deepwater port to speak of there, but there's been plenty of talk of building one — some day. 'There is not just economic and productivity implications of bad federal policy around infrastructure, but national security implications,' Tombe said. Another area in need of a makeover that does not require anything more complicated and time-consuming than playing around with some accounting software datasets is tax policy. Small businesses, defined as companies with less than 500 employees, employ almost 50 per cent of the labour force. But they don't make capital investments in machinery and equipment at the same levels as Canada's G7 peers, apart from the Italians, who invest even less. A worker who lacks the latest tools is not as productive as the worker who does. Companies that retool an assembly line, upgrade laptops and arm staff with best-in-class gadgets are able to write off the expenditures over a number of years, but that 'delays the value' of the tax deductions, Tombe said. Were a company able to write off the new laptops in one fell swoop at the time of purchase, well, now we would be talking, he said, and the conversation would lead to an environment where companies are encouraged to reinvest today. 'It is a way to cut corporate taxes on new investment while maintaining corporate taxes on companies as a whole, so it's less costly than just dropping the corporate tax rate itself,' he said. That may seem an easy thing to do, and the same goes for another productivity fix that relates to Canada's secret weapon: immigrants. Walid Hejazi, an economics professor at the University of Toronto's Rotman School of Management, meets a lot of them, and he said the old joke about the backseat of a taxi being the safest place to have a heart attack still holds up, though the taxi-driving doctor from abroad today is probably behind the wheel of an Uber. Hejazi, through the university, works with a group of immigrant women who all have university degrees from another country. They are smart, savvy and eager to become productive new Canadians. 'Do you know what the No. 1 job these women get offered is?' he said. 'Serving coffee at Tim Hortons.' Rotman puts the newcomers through a crash micro-business course. If successfully completed, that earns them a micro-credential from the school, which hopefully catches the eye of an artificial intelligence employment screener and gets them a face-to-face interview with another human. 'The goal here is to match the women with jobs that are more commensurate with their skills,' he said. As for being compared to the U.S., he said being neighbours has been a gift. We share the same language and customs, generally get along and find it easy to do business with one another to the extent that Canada's ho-hum productivity level has not been a handicap. But where it starts to be a big problem is when the U.S. closes for business and Canadian companies are forced to win market share abroad. 'It is relatively easy for a Canadian company to do business in the U.S., and it requires productivity at a given level,' he said. 'But to go to Europe and Asia and compete requires a much higher productivity level.' Canada may be having a productivity 'emergency,' but its productivity is improving, just at a slower rate than other countries with similar attributes. That is partly why Frances Donald gets the urge to 'vent' when she speaks about productivity, since obsessing over the numbers can obscure a more fundamental question: What kind of Canada do Canadians aspire to? 'You could conceive a plan that would mechanically boost our productivity number,' she said. 'But it wouldn't actually make the Canadian economy better for most Canadians.' For example, not all those productivity-sapping public-sector employees are administrators pushing paper around. They are also teachers, cops, wildfire fighters and doctors. Close to 20 per cent of Canadians have already ticked past age 65, and odds are that a care facility is in their future at some point. 'If I told you that we could quadruple the number of high-productivity engineers, but we dramatically reduce the number of doctors and that would result in higher productivity statistics, then you might hear Canadians say, 'Could I please pick the health-care workers over the high-productivity engineer?'' Donald said. Economists have spent a decade highlighting Canada's productivity ills, from internal trade barriers to reduced investment in the natural resource sector to an affordable housing crisis that only gets worse by the year. It is a drumbeat of doom that can overshadow what Canada has, chiefly, a highly educated population, a massive breadbasket of agricultural goods, oil and gas and critical minerals galore and plenty of room for the world's best and brightest who may be keen to sign on. 'In Canada, we don't have to ask what we are going to bake out of nothing because we already have a long list of something,' Donald said. 'Our project is to have a collective understanding of what this country has been blessed in, from things in the ground to our incredibly high level of education — spanning from goods to a blossoming services sector. Canada is not short on the ingredients to build a powerful economy; where we have fallen short is on the execution.' • Email: joconnor@

Buzz Feed

26 minutes ago

• Buzz Feed

Non-American Military Members, Share Thoughts On Trump

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