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This week’s newsletter focuses on the Supreme Court’s recent ruling related to minors’ access to gender-affirming care, as well as several lawsuits challenging cutbacks in funding for health-related research.
U.S. v. Skrmetti, 605 U.S.____, 2025 WL 1698785 (Docket No. 23-477)
On June 18, 2025, by a 6-3 vote, the Supreme Court upheld the constitutionality of Tennessee’s ban on gender-affirming care for minors. In an opinion written by Chief Justice Roberts, the Court ruled that Tennessee did not discriminate on the basis of sex in banning gender-affirming care for gender dysphoria, gender identity, or gender incongruence. Instead, the Chief Justice reasoned Tennessee simply banned treatments for certain medical conditions, regardless of sex. The Chief Justice then concluded that the law passed the lenient rational basis test. In a concurring opinion, Justice Thomas argued that sexual orientation claims should not be subject to heightened scrutiny under the Equal Protection Clause. He also underscored his lack of faith in scientific experts, stating, “In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct.” Although this lack of faith in scientific expertise was expressed in a concurring opinion, it reflects a disdain for expertise that we have discussed previously. That attitude, as well as the Court’s willingness to accept state laws that deny care to trans people, will likely have significant ramifications in future public health-related cases.
In a dissent, Justice Sotomayor argued that the Court should have applied strict scrutiny to the Tennessee law. She added, “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims.”
Challenges to the Termination of Federal Funding for Research
This week, the National Institutes of Health (NIH) announced that it would pause the termination of grants. This followed several important developments in the litigation challenging such terminations.
In American Public Health Association et al v. National Institutes of Health et al (Docket No. 1:25-cv-10787), the American Public Health Association and other parties filed suit in federal district court in Massachusetts to block some of the NIH grant terminations by the Trump administration. Plaintiffs argued that the grant terminations violated the Administrative Procedure Act (APA), the separation of powers, and was void for vagueness under the Fifth Amendment. In a ruling from the bench on June 16, Judge William Young stated, “This represents racial discrimination and discrimination against America’s LGBTQ community, that’s what this is.” Judge Young promised to follow his bench ruling with a full opinion and refused to pause his order on June 24, causing NIH to reinstate funding for about 900 projects and halt further terminations. Also on June 23, in another case brought by a group of 16 states challenging the termination of NIH grants, Massachusetts v. Kennedy (Docket No. 1:25-cv-10814), Judge Young ruled that the contested terminations were arbitrary and capricious in violation of the APA.
In another case, not specific to grants for health-related research, Thakur et al v. Trump et al (Docket No. 3:25-cv-04737), Judge Rita Lin, from the federal district court in California, ordered different agencies to restore the grants awarded to researchers at the University of California, as Judge Lin found that the grants were terminated without adequate explanation.
Several new complaints have also been filed related to cutbacks in federal funding. In American Federation for Physicians for Human Rights Inc. et al v. National Institutes of Health et al (Docket No. 8:25-cv-01620), a group of medical organizations focused on the promotion of health equity for LGBTQI+ individuals as well as individual health professionals who had their federal research funding terminated sued the NIH. In their complaint filed in Federal District Court in Maryland on May 20, 2025, the Plaintiffs claimed that the federal government unlawfully terminated or withheld more than $800 million in federal research funding for LGBTQI+-related health research, such as research with topics relating to “mental health, antibiotic resistance, aging, suicide prevention, HIV/AIDS, gender dysphoria treatment, eating disorders, drug use, and intimate partner violence” in response to two of Trump’s Executive Orders. The first, Executive Order 14168, directed executive agencies to take actions, such as “remov[ing] ‘all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.’” The second, Executive Order 14151, directed officials to “terminate mandates, policies, programs, preferences, and activities related to diversity, equity, and inclusion, and accessibility.” The Plaintiffs argued that “abandonment of this research is a transparent act of overt discrimination against LGBTQI+ people” and that while “the administration may prefer to deny the existence of LGBTQI+ Americans, the Constitution and federal law do not permit the federal government to erase an entire population from its research agenda out of animus or political expediency.”
As in Washington State Medical Association mentioned in our previous newsletter, the Plaintiffs argued that the Defendants’ actions exceeded their statutory authority and were arbitrary and capricious, in violation of the APA. Additionally, the Plaintiffs allege that the Defendants’ actions were rooted in prejudice against the LGBTQI+ community, especially transgender individuals, thus violating equal protection under the Fifth Amendment. Plaintiffs also argue that the Defendants’ actions also violated § 1557 of the Affordable Care Act (ACA), which “prohibits discrimination based on race, color, national origin, sex, age, or disability in federally funded health programs, including in clinical and health research administered or funded by HHS,” as well as the Due Process Clause of the Fifth Amendment because there was no procedure in place to challenge the termination of this funding before it occurred.
On May 28, the Plaintiffs filed a motion for preliminary injunction asking the court to order the Defendants to stop continuing or taking new actions in this manner. This Motion is still pending.
In a class action lawsuit filed on May 21, 2025 in the United States District Court for the District of Columbia, Vera Institute of Justice et al v. US Department of Justice et al (Docket No. 1:25-cv-01643), a group of nonprofit organizations sued the U.S. Department of Justice and other federal departments and officials claiming that the Defendants “abruptly and summarily terminated more than 370 multi-year cooperative agreements and grants awarding more than $820 million in essential funding” as well as telling them to stop their work on these programs. In an email message from the Office of Justice Programs (OJP) at the time of termination, it explained that the funding “no longer effectuate[] the program goals or agency priorities.” These cut grants funding programs focused on addressing “violence reduction and intervention, policing and prosecution, victims’ services, juvenile justice and child protection, substance use and mental health treatment, corrections and reentry, justice system enhancements, research and evaluation” as well as other public safety concerns.
As in American Federation for Physicians above, the Plaintiffs argue that the termination of this essential funding to their programs violates the APA, the Due Process Clause of the Fifth Amendment, and the Spending and Taxing Clauses. They contend that the OJP may only terminate grants under certain circumstances and they must follow a certain set of procedures. Conversely, here, they argue that the Defendants may not terminate funding without notice and without a reasoned explanation as well as leave the Plaintiffs without a way to appeal the terminations before they occurred. In contrast, the Defendants argue that they followed required procedures and that the programs cut do not align with the President’s priorities. The Defendants filed a Motion to Dismiss on June 9, 2025, which is pending.
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