Madison Mayor Satya Rhodes-Conway and other Wisconsinites took part in a city celebration for Transgender Day of Visibility in March. Wisconsin and 14 other states are suing in opposition to a Trump administration executive order blocking gender-affirming care for people under 19. (Photo by Baylor Spears/Wisconsin Examiner)

A coalition including 15 state attorneys general have filed a multistate lawsuit challenging the Trump administration’s effort to restrict access to medically-necessary care for transgender, intersex and nonbinary youth.

The lawsuit challenges recent federal action to deter doctors and medical providers from offering gender affirming care to youth under the age of 19 years old, including states like Michigan where that care is legal and protected.

Joining the suit are the attorneys general of Michigan, New York, California, Massachusetts, Illinois, and Connecticut, Delaware, Hawaii, Maine, Maryland, Nevada, New Jersey, New Mexico, Rhode Island, Wisconsin, and the District of Columbia, as well as Pennsylvania Gov. Josh Shapiro.

“The Trump administration shouldn’t be interfering with the provision of health care,” said Wisconsin Attorney General Josh Kaul in a statement Friday. “The administration should be respecting individual liberty and equal rights, not shamefully targeting transgender people.”

The attorneys general have asserted that President Donald Trump’s White House is overstepping its authority, using threats of criminal prosecution and federal investigations to pressure health care providers.

“The Trump Administration is attempting to strip away lawful, essential healthcare from vulnerable youth. These orders are illegal and dangerous and have no medical or scientific basis,” said Michigan Attorney General Dana Nessel in a statement. “I will continue to protect families, defend doctors, and stop politicians from putting our kids’ lives at risk.”

Trump in the beginning of his second administration signed an executive order stating that the U.S. would only recognize two sexes, and called for an end to what Trump labeled “gender ideology.” A second order focused on medical restrictions, directing the U.S. Department of Justice to pursue enforcement actions related to that care.

Since then, Nessel’s office said the Department of Justice has issued subpoenas to providers under the guise of criminal law enforcement, but the attorneys general filing the lawsuit Friday argue those efforts lack legal standing and are intended only to intimidate.

“Health care decisions for kids should be made by parents and doctors, not by politicians,” said Erin Knott, executive director of Equality Michigan, a LGBTQ+ advocacy group, in a statement. “The federal government is using funding as a weapon to force providers to abandon their patients and override parents’ rights to make health care decisions for their own children.”

Patricia Wells, a doctor and the medical director of The Corner Health Center in Ypsilanti, Michigan, said in a statement that she and her colleagues are distressed by new punitive changes to funding and regulations, which threaten to dismantle essential care.

“These policies do not protect children; they endanger them,” Wells said. “They undermine trust in the medical system and place affirming providers in an impossible position, forcing hospitals to close clinics and providers to stop offering the very care that helps young people survive and thrive. The loss of these services would not simply be a policy failure; it would be a moral one.”

Wells said the nation must do better.

“These young people deserve our compassion, our evidence-based care, and our unwavering commitment to their well-being,” she said. “I applaud the leadership of the state of Michigan for protecting transgender and gender nonconforming youth, their families, and the caregivers who are saving lives every day.”

Erik Gunn of Wisconsin Examiner contributed to this report.

Michigan Advance is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Michigan Advance maintains editorial independence. Contact Editor Jon King for questions: info@michiganadvance.com.

GET THE MORNING HEADLINES.

SUBSCRIBE

U.S. Senate Majority Leader John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C.  after a meeting with President Donald Trump. (Photo by Anna Moneymaker/Getty Images)

This report has been updated.

WASHINGTON — President Donald Trump on Thursday told his supporters to call members of Congress and lobby them to support the “big, beautiful bill,” a crucial push with just days to go before a self-imposed Fourth of July deadline.

Trump’s plea follows several tumultuous days on Capitol Hill as GOP leaders struggled to find consensus on multiple policy disagreements, especially after the parliamentarian ruled core elements of the package don’t meet the complex rules for moving a budget reconciliation bill.

Trump during an event in the White House’s East Room that was attended by several GOP lawmakers also cautioned Republicans against voting down the tax and spending cut package.

“We don’t want to have grandstanders,” Trump said. “Not good people. They know who I’m talking about. I call them out. But we don’t need grandstanders. We have to get our country back and bring it back strong.”

Some Republican senators remain optimistic they can work through the weekend and that the House votes will come together next week, despite growing opposition from members in that chamber.

Sen. Eric Schmitt said he doesn’t think the parliamentarian’s rulings will delay the votes “outside the weekend window, which has been the goal all the time.”

“We’re probably voting into the weekend, though. That’s probably my guess — Saturday and I suppose even Sunday — but, that’s the goal, I don’t think that materially changes too much,” the Missouri Republican said.

Senate Majority Leader John Thune, R-S.D., however, appeared a bit less definite, telling reporters in the afternoon that he didn’t know when the chamber would take the procedural vote that kicks off floor consideration.

“I’ll get back to you on that,” he said.

Medicaid provisions tossed

Earlier Thursday, Senate Republicans suffered a significant setback when the parliamentarian ruled several changes to Medicaid in the bill don’t comply with the rules, which means billions of dollars in savings are no longer available for the GOP to offset the cost of tax cuts.

Finance Committee Chairman Mike Crapo. R-Idaho, must rework or completely eliminate nine changes the committee proposed to the health care programs, though more of the panel’s proposals are still under review.

Republicans can no longer reduce the amount of federal matching funds for state governments that use their own tax dollars to provide Medicaid coverage for immigrants in the country without proper documentation.

The GOP bill cannot bar gender-affirming care for Medicaid patients.

And Republicans need to change or scrap a proposal to reduce states’ Medicaid provider tax credits, an issue that is relatively in the weeds of health care policy but has sharply divided the GOP and drawn fierce opposition from states.

The changes or eliminations will have a major impact on how much in savings the GOP tax and spending cut bill will generate during the next decade and will likely make the overall package’s deficit impact higher than before. The legislation is intended to extend the 2017 tax cuts and make spending reductions.

The ruling might make it more difficult for Trump and GOP leaders in Congress to get the votes needed to pass the bill at all, let alone before their self-imposed Fourth of July timeline. Senate GOP leaders had said they wanted to begin procedural votes as soon as Friday.

The measure already had been stuck on Wednesday amid growing disputes over how Medicaid changes will impact rural hospitals and far more.

Democrats to continue scrutinizing bill

Senate Budget Committee ranking member Jeff Merkley, D-Ore., who released the parliamentarian’s rulings, wrote in a statement that Democrats will continue to advocate for removing dozens of proposals from the bill that they believe don’t meet reconciliation rules.

“Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced,” Merkley wrote.

A staffer, who was granted anonymity to discuss the chairman’s plans, said the Finance Committee will “rework certain provisions to address the Byrd guidance and be compliant with reconciliation.”

The Byrd rule, named for former West Virginia Sen. Robert Byrd, includes several guardrails for reconciliation bills.

Finance Committee ranking member Ron Wyden, D-Ore., wrote in a statement that the parliamentarian’s ruling will lead to “more than $250 billion in health care cuts removed from the Republicans’ big bad bill.

“Democrats fought and won, striking health care cuts from this bill that would hurt Americans’ walking on an economic tightrope. This bill is rotten to its core, and I’ll keep fighting the cuts in this morally bankrupt bill until the end.”

The parliamentarian is still deciding whether several health provisions meet reconciliation rules, including language that would block all Medicaid funding from going to Planned Parenthood, effectively blocking Medicaid patients from visiting the organization for routine health services.

Federal law already bars funding for abortions with exceptions for rape, incest, or the life of the pregnant patient.

The parliamentarian will also decide later whether Republicans’ bill can block the Department of Health and Human Services from implementing a Biden-era rule that would require nursing homes to have a nurse working 24 hours a day, seven days a week.

Higher ed provisions axed

The parliamentarian also struck down several attempts from congressional Republicans to overhaul the higher education system.

GOP lawmakers cannot streamline student loan repayment options for current borrowers to just a standard repayment plan or an income-driven repayment plan, making such restrictions apply to only new borrowers.

Republicans have to nix a proposal that opened up the Pell Grant — a government subsidy that helps low-income students pay for college — to institutions that are for-profit and not accredited.

The parliamentarian scrapped a proposal that would have barred payments made by students enrolled in a medical or dental internship or residency program from counting toward Public Service Loan Forgiveness.

The federal program eliminates remaining debt for borrowers when meeting certain requirements, including working for a qualified employer within the government or nonprofit sector.

The parliamentarian rejected GOP lawmakers’ proposal to end federal student aid eligibility for certain immigrants who are not U.S. citizens.

‘Too many Medicaid cuts’

Missouri Republican Sen. Josh Hawley said the parliamentarian’s ruling on the Medicaid provider tax rate will give lawmakers “a chance to get it right.”

“This is a chance for the Senate to fix a problem that they created and not defund rural hospitals,” Hawley said, later adding he supports the House language that would freeze the rate at 6% instead of decreasing it to 3.5% over several years. 

Hawley said hours before Trump’s event that he expects the president to get more involved in negotiations now that he’s back from a NATO conference in Europe and said Trump was in a “terrific mood” during a recent phone call.

“I think he wants this done. But he wants it done well. And he does not want this to be a Medicaid cuts bill,” Hawley said. “He made that very clear to me. He said this is a tax cut bill, it’s not a Medicaid cuts bill. I think he’s tired of hearing about all these Medicaid cuts, you know. As am I. It’s because there are too many Medicaid cuts.”

Louisiana Republican Sen. Bill Cassidy early Thursday night called on leaders to put the House’s language regarding Medicaid back into the bill, wiping out changes made by the Finance Committee.

“My position is that cuts, and especially drastic cuts, to Medicaid have to be avoided. The Senate bill cuts Medicaid too much,” the influential chairman of the Health, Education, Labor and Pensions Committee wrote in a social media post. “I agree with President Trump, the House version is better.”

SNAP cuts

The Agriculture Committee also is reworking parts of its bill, some being closely watched by states, to meet the rules that govern reconciliation.

Committee Chairman John Boozman, R-Ark., said he expects to hear from the parliamentarian before the end of Thursday about whether a revised state cost share provision for the Supplemental Nutrition Assistance Program that’s based on error rate payments will be in the final bill.

“It was thrown out the first time, so we actually gave her revised text. If she rules the revised text is fine, then we’ll release it,” Boozman said.

The committee released a statement later in the day announcing the parliamentarian had cleared the revised state cost share for SNAP that’s based on a state’s error payment rate.

States that have SNAP error payment rates higher than 6% will have to contribute some of the cost of the program. The updated proposal will give states the option of choosing between fiscal 2025 and fiscal 2026 to determine their match, which will begin during fiscal 2028. After that, a state’s match will be determined by its error payment rate for the last three fiscal years. 

State and local tax, ‘revenge tax’

Senate Republicans also remained stuck on finding a deduction level for state and local tax, or SALT, that passes muster with House Republicans who represent high-tax blue states.

The House version would allow taxpayers making under $500,000 to deduct up to $40,000 in SALT from their federal tax bill. Both the $40,000 cap and the $500,000 income threshold will increase annually at 1% until hitting a ceiling of $44,000 and $552,000. The deduction cap phases down for higher earners.

Senate Republicans and the White House sought to lower the income threshold but were shot down Thursday by House Republicans, according to multiple reports.

Sen. Markwayne Mullin of Oklahoma, the lead negotiator on SALT for Senate Republicans, said he remained optimistic.

“We’re gonna be in a good spot. We’re gonna find a landing spot,” Mullin said.

A Senate Finance Committee spokesperson declined to comment on current negotiations, including any proposed income level changes.

Treasury Secretary Scott Bessent also weighed in on another tax provision: the so-called “revenge tax” on investments from countries whose trade policies the president views as unfair to U.S. businesses.

Bessent asked lawmakers to remove the up to 20% tax from the mega-bill following an agreement made with G7 partners, he wrote on social media.

“This understanding with our G7 partners provides greater certainty and stability for the global economy and will enhance growth and investment in the United States and beyond,” Bessent said.

The retaliation tax would have raised roughly $116 billion over 10 years, according to the Committee for a Responsible Federal Budget.

Timing on votes

Republican lawmakers don’t have much time left to rework all of the ineligible provisions, clear them with the parliamentarian, read through final bill text, slog through a marathon amendment voting session in the Senate and then move the bill through the House before their self-imposed deadline.

White House press secretary Karoline Leavitt said during a briefing before Trump’s event that the president is “adamant” Congress must pass the “big, beautiful bill” within the next week, despite the latest ruling.  

“We expect that bill to be on the president’s desk for signature by July Fourth. I know there was a ruling by the Senate parliamentarian this morning,” Leavitt said. “Look, this is part of the process, this is part of the inner workings of the United States Senate. But the president is adamant about seeing this bill on his desk here at the White House by Independence Day.” 

Transgender rights opponents and a supporter rally outside of the U.S. Supreme Court as the justices hear arguments in a case on transgender health rights on December 04, 2024 in Washington, DC. The Supreme Court Wednesday upheld Tennessee's law banning gender-affirming care for minors. (Photo by Kevin Dietsch/Getty Images)

The U.S. Supreme Court upheld Tennessee’s law prohibiting gender affirming care for minors, saying children who seek the treatment don’t qualify as a protected class.

In United States v. Skrmetti, the high court issued a 6-3 ruling Wednesday overturning a lower court’s finding that the restrictions violate the constitutional rights of children seeking puberty blockers and hormones to treat gender dysphoria. The U.S. Court of Appeals overturned the district court’s decision and sent it to the high court.

The court’s three liberal justices dissented, writing that the court had abandoned transgender children and their families to “political whims.”

Tennessee lawmakers passed the legislation in 2023, leading to a lawsuit argued before the Supreme Court last December. The federal government, under the Biden administration, took up the case for the American Civil Liberties Union, Lambda Legal and three transgender teens, their families and a Memphis doctor who challenged the law, but the U.S. Department of Justice under President Donald Trump dropped its opposition.

In its ruling, the court said that the plaintiffs argued that Senate Bill 1 “warrants heightened scrutiny because it relies on sex-based classifications.” But the court found that neither of the classifications considered, those based on age and medical use, are determined on sex.

“Rather, SB1 prohibits healthcare providers from administering puberty blockers or hormones to minors for certain medical uses, regardless of a minor’s sex,” the ruling states.

The ruling says the application of the law “does not turn on sex,” either, because it doesn’t prohibit certain medical treatments for minors of one sex while allowing it for minors of the opposite sex.

The House Republican Caucus issued a statement saying, “This is a proud day for the Volunteer State and for all who believe in protecting the innocence and well-being of America’s children.”

Senate Majority Leader Jack Johnson, who sponsored the bill, said he is grateful the court ruled that states hold the authority to protect children from “irreversible medical procedures.”

“The simple message the Supreme Court has sent the world is ‘enough is enough,’” Johnson said in a statement.

The Tennessee Equality Project, an LGBTQ advocacy group, expressed dismay at the decision: “We are profoundly disappointed by the U.S. Supreme Court’s decision to side with the Tennessee legislature’s anti-transgender ideology and further erode the rights of transgender children and their families and doctors. We are grateful to the plaintiffs, families, and the ACLU for fighting on behalf of more than 1.3 million transgender adults and 300,000 youth across the nation.”

The group said gender-affirming care saves lives and is supported by medical groups such as the American Academy of Pediatrics and the American Medical Association.

The court also rejected plaintiffs’ argument that the law enforces “a government preference that people conform to expectations about their sex.”

The court found that laws that classify people on the basis of sex require closer scrutiny if they involve “impermissible stereotypes.” But if the law’s classifications aren’t covertly or overtly based on sex, heightened review by the court isn’t required unless the law is motivated by “invidious discriminatory purpose.”

“And regardless, the statutory findings on which SB1 is premised do not themselves evince sex-based stereotyping,” the ruling says.

In response to the outcome, Tennessee Attorney General Jonathan Skrmetti said Tennessee voters’ common sense won over “judicial activism” on a law spurred by an increase in treatment for transgender children.

“I commend the Tennessee legislature and Governor Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood,” Skrmetti said.

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., criticized the ruling just moments after it came out after being asked about it during a press conference.

“This Supreme Court seems to have forgotten that one of their jobs is to protect individual rights and protect individuals from being discriminated against,” Schumer said. “It’s an awful decision.”

Democrats, he said, are “going to explore every solution,” though he didn’t elaborate.

Chief Justice John Roberts wrote in the opinion: “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. 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. 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.”

The ACLU said in a statement the decision is based on the record and context of the Tennessee case and doesn’t extend to other cases involving transgender status and discrimination.

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, called the ruling “devastating,” but despite the setback said transgender people still have health care options.

“The court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful,” Strangio said in a statement.

Tennessee Lookout is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Tennessee Lookout maintains editorial independence. Contact Editor Holly McCall for questions: info@tennesseelookout.com.