Facing an onslaught of sensational constitutional challenges this term, the US Supreme Court (SCOTUS) found itself, yet again, at the center of significant controversies in health law and policy. Adding to the Court’s slate this year has been a flagrant level of confrontation, dissension, and outrage by President Trump and his administration regarding SCOTUS’ independence as the nation’s supreme arbiter of constitutional meaning. Congressional and public criticism of the Court reigned as well, with some legislators on Capitol Hill calling for the impeachment of Chief Justice John Roberts, among other actions.Reference Wegman ¹ Seemingly unmoved and sometimes defiant, the Justices issued a series of decisions in critical cases with mixed effects on the public’s health.

As per Figure 1 and accompanying analyses below, key health-related decisions this term arose in select cases across the nation. Major topics addressed by the Court include: (1) the scope and limit of emergency constitutional and statutory authorities entrusted to the president; (2) ongoing state-led debates over LGBTQ+ rights and discrimination, specifically in parental contexts and sports-related settings; (3) the power of First Amendment interests over states’ rights to regulate medical professionals or require vaccinations; (4) expansion of Second Amendment rights to possess firearms despite substantial public safety concerns; and (5) access to courts to raise state-based product liability and other claims foreclosed via Congress.

Figure 1.

Select SCOTUS Cases 2025–2026.

Figure 1. Long description

A map of the contiguous United States with yellow stars and red lines connecting legal case labels to specific states.

* Top-Left: Little v. Hecox (Title IX) points to Idaho (I D).

* Top-Center: First Choice Women’s Res. Ctrs v. Davenport (Section 1983) points to New Jersey (N J).

* Top-Right: Miller v. McDonald (Vaccine exemptions) points to New York (N Y).

* Upper-Right: Trump v. Illinois (Nat. Guard) points to Illinois (I L).

* Middle-Right: Learning Resources v. Trump (I E E P A) points to Maryland (M D).

* Lower-Right: West Virginia v. B. P. J. (Title IX) points to West Virginia (W V).

* Bottom-Right: Doe v. Dynamic Phy. Ther. L L C (Liability) points to Delaware (D E).

* Bottom-Center: U. S. v. Hemani (2nd Amdt) points to Louisiana (L A).

* Bottom-Center: Danco Labs v. L A (Mifepristone) points to Texas (T X).

* Bottom-Left: Wolford v. Lopez (2nd Amdt) points to Hawaii (H I), noted in the legend.

* Middle-Left: Monsanto v. Durnell (Product liability) points to Missouri (M O).

* Middle-Left: Chiles v. Salazar (1st Amdt) points to Colorado (C O).

* Far-Left: Mirabelli v. Bonta (Free exercise) points to California (C A).

A legend at the bottom-left lists A K for Alaska, H I for Hawaii, P R for Puerto Rico, and V I for U. S. Virgin Islands. The A S U Sandra Day O’Connor College of Law logo is in the bottom-left corner.

As in every term, the Court jettisoned some cases via denials of review or issuance of non-substantive, non-standard decisions. On May 14, 2026, it sidestepped ongoing debates in Danco Laboratories, LLC. v. Louisiana ² as to whether the Food and Drug Administration improperly lifted the in-person dispensing requirement for the medical abortion drug mifepristone in 2023. SCOTUS granted a temporary stay of a hasty order by the Fifth Circuit Court of Appeals disallowing national dispensation of the drug despite dissents by Justices Thomas and Alito. The case may be substantively reviewed by SCOTUS in its next term. In early June 2026, the Court denied certiorari for a slate of lower court decisions challenging Medicare’s drug pricing negotiation program regulations implemented by the Centers for Medicare and Medicaid Services pursuant to President Biden’s Inflation Reduction Act of 2022. ³ To date, the Court has not chosen to review any of these controversies despite repeated requests for its input on structural and procedural constitutional arguments. And while the Court selected two primary Second Amendment cases for full review this term, as discussed below, it rejected multiple other cases on similar grounds brought largely by aggrieved gun rights activists.

Presidential Emergency Powers. In two key decisions, SCOTUS assessed President Trump’s distinct uses of executive powers to (1) mobilize state National Guard members to purportedly maintain civil order; and (2) impose severe tariffs for alleged public health (and other) reasons. In each case, the Court limited his authority despite castigation from the president himself.Reference Dallas ⁴

In Trump v. Illinois, ⁵ President Trump relied on a longstanding federal statute ⁶ to mobilize Texas and Illinois National Guard members in 2025 to quell Immigration and Customs Enforcement (ICE) protests in Chicago.Reference Aleaziz and Bosman ⁷ The statute explicitly empowers the president to use militia (i.e., National Guard) to execute US laws if unable to do so “with regular forces.” ⁸ In a per curiam interim docket decision on December 23, 2025, SCOTUS found President Trump lacked authority to call on state National Guard troops because he did not initially deploy US armed forces as the statute explicitly required. ⁹ In essence, the Court limited President Trump’s power due to his failure to follow statutory procedure.

SCOTUS’ decision was a win for civil rights in the backdrop of presidential overreach. Yet, in his concurring opinion, ¹⁰ Justice Kavanaugh proffered a different pathway for militia mobilization under the distinct federal Insurrection Acts. ¹¹ Though rarely invoked in modern times, SCOTUS has traditionally given substantial discretion to presidents wielding insurrection-curbing powers. If President Trump had relied on these authorities, summed Justice Kavanaugh, the Court’s outcome may have been inapposite despite historic, overzealous exercises of these powers purportedly to rebuff rebellions.Reference Nunn and Goitein ¹² President Trump’s repeated threats to invoke insurrection powers during his first and second terms present very real risks to the health, security, and rights of Americans.Reference Hodge and Gaith ¹³

In Learning Resources v. Trump, ¹⁴ SCOTUS quashed President Trump’s use of tariffs applied toward specious public health ends. Classifying the rise in illicit drug imports as a health crisis, the President declared a national emergency under the International Emergency Economic Powers Act (IEEPA) ¹⁵ on April 2, 2025. He then imposed tariffs against China, Mexico, and other countries that ultimately raised prices for consumer goods affecting American households.Reference Jones and Cecco ¹⁶ On February 20, 2026, SCOTUS affirmed that constitutional power ¹⁷ to impose tariffs lies exclusively with Congress. ¹⁸ Under the IEEPA, at least, President Trump cannot unilaterally impose tariffs to address issues of national security or public health. Concomitantly the Court noted that presidential exercises of power are judicially reviewable even during “emergencies” under the Constitution, providing a key stopgap to ongoing expansion of executive authorities. ¹⁹ Still, on June 15, SCOTUS denied review of a separate case challenging President Trump’s tariff authorities under a distinct statutory route. ²⁰

LGBTQ+ Rights and Discrimination Protections . SCOTUS’ penchant for asserting its views related to LGBTQ+ laws and policies nationally seemed to reach its zenith last term with its decisions in Skrmetti ²¹ (allowing Tennessee’s ban of specific surgical interventions involving transgender minors) and Mahmoud ²² (requiring parental opt-outs of their children from Maryland public school LGBTQ+ instructions on religious grounds). Not so. On March 2, 2026, in a per curiam decision, Mirabelli v. Bonta, ²³ the Court took down California’s school-based privacy protections of minors with gender dysphoria. Parents of one eighth grade minor (who attempted suicide) objected to California’s law allowing schools to withhold a minor’s transitioning status exhibited at school from their parents. Some parents were literally kept in the dark by schools about their child’s behaviors in the interests of adolescent privacy. This, stated the Court, “substantially interfere[d] with the ‘right of parents to guide the religious development of their children,’” ²⁴ guaranteed in Mahmoud. ²⁵ Despite procedural objections raised by Justices Kagan and Jackson underlying the Court’s “slapdash” resolution of the case via its non-standard docket, ²⁶ California’s law stands no real chance of surviving strict scrutiny under the lower courts assessment.

Then, in two cases joined by the Court in a single opinion issued on June 30, a 6–3 majority led by Justice Kavanaugh ruled that state legislation in West Virginia ²⁷ and Idaho ²⁸ expressly prohibiting transgender females from participating on biologically-female sports teams did not violate Title IX of the federal Educational Amendments Act of 1972 ²⁹ or the Equal Protection Clause. In West Virginia v. B.P.J., ³⁰ the Court determined that Congress’ clear prohibition of sex-based discrimination in federally-funded athletics (under the subsequent Javits Amendment to Title IX) applied only to biological sexes. Neither Title IX nor principles of equal protection prevented states from limiting biological males from playing on female teams. States could ban such athletes from competing on female teams irrespective of their claims of unique physical limitations as transgender females. SCOTUS’ conclusion was unsurprising perhaps following oral arguments as well as its prior decision in Skrmetti, noted above. ³¹ While the Court endorsed state prohibitions of transgender females from participating in biological female sports, it did not decide “whether, under Title IX and the Equal Protection Clause, schools may allow [transgender] males to participate on girls’ and women’s sports teams.” ³² Some states are already challenging the Court’s disposition on this front.

Sanctioning categorical state-based discrimination against all transgender female athletes drew an impassioned dissent by Justice Sotomayor. ³³ Just how much further may such discrimination go? The Court refused to equate its reasoning in West Virginia as overturning its 2020 ruling in Bostock v. Clayton County. ³⁴ In Bostock, Justice Gorsuch held that sex-based employment protections under the Civil Rights Act Title VII included discrimination based on one’s homosexual or transgender status. West Virginia’s majority clarified how the distinct setting, specifically sports teams, qualified its ruling without diminishing its findings in Bostock. Admitting in his separate concurring opinion in West Virgina that “discriminating against individuals for being homosexual or transgender qualifies as discrimination ‘because of ’ their biological sex,” ³⁵ Justice Gorsuch still concluded (along with the majority) that it would be “a mistake to assume that … sponsoring a single-sex sports team limited to biological women or girls must also amount to unlawful discrimination in violation of Title IX.” ³⁶ Apparently denying access to employment based on one’s transgender status is unlawful sex discrimination, but not blanket denials of access to sports teams. The Court’s decision in West Virginia does not bode well for other forms of transgender discrimination ahead.

Medical Standards of Care, Privacy, and the First Amendment . In a series of pivotal decisions, the Court’s majority affirmed the realm of First Amendment protections of free exercise, speech, and association against substantial challenges. In Miller v. McDonald ³⁷ Amish parents challenged New York State’s refusal to allow religious exemptions for school vaccination requirements. New York’s legislature abolished religious exemptions years earlier following a measles outbreak among religious groups. Lower courts flatly rejected Amish arguments that they had a First Amendment free exercise right to forego state-based vaccine mandates. ³⁸ In a terse, one-page order on December 8, 2025, SCOTUS instructed the Second Circuit Court of Appeals to review closely the Supreme Court’s 2025 aforementioned decision in Mahmoud. ³⁹ Parents’ free exercise rights, determined the Court, demanded accommodation. While the Second Circuit has yet to render a decision in Miller, SCOTUS’ charge is clear: state-based prohibitions of religious vaccine exemptions run counter to Mahmoud. If this conclusion takes hold nationally, governments at all levels may have to grant religious exemptions to all sorts of vaccine (and likely other medical) mandates. Vaccination rates will decline. Adverse public health impacts will follow.

That religious exemptions may soon be imbedded into national childhood vaccination practices diminishes the prevailing standard of care, implicating serious questions for pediatricians and parents ahead. In Chiles v. Salazar, ⁴⁰ the Court examined governmental efforts to assure medical professionals provide legitimate, non-harmful guidance to patients. Kaley Chiles is a Colorado licensed counselor treating adult and minor patients. She seeks to discuss “conversion therapies,” with some minor patients, which Colorado’s legislature prohibits. ⁴¹ Conversion therapy includes spoken word guidance on how to change one’s sexual orientation. Long debunked by medical associations for associated psychological harms, Chiles claimed her First Amendment rights to free speech were infringed by Colorado’s “viewpoint discrimination.” In an 8–1 decision the Court wholly agreed. “The First Amendment is no word game,” Justice Gorsuch stated for the majority. ⁴² Colorado cannot invoke its licensure authority over Chiles to dictate what she can discuss with her patients. Patent viewpoint discrimination is unconstitutional absent clear cases of fraud, defamation, or fighting words. Just as it decided in the aforementioned Skrmetti case, ⁴³ SCOTUS ignored medical guidance on prevailing standards of care in favor of First Amendment and other rights.

In First Choice Women’s Resource Centers, Inc. v. Davenport, ⁴⁴ a Christian-centered pregnancy center was subpoenaed by the New Jersey Attorney General to turn over the center’s donor records. The Attorney General sought the records under investigation of entities potentially violating New Jersey’s reproductive rights. Seeking to keep its donors’ data private, First Choice refused to comply objecting on First Amendment rights to association grounds. On April 29, 2026, Justice Gorsuch confirmed for a 9–0 majority that First Choice can raise constitutional violations under 42 U.S.C. § 1983 without having to comply with the subpoena. ⁴⁵ Demanding donor information from nongovernmental organizations (NGOs) like First Choice chills rights to association even if the donors’ information is purportedly kept confidential. While the Court’s decision impinged state efforts to promote reproductive freedoms in this case, it also established a clear First Amendment precedent against government seeking similar data from public health NGOs later.

Firearm Possession Under the Second Amendment . SCOTUS’ uneven track record on the scope of Second Amendment rights to bear arms over the past decade has befuddled law- and policymakers attempting to balance gun access and public health and safety. In two cases this term, the Court clarified that access to firearms takes prominence over competing communal interests. In United States v. Hemani, ⁴⁶Justice Gorsuch, again for a 9–0 majority, flatly rejects application of the federal Gun Control Act ⁴⁷ to prosecute Hemani for mere possession of a firearm and occasional use of marijuana at his residence. Under the Act, Congress explicitly disallows gun possession among persons unlawfully using controlled substances. ⁴⁸ However, the Court found no sufficient analogue between the Act’s prohibition and historic bases for limiting firearm access under the Court’s “why” and “how” tests emanating from its prior Second Amendment decisions in Bruen ⁴⁹and Rahimi. ⁵⁰ Unless the federal government could show Hemani’s marijuana use presented some direct threat related to his gun possession, his Second Amendment rights prevail. ⁵¹ Under the Court’s logic, apparently Americans must wait for drug users like Hemani to constitute real risks to their safety before users’ guns can be confiscated.

Whether private property owners can restrict possession of firearms on their premises under the Second Amendment was before the Court in Wolford v. Lopez. ⁵² Following SCOTUS’ 2022 decision in Bruen, ⁵³ Hawaii (and select other states) enacted laws prohibiting the carrying of firearms onto private property, even commercial businesses open to the public, unless “the person has been given express authorization … by the owner, lessee, operator, or manager ….” ⁵⁴ Authorization may be provided through conspicuous signage allowing weapon carrying on the premises; otherwise a person would need to obtain specific permission orally or in writing to carry. Hawaii’s property-oriented approach resonated with the state’s longstanding limits on firearm access. It also violated the Second Amendment, ruled Justice Alito for a 6–3 majority on June 25. ⁵⁵ Without even attempting to assess public health and safety concerns, Justice Alito adjudged Hawaii’s law as an affront to licensed gun owners’ rights to come and go as they please from private property opened to the public (including groceries, theaters, and gas stations). In a forceful dissent, Justice Jackson characterized Hawaii’s law as “an exercise of state … property law, not the Second Amendment.” ⁵⁶

Public Health Liability Claims . SCOTUS’ input on liability claims arising from the COVID-19 pandemic has been scrutinized for the manifold petitions for certiorari that it has denied. It has repeatedly, for example, refused to opine on state-based claims challenging the scope of federal immunities under the Public Readiness and Emergency Preparedness (PREP) Act. ⁵⁷ In Doe v. Dynamic Physical Therapy, ⁵⁸ however, the Court issued a per curiam opinion proffering at least some guidance on December 8, 2025. Like many states, Louisiana immunized health care workers from some civil claims during declared emergencies in response to the pandemic. ⁵⁹ Patient Doe, who suffered from severe back pain, was allegedly denied treatment because of his HIV+ status during the pandemic. He sued the provider under the federal Americans with Disabilities Act (ADA) ⁶⁰ and Rehabilitation Act. ⁶¹ The provider claimed immunity under an existing state-based emergency declaration. The Louisiana Court of Appeals agreed. As SCOTUS observed in a brief opinion, “[t]hat decision is incorrect … a State has no power to confer immunity from federal causes of action.” ⁶² Asserting its unique role in interpreting federal law, SCOTUS affirmed that state judges are constitutionally “bound to follow federal law, ‘any Thing in the Constitution or Laws of any state to the Contrary notwithstanding.’” ⁶³

The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA), ⁶⁴ as amended, preempts states from imposing labeling or packaging requirements inconsistent with federal labeling. For years the Environmental Protection Agency (EPA) repeatedly maintained that an active ingredient, glyphosate, in the popular weedkiller, Roundup^®, manufactured by Monsanto^® (owned in turn by Bayer^®), is not a carcinogen requiring a specific cancer warning. Thousands of plaintiffs pose otherwise, raising class action and other claims that Roundup^® has led to their cancer harms. In Monsanto Co. v. Durnell, ⁶⁵ claimants in Missouri asserted that Monsanto^® violated state-based failure to warn labeling requirements. The company argued it was preempted from state labeling requirements when EPA determined under FIFRA that its product is not carcinogenic. On June 25, Justice Kavanaugh, writing for a 7–2 majority, agreed. ⁶⁶ EPA’s finding under FIFRA absolutely preempts contrary state-based labeling claims in line with Congressional and regulatory provisions. The Court’s ruling negates plaintiff state-based product liability claims based on failures to warn in one of the largest public health liability issues of the modern era.