Could Supreme Court rulings make America’s prisons much crueler?
Trump’s prison care order
On the first day of his second term, President Donald Trump ordered the Bureau of Prisons to stop using federal funds for treatments intended to align an inmate’s appearance with their gender. The order came alongside 26 other executive orders and reflected an issue Trump emphasized during his 2024 campaign.
The Supreme Court is now considering the order and Bureau of Prisons memoranda in Trump v. Kingdom. The case directly concerns incarcerated transgender people, but its implications could reach other prisoners’ access to medical care.
The constitutional question
In Estelle v. Gamble, a 1976 decision, the Supreme Court held that the Eighth Amendment requires the government to provide medical care to people it incarcerates. Prisoners cannot independently seek hospital treatment, and inadequate care can leave illness untreated or lead to death.
The justices are unlikely, for procedural reasons, to decide immediately whether that precedent requires prisons to provide gender-affirming care. But the broader question of when the Eighth Amendment requires medical treatment is central to Kingdom, and a decision could affect healthcare access across prisons.
How the issue became political
In 2019, the ACLU asked presidential candidates whether they would ensure access to gender-transition treatment, including surgery, for transgender and nonbinary people dependent on state care, including those in prison or immigration detention. Kamala Harris said she would, and said she had urged California corrections officials to provide transition surgery to state inmates when she was attorney general.
During a 2024 debate, Trump accused Harris of supporting transgender operations for undocumented immigrants in prison. Opposition to gender-affirming care for incarcerated transgender people later became a key campaign issue. The ACLU, which represents the pro-trans side in Kingdom, says federal prisoners had access to at least some gender-affirming care since at least 1992.
Earlier federal policy
A 2018 memo from Trump’s own administration said the Bureau of Prisons’ duty to provide basic medical and mental healthcare required care for transgender prisoners. It listed hormone therapy, hair removal and surgery when an individual assessment found surgery applicable.
The memo said these interventions should be provided when doctors determine they are medically necessary. The case puts that earlier approach in tension with Trump’s later order restricting federal funding for gender-affirming treatment.
Key points
- Trump’s order bars federal funding for specified gender-affirming treatments for incarcerated people.
- Trump v. Kingdom could affect constitutional requirements for prison medical care beyond transgender healthcare.
- The Supreme Court’s 1976 Estelle decision recognized a government duty to provide medical care to prisoners.
- A 2018 administration memo supported several forms of gender-affirming care when medically necessary.