The conservative Supreme Court dealt a significant blow to transgender Americans on Wednesday, issuing a sweeping decision that may have implications beyond the medical care that was at center of one of the court’s highest-profile disputes this year.

The Supreme Court has upheld Tennessee’s ban on gender-affirming care for transgender minors, a stunning setback to transgender rights.

The decision to uphold the Tennessee law will most likely mean a patchwork of laws throughout the country, a map that traces current political polarization.