The U.S. Supreme Court this week upheld Tennessee’s ban on transgender health care for minors, leaving the issue to the states — Idaho is one of 25 states with a similar ban.

Idaho’s law prohibiting providing health care to minors under 18 to treat gender dysphoria — known in the medical community as gender-affirming care — had been previously blocked from going into effect by a federal judge while the constitutionality of it was weighed in court. The Supreme Court, at the request of Idaho, later narrowed the block to only block its enforcement on the two plaintiffs in the case.

The 6-3 ruling from the nation’s high court on Wednesday determined that the type of ban does not require the high level of scrutiny used to determine other types of discrimination under the equal protection clause of the 14th Amendment.

“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field,” Chief Justice John Roberts wrote in the majority opinion. “The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”

Roberts wrote that the majority concluded the law did not violate the equal protection guarantee under the 14th Amendment, and so the court will “leave questions regarding its policy to the people, their elected representatives, and the democratic process.”

The opinion “put the court’s blessing on Tennessee and other states like Idaho who have laws restricting this kind of care for minors,” said Richard Seamon, a University of Idaho College of Law professor who specializes in constitutional law and the Supreme Court. It puts an end to similar challenges, but Seamon said that those who oppose the bans could still challenge them under the language in state constitutions.

The Tennessee ban was challenged by transgender children and parents in Tennessee, who argued they were unconstitutionally denied equal protection because the treatments that were banned to treat gender dysphoria — such as hormones or puberty blockers — could be provided to other minors for other diagnoses.

Supreme Court Justice Sonia Sotomayor argued in her dissent that Tennessee’s ban does discriminate based on sex, and should be subject to higher scrutiny than what the majority opinion decided.

“Tennessee’s law expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny,” Sotomayor wrote. “The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee’s categorical ban on lifesaving medical treatment so long as ‘any reasonably conceivable state of facts’ might justify it.”

Idaho’s law had been challenged under a similar argument, but was dismissed because the families of the trans children plaintiffs had moved out of the state, according to a press release from the ACLU of Idaho.

“Transgender people deserve access to lifesaving medical care, full stop,” ACLU of Idaho Legal Director Paul Carlos Southwick said in a press release. “This ruling sidesteps the protections our Constitution affords to our transgender community. We will continue fighting to uphold the Constitution and to ensure everyone is treated equally and can access medically necessary medical care.”

Idaho Attorney General Raúl Labrador on Wednesday announced the dismissal of the case, allowing the state’s ban to fully go into effect.

“For two years, my office defended Idaho’s common-sense law that protects kids from experimental procedures with lifelong, irreversible consequences,” Labrador said in the press release. “Idaho’s Vulnerable Child Protection Act recognizes that children suffering from gender dysphoria need love, support, and medical care rooted in biological reality—not life-altering drugs and surgeries.”

Roberts in the majority opinion did not weigh in on whether the treatment was medically necessary or harmful; instead he focused on if the law discriminated based on sex. The majority said no, arguing instead that it differed based on condition rather than sex because a transgender child could still access the treatments for other conditions. He cited another past court ruling that exclusion based on pregnancy was not sex-based discrimination, even if biological women are the only ones who experience the condition.

“By the same token, SB1 (the Tennessee law) does not exclude any individual from medical treatments on the basis of transgender status but rather removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions,” Roberts wrote.

In a 2020 U.S. Supreme Court decision, the majority of the justices ruled that discrimination based on transgender status in the workplace was sex-based discrimination and therefore illegal.

Seamon said the differing outcomes are because the court was interpreting two different areas of the law. The 2020 majority decision ruled that discrimination based on transgender status was a violation of Title VII of the Civil Rights Act. Wednesday’s decision focused on the 14th Amendment to the Constitution.

This week’s decision was narrowly focused on the bans similar to Tennessee’s and Idaho’s, Seamon said, and wouldn’t necessarily apply to the challenges to other laws targeting transgender people.

The Arizona-based Alliance Defending Freedom legal counsel had filed a brief with the Supreme Court in support of Tennessee’s ban. The ADF, a conservative, religious legal advocacy group, also assisted Labrador’s office to defend the law in Idaho and other states.

ADF is supporting other cases pending before the courts dealing with transgender issues, including a ban on trans athletes participating in women’s and girls’ sports. Idaho became the first state to impose such a ban when Gov. Brad Little signed it into law in 2020. The decision on Wednesday did not resolve the questions posed in the other lawsuits before the court.

The ACLU of Idaho wrote in its press release it “is still advancing other lawsuits to protect trans rights.”

John Bursch, ADF senior counsel and vice president of appellate advocacy, said that he thought it could be possible for states to restrict medical care for transgender adults down the line, NPR reported Wednesday.

“I think there would be a rational basis to also prohibit it for adults, and that would be up to the states to decide,” he said.