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

The justices’ 6-3 decision effectively protects from legal challenges many efforts by the Trump administration and state governments to roll back protections for transgender people.