SCOTUS, Trans Healthcare, and Christian Nationalism
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What does the Supreme Court’s latest ruling mean for trans rights in America?
In this episode of Straight White American Jesus, Brad Onishi is joined by Dr. Kelsy Burke, sociology professor at the University of Nebraska–Lincoln, to unpack the Supreme Court’s decision in EDI v. United States. The case—centered on gender-affirming care for minors—has far-reaching consequences for trans healthcare across the country, especially in states like Tennessee.
Brad and Dr. Burke explore how the case originated, the political and religious forces behind the legislation, and the deep influence of conservative Christian groups. They examine shifting public opinion on trans rights and the troubling silence from Democratic leaders in response to this wave of anti-trans policymaking. With clarity and urgency, this conversation brings historical context to one of the most pressing civil rights battles in America today.
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you you you Welcome to Straight White American Jesus.
I'm Brad O'Nishi, and today we're here to talk about the decision from the Supreme Court in Scrum Edi versus the U.S. This is the case involving trans healthcare for children.
I welcome back to the program Dr. Kelsey Burke, who is faculty at the University of Nebraska-Lincoln.
Been following this case closely and a great conversation partner for today.
Not only breaks down what this means going forward, the details of the case and the history of trans healthcare and trans rights in the United States, the scholar of religion who can give us insight into the religious dimensions of this case and the ways that this case came directly from the conservative Christian world, the Family Research Council, the Alliance for Defending Freedom, and so on and so forth.
This is a case steeped in Christian nationalism and Christian supremacy.
Dr. Burke explains all that and more.
At the end of the conversation, we get into the idea of the nuclear family and the way it has been weaponized against queer people for 75 years.
I'm Brad Onishi, and this is Straight White American Jesus.
Straight White American Jesus.
Welcome to Straight White American Jesus.
Great to be with you on this Monday.
As I said Friday, and I said in my open, we are here to talk about the Supreme Court case and the decision that means healthcare for trans minors will be essentially outlawed or at least not available in most of the United States.
And I'm here to talk about that with a returned guest who is Dr. Kelsey Burke, who has been here a couple of times before.
Dr. Burke, thanks for coming back.
Thank you so much for having me.
You are someone that people should remember from one of our most popular episodes on this show, and that is about your last book, Pornography Wars, The Past, Present, and Future of America's Obscene Obsession.
You are writing a new work on the origins and evolution of the anti-transgender movement in the United States.
And you're, of course, a sociology professor at the University of Nebraska-Lincoln and do a lot of great work as an affiliate scholar with PRRI.
So I know you've been following this case for a long time.
I want to ask you about the decision and what you found there.
But real quick, would you just give us like the 30-second origin story of the case and like how this got all the way to the Supreme Court?
Can we just do like a real quick primer for some folks that are trying to catch up and figure out how we got to this point?
Yes, let me see.
I don't know if I can do it in 30 seconds, but I will try.
So the case originated in 2023 when the state of Tennessee passed a law banning gender-affirming health care for minors, which means that trans kids, adolescents couldn't get puberty blockers, hormone replacement therapy, or surgery to adjust their physical appearance to better match their gender identity.
Families who were affected by the law, along with the ACLU and eventually the federal government under the Biden administration, that's why the case name is US v.
Skirmetti, took the state of Tennessee to court.
Tennessee's Attorney General is Skirmetti.
So without getting too much into the weeds, the question before the Supreme Court was whether Tennessee's laws discriminated on the basis of sex or on the basis of transgender status, because the law does permit these same kind of medications, puberty blockers, hormone therapies for cisgender kids, for non-trans kids who could be prescribed these medications for any number of reasons.
But the court ruled that because this law said that trans kids couldn't use those medications, that that was not discrimination on the basis of their transgender status.
Rather, it was a classification based on the medical condition or the diagnosis of gender dysphoria, and also a classification based on age, because it does have to do with their minor status.
So basically, the ruling is in favor of the state of Tennessee, but the court is signaling that it's not going to get involved in Tennessee's law or similar laws, as you mentioned, which now exist in the majority of the country and 27 other states.
I have so many questions about the on-the-ground prescription things there, but let's go through some other things first.
Where do Americans fall on this?
If we look at polling and we look at opinion measurements, where do people come out on the case or on transgender equality issues more generally?
And how has that changed in recent memory?
So, I mean, one caveat is that polling firms have not actually been asking questions about trans Americans for all that long.
So our data is pretty recent, basically as a result of these political debates.
So as you mentioned, PRRI that I'm affiliated with, I've been looking at their data.
They've been asking questions since 2022 on whether Americans support gender affirming care for minors or the laws that ban that.
And Americans have become slightly less opposed to legal bans.
I'm sorry, that have become more supportive of the legal bans of that care.
The shift has been greatest among Republicans.
This is understandable given that it's the GOP that has almost been single-handedly responsible for all of these state laws.
But Democrats have also been changing their minds.
So there's been a move from 75% who supported trans access to gender-affirming care for minors to 70%.
And as a whole, we've moved slightly more conservative, though it's still about that 50%.
PRRI is saying it's about 49% who support access to trans health care for kids.
There are groups, there are communities, there are institutions that have historically supported gay and lesbian rights in the country, gay and lesbian equality, representation.
They're not showing the same support for gender-affirming health care for trans folks and for trans kids.
What's that about?
I think this is sort of the million-dollar question.
A lot of pundits have been talking about that.
I saw Ezra Klein just had a recent podcast with a senator from Delaware who was talking about this very issue.
My take on this is that when it comes to transgender equality, the conservative movement has really invented a social problem and has masked the ways in which this has really become an intentional strategy to attack transgender rights and autonomy, that this has been predetermined by national political organizations and political leaders.
But the rhetoric and messaging actually masks that intentionality behind this movement.
It makes it seem like it's just concerned parents, concerned citizens who are asking questions, who are worried about their kids, who don't want to rush into medical interventions, which on the face all seems like really reasonable talking points.
But in fact, that, you know, trans kids have really become a wedge issue, have become a way for conservative leaders to gain appeal and gain power.
I can share some of my own observations in my home state of Nebraska.
So we passed a law that was similar to Tennessee that same year in 2023.
And I was down the street at my state capitol to observe all of the testimonies and floor debate that led up to the passage of the bill.
The bill's sponsor, who was a Republican senator, a first-year senator, Kathleen Kaut, she presented this law as one that really responded to the concerns of her constituents.
Parents who thought their kids were learning about gender ideology from social media, kids that were rushing into medical interventions that they would later regret.
And the first round of public testimony included stories of these desisters, as they call them, selves who have transitioned and then gone to detransition.
All but one of those who testified in Nebraska were flown in from out of state.
So they were brought in by national political organizations.
They were not Nebraskan citizens who were concerned about this law.
The first clinician who spoke and talked in support of the law talked about all of her clinical experience working with families, but really glossed over the fact that she was a staff member of the Family Research Council based in Washington, D.C. This is one of the national organizations that drafted the model legislation that was the basis of the law in Nebraska, Tennessee, and all of these other states.
So I think it's really important to understand that this is a social problem that has really been constructed intentionally by the conservative movement.
I feel that in my home state of California, where there's been what appears to many of us to be an astroturfed controversy surrounding a young woman who's competing in track and field in Riverside, a girl, I should say, a minor.
And so anyway, that same sense of like manufacturing outrage, manufacturing crisis, it happens in Nebraska.
It also happens in California.
One of the things that someone might be wondering is, all right, I'm glad you all are talking about this.
This is helpful.
This is insightful.
But this is a show about religion.
Your lane is religion.
Straight white American Jesus is supposed to be about the religious right, Christian nationalism.
You already mentioned the Family Research Council, so I think we probably know the answer.
But it's worth discussing how this case is really a case about religion, whether that's religious imposition, whether that is theology forming our policies and our laws in this country or other things.
So I'll leave it to you to make those connections.
What does religion have to do with Skirmetti?
Yeah, well, the Family Research Council is a great case in point.
So they tweeted immediately after the decision was announced saying that, you know, American medical societies that support gender transition procedures on minors are the ones motivated by politics and ideology and that they're ignoring the data.
So the Family Research Council really puts forward scientific and medical sounding language, but all that aligns with a very particular theological and religious view.
So we know, of course, I mean, your listeners know this is an organization that's explicitly an evangelical Protestant political organization.
And that's true of so many of the groups that have come out in support of Tennessee's law, that they use language of science, medicine, data, but it's all in the service of a particular worldview that is not actually objectively scientific, but is reflecting really clear religious values.
And so I think we have to understand the Tennessee law, Senate Bill 1, and the subsequent lawsuits that led up to Skermeti as really part of this broader legal strategy of the conservative Christian movement.
So we have other cases on the docket that are likely going to be announced, well, we're recording this episode on Friday, so announced next week, that are more explicitly about the rights of conservative Christians, whether religious parents can opt out of schools that teach stories that include LGBT characters, whether Christian businesses have to offer preventative health care that includes PrEP medication to prevent the contraction of HIV.
So those are all the same network of the conservative Christian legal movement that has been really involved in the Skirmetti case.
So Alliance Defending Freedom, which is another one of these evangelical organizations that has been leading this legal pathway when it comes to lawsuits having to do with religious freedom, opposing reproductive rights and LGBTQ rights, they wrote a brief in support of Skirmetti.
So this is really a part of all a much broader and interrelated agenda.
So the Family Research Council and the ADL are part of just a network of institutions that are mainly evangelical, at least in their window dressing, but are part of a long-standing Protestant-Catholic alliance on the American right.
And one of the arguments I have made on this show and in other places is that, you know, in the 1970s, the bet was if we can make the nuclear family and the nuclear family meaning a heterosexual, patriarchal,
cisgendered, reproductive family, if you can convince Americans that that is the bedrock of civilization, as William Marsher calls it, then you can frame any threat to that kind of family as a threat to America and as a threat to Christianity.
And so, you know, the trick, if you're going to make that convincing argument, is that you have to convince people that anything that doesn't fall in line with that family is a couple of things, but one of them is new.
It's new.
Oh, when I was growing up, there was no trans kids.
When I was growing up, there was no gay people.
When I was growing up, I didn't know what a non-binary person.
It's all new.
It's all invented.
It's all from Satan and so on.
Chelsea Eben and Seth Dallin, so many others have done great work showing us how this operates mechanically.
But I suspect that if we look into the history of how American leaders have felt about and come down on trans health care, it's probably more diverse than people expect.
Just as it's surprising to many people to learn that in the 1960s, a huge majority of Southern Baptists were in favor of abortion of some kind.
I mean, when you start doing history, people get really mad, I've discovered, because it doesn't match what they're thinking and what they expect and what their narrative needs.
Is that the case when it comes to trans health care in the history of the United States?
I'm so glad you asked that question because a lot of my work has been tracing this history of how different groups have reacted to transgender medicine over time.
One of the clinics that actually is referenced in Tennessee's law in Senate Bill 1 is the Johns Hopkins Gender Identity Clinic.
It was the first of its kind that opened in 1965.
It was led most famously by a psychologist, Dr. John Money.
And so he's referenced in the Tennessee law as this sort of nefarious character who was experimenting on children.
And the clinic, when it opened, you know, made headlines all across the country about performing quote-unquote sex change surgeries on its patients.
But what I found in the archives was really a lot of silence when it came to religious periodicals who really didn't talk much about the clinic opening.
And in fact, the Baltimore Sun published a piece that surveyed local clergy, both Catholics and Protestants, to ask their perspective and their reaction to the opening of the gender identity clinic.
And their views were overwhelmingly supportive.
So they talked about how these kinds of surgeries would be in accordance with Christian teaching, how they didn't see moral objection to it, how they needed to offer compassion towards transgender people and the doctors who were providing their care, how they needed to trust the expertise of doctors who were making decisions that was, you know, for the health of their patients.
So this is really different than the claims today on behalf of many religious leaders who are speaking out against gender affirming healthcare and really making it sound like their religious views are all but universal, are timeless, when that's just not the case when it comes to history.
And so it's notable that you walk through this history that the Gender Identity Clinic opened in 1966.
And this was really before what we think of as the Christian right emerged.
So before this Protestant Catholic coalition that really coalesced around, I think you're absolutely right, gender and sexuality issues.
Well, and I just, if we can just follow up on that, you know, so in 1966, we have the opening of this clinic.
We have the teaching of comprehensive healthcare, sex ed, in the country.
We have the integration of schools.
And all of a sudden, five and eight years later, we arrive at a place where schools are supposedly secular humanist dens of sin.
And this idea of the nuclear family, issues of gender, issues of sex are the central thing driving the religious rights sort of crusade as it comes to protecting our kids.
50 years later, this is the, I mean, I've said it on the show.
I think some people may be tired of hearing it, but you are uniquely positioned to comment on this.
It seems to me the same playbook with a different target.
There was a target before of gay and lesbian people of sex, ed, and so on.
The target now is trans kids and the trans community writ large.
Does that feel accurate to you?
What do we need to add to that picture?
Yeah, I think that's exactly right.
And I would just slightly rephrase same playbook, different target.
It's the same playbook, and on the surface, it seems like a different target.
But I think all along, this defense of binary sex difference that relies on assumptions about heterosexuality, like that's been the movement all along.
And whether it's attacking sex education, abortion rights, gays and lesbians, transgender people, it all is in response to this core idea that is perceived to be under threat and that, you know, the conservative Christian movement really believes is what needs to differentiate between those who are deserving of rights within this country and those who are not.
No, great point.
And I totally thank you for that because you're exactly right.
And yeah.
There's so many things I want to follow up on there, but I want to make sure we get to a couple of really important things first.
One is one of the kind of authorities cited in the case is the CAS report.
We've talked about the CAS report in this show.
Dan Miller's done a great job sort of outlining what that is in a bonus episode.
But would you help us understand what is the CAS report?
I think Europeans and people in the UK, especially the UK, are much more familiar with it.
It's made waves.
It's been on the front page.
I think in the States, we may start to get some of that familiarity given a case like this.
But the CAS report seems like, to me at least, and you can tell me if I'm wrong, scientific sheen based on bad methodology and not great data.
But I'll leave it to you.
You tell me.
Is that right?
Or what do we need to know?
I think that's right.
The CAS report is referenced in the majority opinion.
It's referenced in virtually all of these state laws like Tennessee's.
It came out in the UK.
It was commissioned to be authored by a pediatrician whose last name is CAS.
That's how it gets the name, the CAS report.
It was intended to be a comprehensive review of existing literature, research, evidence when it comes to what is called gender-affirming health care.
Critics have pointed out that it really seems to be an impartial review of the evidence in that its takeaways.
You know, one of, I think, the misnomers is that the CAS report explicitly supports banning gender-affirming healthcare for minors.
It doesn't.
It is framed as asking questions, as there being uncertainty when it comes to the state of transgender medicine.
And the Supreme Court justices really latched on to that uncertainty to say that it wasn't their place to make a determination about whether gender-affirming health care should be legal or not.
But because this is an open-ended question in the eyes of the court, that it should be up to the states to pass laws regulating it.
So I want to talk through some things on the ground.
I think the first question would be, what are the reactions from the trans community?
What are the reactions from folks who are most directly affected by this?
What is the mood at this moment?
I don't know that anybody was particularly surprised by this ruling.
If you paid attention or listened to the oral arguments back in December, it seemed fairly clear that the justices were lean towards this decision.
I think it's a blow, to be sure, to trans folks and their allies, but it's in a long series of blows that has been culminating in 2025, beginning with President Trump's Inauguration Day executive orders that started to codify attacks on trans people and trans identity from the federal government.
So I don't think that this was surprising.
At the same time, I think across both sides, so like I got onto a call to observe how some conservative groups were responding to this ruling.
And I think across both sides, there's a perception that things could have been better and things could have been worse.
So for conservatives, you know, the ruling was actually quite limited.
So they are celebrating Skirmetti as a victory, to be sure.
But there's also, you know, perhaps some disappointment that the justices didn't go further in making claims about transgender status not being a protected class.
So there's a reference to the Supreme Court ruling of Bostock versus Clayton County, which is where the justices ruled that sexual orientation and gender identity were a part of this category of sex, and therefore you could not discriminate in the workplace on the basis of sexual orientation or gender identity.
So there was some hope that this Skirmetti decision might actually walk back that decision when it comes to transgender status.
That's something the court did not do.
So that leaves open what will be happening in future cases.
Can I ask about something you said at the very beginning of our conversation, which is that these drugs, these healthcare dynamics are available to cisgender youth.
And so I'm asking from a place of complete ignorance here.
This is a place where I really don't know the answer and I'm really trying to kind of figure something out.
How does that look on the ground if you are someone who walks into a doctor?
I guess what I'm wondering is like, if you walk into a doctor's office with a nine-year-old, how is it determined?
You know, are there ways that like this ruling will lead to kind of strange relationships with doctors where if you are a cisgendered kid, you can have these, you know, you can be prescribed these drugs.
How does that work on the ground?
Is there any sort of like situation where it's going to create barriers between, you know, parents, kids, and their doctors and identity and purpose?
And what are these, why do you need these and what are they for?
I'm not sure what I'm asking, but hopefully I'm gesturing towards some question that makes some kind of sense.
Yeah, absolutely.
These are the kinds of hypotheticals that the justices were trying to work through in both the majority opinion and then also in Sotomayor's dissenting opinion.
So kids who are cisgender, who are not trans, may be prescribed puberty blockers or hormone therapies if they have, say, early onset puberty.
So they're starting to, you know, display or develop physically in ways that they want to sort of slow down.
They could be prescribed puberty blockers.
So in this case, it would be a cis kid who's taking medication to better align with their sex assigned at birth.
Exactly.
And so what the majority opinion wrote was that if there was a trans kid who was taking these medications for a reason other than gender dysphoria.
So if they had some congenital defect that required hormone therapies, they could legally be prescribed that medication.
So it's all about the diagnostic criteria.
So I think that may lead to some interesting or creative loopholes on behalf of families and providers.
But it's really the dissenting opinion really seems like the tone of it is just incredulous that this kind of reasoning is not about transgender status, that it's trying to do this sort of verbal jiu-jitsu to say that this is about the medical diagnosis of gender dysphoria when this is really about trans identity.
I guess that those loopholes and those creative diagnoses is where I was going and the ways that this leaves open this.
Anyway, there's just so many ways this creates barriers for folks trying to get care of any kind of course.
Yeah, in the state of Nebraska, we passed a ban, but then in its implementation, it's not an all-out ban.
There's a requirement that a minor can get 40 hours of therapy.
No one quite knows why 40 is the magic number, but this is what is now required to be prescribed certain kinds of medications.
So clinicians here in our state are working towards that number, are working with families so that they can access the care that they need and deserve.
And so I think across the country, there are different ways in which these laws have ultimately ended up making it through to law and how people are responding to those is unique in some situations.
All right, y'all.
I'm going to ask Dr. Burke a bunch of questions about Democrats and zooming out for 2028.
I also want to keep talking about the ways that the idea of the nuclear family plays into politics in this country and how the right has weaponized the idea of family against people who don't fit their vision of it.
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