Category: Blog

Conversion Therapy on Trial: What Chiles v. Salazar Means for Medical Regulation and LGBTQ+ Protections

The Supreme Court heard arguments on October 7, 2025 to lift Colorado’s ban on “conversion therapy,” a discredited practice which targets LGBTQ+ youth to change their sexual orientation or gender identity. In Chiles v. Salazar, Kaley Chiles, a Colorado-licensed professional counselor, challenged a Colorado state regulation which prohibits providers from engaging in “conversion therapy” with anyone under 18. The practice can include anything from talk therapy to electric shock or pharmaceutical interventions. The Court heard arguments about what therapists may say to their patients—specifically, whether talk counseling is “conduct” or “speech,” and whether it is protected under the First Amendment and the Free Exercise Clause.

There is overwhelming evidence and medical consensus that the efforts to change a child’s sexual orientation or gender identity are unsafe and ineffective. In August 2025, the American Psychological Association, joined by the American Psychiatric Association and 12 other mental health and medical professional organizations, filed an amicus brief in support of the Colorado law. Research consistently demonstrates that “conversion therapy” has long-lasting consequences, including depression, anxiety, suicidality, substance misuse, damaged familial relationships, loss of connection to community, self-blame, guilt, and shame. Twenty-three states have prohibited healthcare providers from subjecting minors to “conversion therapy.” A recent UCLA study shows 698,000 LGBTQ+ adults have undergone “conversion therapy,” with half of them (350,000) receiving the treatment as adolescents.

The central question for the judges in Chiles is whether Colorado’s law interferes with free speech protected by the First Amendment, or whether it is a necessary legal regulation of professional conduct. Chiles argues that “conversion therapy” is speech, not conduct, and thus states “do not have a freer hand to regulate speech simply because the speaker is ‘licensed’ or giving ‘specialized advice.’” Conservative judges shared concerns about the law’s apparent threat to Christianity-informed free speech. Justice Alito called the statute “blatant viewpoint discrimination,” posing two hypotheticals—one in which a boy asks a therapist to help end his attraction to men, and one in which he asks for support to feel comfortable being gay—and stating that the statute requires opposite results depending on the viewpoint expressed. Justice Gorsuch and Justice Barrett also raised concerns regarding how laws justify medical regulations.

Justice Jackson, conversely, noted that states have a long history of regulating medical treatment, and doctors would clearly be liable if they used medication that the state deemed substandard care. Citing the Supreme Court 2024 decision in Skrmetti, which upheld the Tennessee law banning gender-affirming care for minors, Jackson questioned why the Colorado regulation “isn’t just the functional equivalent,” since both prohibit a medical treatment for minors that major medical associations say can lead to an increased risk of depression and suicidal thoughts. Justice Sotomayor was fundamentally concerned with whether Chiles even had standing to challenge the law, noting that “merely having a law on the books is not enough.” She pressed Chiles’ attorney to explain how she was personally harmed by the law, observing she does not face a “credible threat of prosecution.”

There is no clear consensus among circuit courts on First Amendment protections regarding professional speech. For example, the Ninth Circuit has held that there is a continuum, where on one end “public dialogue” gets robust protection, and on the other end, conduct such as individual treatment or professional counseling is not protected. Other courts insist that speech protections apply fully to counseling conversations even in professional settings, while many reaffirm that health professionals must provide treatment consistent with the government-regulated standard of care. In Chiles, the court seemed skeptical of Colorado’s claim that conversion therapy is conduct and not speech, but it remains uncertain if it will be sent back to the lower courts.

Chiles comes amidst a nationwide surge of anti-LGBTQ+ legislation and decisions, including laws that ban or punish gender-affirming care, restrict trans athletes from participating in sports, and create religious exemptions for LGBTQ+ nondiscrimination protections. In two Colorado cases, in 2017 and 2023, the Supreme Court sided with Christian business owners who opposed marriage equality and rebuked LGBTQ+ nondiscrimination laws in the process. Chiles could not only redefine the boundary between speech and conduct and set precedent for medical regulations, but also have wide-ranging consequences on legal safeguards meant to protect LGBTQ+ youth from discrimination and harm.

Does Trump’s Call For Expanding IVF Access Have Any Real Legal Teeth?

Assistance with fertility care is an urgent need for many families across the United States. According to findings from the 2024 Kaiser Family Foundation(KFF) Women’s Health Survey, one in eight reproductive-age women said that they or their partner needed fertility services to help them become pregnant or prevent a miscarriage. Fifteen states require some private insurers to cover some fertility treatment, but significant gaps in coverage remain. Only one state Medicaid program covers any fertility treatment, and no Medicaid program covers artificial insemination or in vitro fertilization.

Following the Dobbs decision, the future of assisted reproductive technology (ART) has been in question. In February 2024, the Alabama Supreme Court issued a ruling declaring frozen embryos in that state to be “unborn children” for the purposes of civil liability under Alabama’s wrongful death statute. Following national outrage from the decision, in March 2024, Alabama passed a law that provides immunity from civil and criminal charges for in vitro fertilization (IVF) patients and providers, which helped restart IVF services. However, this law did not overturn the state Supreme Court’s decision, keeping the legal status of embryos as “children” under the wrongful death statute.

In response to the uproar over the Alabama case, Senate Republicans announced support for protecting nationwide access to IVF. During the 2024 presidential campaign, Donald Trump pledged to make IVF free. On February 18, 2025, President Trump signed an executive order aimed at expanding access to in vitro fertilization (IVF). Following that executive order, on October 16, 2025, the White House revealed plans to offer discounts on certain IVF medications through a new government website, TrumpRx.gov. The White House also stated that it would work to develop more options for employers to voluntarily assist with fertility and family formation costs for their employees and dependents.

Following the White House’s announcement, the American Society for Reproductive Medicine (ASRM) issued a statement noting that, although the initiative was presented as a breakthrough for affordability, “key details about its implementation, scope, and equity remain unresolved.” Regarding legal considerations, they noted that classifying fertility coverage as an “excepted benefit” could undermine consumer protections under the Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA). Additionally, the announcement did not address the issue that across the country states are still navigating an evolving legal landscape that is emerging from disputes about pre-embryos making their way to court.

Many patients lack access to fertility services mainly because of high costs and limited coverage from private insurance and Medicaid. This initiative has no impact on existing state coverage mandates. As stated in the American College of Obstetrics and Gynecologists’ response to increase access to comprehensive care, employer-sponsored insurance plans should be both affordable and universally available. Coverage of IVF benefits can vary significantly and may not fully cover the entire cost of an IVF cycle, which typically ranges from $15,000 to $20,000. Many individuals facing infertility may need more than one IVF cycle. The cost of medication is just one part of the IVF process; discounts on these medications do not significantly lower the total expenses, which usually include both procedural and lab fees. As noted by KFF, laws regarding IVF insurance coverage vary, often limiting benefits to those with an infertility diagnosis and excluding single people and same-sex couples, and they do not apply to self-funded employer plans. The White House announcement leaves important gaps unaddressed. It also omits the 16 million reproductive-age individuals enrolled in Medicaid, who, even with a discount through TrumpRX, would find these treatments prohibitively expensive.

Senate Republicans have had the opportunity to support legislation that would provide comprehensive coverage of IVF and other ART treatments. However, despite their declared support, they blocked the passage of the Right to IVF twice, first in June and then in September 2024, legislation that would establish a right to IVF and ART, and help lower the costs of IVF treatments through expanded coverage. Republicans have cited increased costs to medical plans as their main concern with the bill, even though in 2024,  97% of large employers voluntarily offered fertility benefits reported no significant increase in costs to their medical plans. Despite this, the Access toFertility Treatment and Care Act, which would require most private insurance plans, as well as plans offered by Federal Employees Health Benefits Program, Medicaid, TRICARE, ERISA, and VA to provide coverage for treatment of infertility without any insurance or copays, remains a partisan bill. While the discounts are a step in the right direction, they fall short of truly enabling families to access the care they need.

The Patent Thicket Just Got Thicker: Limiting Inter Partes Review for Biologic Drug Patents

While a best-selling small molecule drug could be covered by up to five patents, biologic drugs (large chemical compounds produced by living cells) are covered by hundreds of patents. A primary purpose of patents is to give a limited monopoly to inventors to incentivize innovation, but this monopoly comes at a cost to consumers. For example, Humira (a rheumatoid arthritis medication) has 134 active patents and AbbVie Inc. charges consumers $6,500 per month for treatment. Most of these patents are “secondary patents” of questionable validity, covering things like dosage, drug formulations, and methods of using the drug to treat a new condition.

To combat these exorbitant prices, companies have been using biologic drugs as templates to produce biosimilars—therapeutically equivalent molecules. Without the extensive research and development costs associated with producing a novel biologic drug, biosimilars are brought to market and sold for less—around 90% less. Returning to the previous example, the biosimilar for Humira cost as little as $650 per month—just a tenth of the $6,500 monthly payment for the brand-name biologic.

The price of biosimilars could become even more affordable due to a recent announcement from the U.S. Food and Drug Administration (FDA) that it would be simplifying the process by which companies could bring biosimilar drugs to market. Now, the FDA will allow biosimilar manufacturers to circumvent expensive clinical testing in exchange for analytical testing. The manufacturer must show that their biosimilar does not have any clinically meaningful differences from the brand-name biologic drug (which has undergone clinical testing). The FDA used to require biosimilars to conduct “switching” clinical tests where patients would be treated first with the biosimilar drug then with the biologic drug (or vice versa) to determine any difference in responses to the drugs. If no meaningful differences were found, then the biosimilar was given “interchangeable” status, allowing pharmacists to prescribe the cheaper biosimilar instead of the brand-name biologic.

However, generic drug companies face another issue: challenging the validity of patents on a brand-name biologic drug. The web of patents protecting a single biologic drug makes it difficult for generic drug companies to enter the market because they must first demonstrate all the existing patents are invalid or not infringed by their product. Litigating these patents in a district court is expensive, complicated, and time-consuming.

Inter partes review (IPR) exists as an easier way for generic drug companies to clear out the patent thicket created by brand-name biologic drug manufacturers. However, the U.S. Patent and Trademark Office (USPTO) proposed a rule shortly before the FDA’s announcement, limiting the ability of biosimilar manufacturers to challenge the numerous patents filed on brand-name biologics. Previously, biosimilar manufacturers often used IPR through the Patent Trial and Appeal Board to challenge the validity of patents on brand-name biologic drugs. Now, IPR will not be available when “a petitioner intends to pursue invalidity challenges under §§ 102 [novelty requirements] or 103 [non-obviousness requirements] in other venues, such as district court or the U.S. International Trade Commission.” The USPTO frames this amendment as a way to “promote fairness and efficiency by channeling similar patent challenges to a single forum” and ensuring that IPRs are, not used in addition to, but as a complete substitute for, at least a phase of litigation. This has the effect of eliminating IPR as an avenue for biosimilar drugs to challenge the validity of broadly-drafted patents restricting their entry to the market, and thus increasing the cost of determining whether the numerous brand-name biologic drug patents are valid.

Allowing biosimilar manufacturers to use IPR as an avenue for challenging brand-name patent validity is important for two main reasons: lower costs and accelerated market entry. First, only 5% of prescription drugs are biologic drugs, but they account for $300 billion dollars in national total spending on medications. Thus, by creating therapeutic equivalents to patented biologics—biosimilars—which can compete with brand-name biologic drugs, prices will drop closer to the marginal cost of production and become more affordable to regular Americans. Second, legal battles between biologic manufacturers and brand-name biologics manufacturers can last years, delaying the arrival of affordable alternatives to consumers. Returning again to Humira as an example, it took seven years in court before the patent issues were resolved and the biosimilar could reach the market.

Although patents are meant to incentivize innovation by providing a limited monopoly, they are also meant to increase public access to cutting edge, socially beneficial technology, such as biologic and biosimilar drugs. By making it more difficult for biosimilar manufacturers to challenge validity of biologic drug patents, inventors and their monopoly are protected, but the USPTO has forgotten the public which patent law also seeks to protect.

What C.K. v. McDonald Mean for Children’s Mental-Health Access Through Medicaid

In August, it was announced that a landmark settlement agreement, was reached in a New York class action lawsuit against the New York State Department of Health (NYSDOH) and the New York State Office of Mental Health (NYOMH). This settlement follows settlements of similar cases in Michigan and Iowa, showing a movement towards systemic change for youth mental health and children’s advocacy. In C.K. v. McDonald, filed in 2022 by children and disability rights groups on behalf of four children in the U.S. District Court for the Eastern District of New York, the plaintiffs alleged that federal law requires mental health services be made available and provided through a state’s Medicaid program, yet, New York State’s services were “inadequate, inaccessible, and dysfunctional.” The plaintiffs primarily alleged that New York systematically denied Medicaid-enrolled youth access to community-based mental health care, which violated their federal rights and left them at risk of institutionalization and long-term harms. The complaint highlighted that the failure of NYSDOH and NYOMH disproportionately effect youth from low-income households and children of color.

Specifically, the plaintiffs cited a number of federal requirements that New York state was not adhering to, including the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) provision, which requires that Medicaid beneficiaries under 21 receive a number of medical services, including mental health care. The plaintiffs also brought claims under Title II of the Americans with Disabilities Act (ADA), which, under 28 C.F.R. § 35.130, prohibits discrimination or exclusion of qualified individuals from participation in services of a public entity by reason of disability.  The plaintiffs noted that 29 U.S.C. § 794 maintains identical requirements for any program or activity that receives Federal funding. Finally, the plaintiffs cited to Olmstead v. L.C., where the Supreme Court held that the ADA requires states to “provide community-based treatment for persons with mental disabilities.”

 The settlement agreement outlines an 18-month plan of action that the State must implement to improve mental health services for children. The plan establishes that agencies must provide intensive care coordination, in-home behavioral health services, and crisis response planning that does not rely on police. Additionally, the settlement establishes that the State must increase Medicaid reimbursements and institute annual quality audits of these services. The State will also initiate screening and assessment for children who are eligible for services and ensure that an expert is hired in tracking New York’s progress in meeting the agreements of the settlement.

While the settlement is awaiting the court’s final approval, the case outcome demonstrates progression towards improvements in mental health care for the 2.5 million children under 18 who are enrolled in New York’s Medicaid. This step addresses a major gap in care for some of the State’s most vulnerable residents, who so often have to rely on hospitals and residential facilities for care rather than in-home and communal services, which can be extremely distressing and traumatizing. Beyond New York, this case represents  systemic challenges that have been prevalent throughout the country for decades. The New York case, as well as the Michigan and Iowa cases, reinforce a legal precedent that States must be held accountable for providing meaningful, community-based mental health services that are non-discriminatory for Medicaid-eligible and enrolled children. Given the threats to Medicaid funding and massive financial cuts at the Federal level, it is more important than ever that Medicaid funds be spent on proven and effective services.

The Patients Over Profits Act: What It Could Mean for Patients and Providers

The Patients Over Profits Act (“POP Act”) was introduced in both Houses of Congress this fall. The proposed Act addresses vertical integration in the healthcare system, specifically covering various stages of insurance coverage. Vertical integration, as opposed to horizontal integration, is when multiple stages of a certain industry are all controlled by the same company. For example, vertical integration in the healthcare industry happens in various situations, but in this context happens when a certain company owns or controls both the insurer and the physician. 

Multiple industries have been trending towards vertical integration, and the healthcare industry is no exception. The Supreme Court has stated that any sort of integration is “highly relevant” in deciding whether anticompetitive effects exist. The Patients Over Profits Act seeks to address the effects of vertical integration in the healthcare industry on patients. 

Specifically, the supporters of the POP Act argue that insurers can now control physician practices, and then set their own policies regarding insurance. Supporting documents explain that these financial incentives surrounding insurance companies can in turn affect the care and treatment patients receive from providers who are owned by companies who control both the physicians and the insurance payouts. Proponents of the Patients Over Profits Act not only argue that the financial incentives can influence clinical decision-making, but they also have the ability and desire to increase costs and drive up profits for their company.  Recently, many insurance conglomerates have purchased clinics and other physician-groups, resulting in vertical integration. For example, UnitedHealthcare purchased a large physician-owned clinic in Oregon, after they had already purchased other similar medical groups in Oregon. This type of integration is not unique to Oregon, it is happening throughout the United States.  

Specifically, the Patients Over Profits Act addresses physicians and insurers participating in Medicare and Medicaid. Medicare and Medicaid protect our most vulnerable citizens. Medicare provides healthcare assistance through a federally funded insurance program to people who are sixty-five or older, and others who qualify or have certain disabilities. Medicaid similarly provides insurance assistance through federal and state funding for low income citizens. The POP Act addresses these concerns in many ways. First, it seeks to prohibit ownership of both a health insurance company and a medical provider who participates in Medicare and Medicaid. Further, it seeks to control Management Services Organizations  (MSOs) through their Management Service Agreements (MSAs). MSOs provide non-clinical services to medical providers, and they use their MSAs, which are contractual agreements, to govern these services. The POP Act seeks to restrict the mechanisms these entities can use to control the medical services the MSOs provide. Further, the Act seeks to enable federal enforcement through the Department of Justice, Federal Trade Commission, and the Department of Health and Human Services regarding those insurance companies engaging in vertical integration, especially those participating in Medicare and Medicaid. 

In short, the Patients over Providers Act seeks to protect patients, rather than providers of healthcare services and insurance companies receiving all of the benefits. By requiring these entities to disclose their information and subject them to strict enforcement through federal agencies, the Act hopes to ensure patients receive care with fair payment. If the POP Act passes, health insurers will need to disclose interests they have in medical practices, or they will be subject to high financial penalties or suspension from federal health programs, such as Medicare and Medicaid. 

The ‘Elder’ Medical-Legal Partnership and Caregiving from an Interdisciplinary Lens

New frameworks, interdisciplinary collaborations, and models of health care may need to emerge to address the impending “caregiving crisis,” or growing strain on the elder caregiving workforce with our aging population. The medical-legal partnership (MLP) model is one potential approach in addressing elder well-being, health, and the caregiving crisis. Medical legal partnerships are an established interdisciplinary framework, combining the legal and medical worlds to holistically serve a population’s needs. Within MLP clinical sites, attorneys are placed directly onsite to work with healthcare providers in identifying and remedying health-harming legal needs.

The model is based on the understanding that health issues are seldom solvable by addressing medical needs. For instance, an elder patient and their caregiver may need assistance in accessing incapacity plans or safe housing for an elder at risk for falls at home. By utilizing the MLP model, clinics can assist older adults and caregivers in navigating the multidimensional, overlapping legal and health issues that elders face, potentially reducing some of the burden on the caregiving population. Addressing common elder issues in one clinic with the expertise of two professions can help streamline access to other resources like public benefits, support the dignity and autonomy of elders, and address a variety of unmet financial, housing and legal needs. The MLP can also assist with the fact that elders have specific barriers to legal and healthcare related to mobility, transportation, and isolation by acting as a “one stop shop” for holistic support. Contributors to elder law also point out that medical providers and attorneys are well-positioned to collaborate so that providers can identify elder abuse.

While MLPs have become increasingly popular, they have scarcely been tailored to elder populations. The Medical-Legal Partnership for Seniors (MLPS) in San-Francisco, a law school clinic that trains medical providers on the legal needs of elders, is one example of an MLP tailored to the elder populations. But for the most part, MLPs have been utilized at the pediatric level where pediatricians are trained to identify the causes of their patient’s health conditions, which often stem from social determinants of health (SDOH) like poor housing conditions. Research has suggested that SDOHs are more important to individual health than genetic predisposition, where SDOHs such as socioeconomic resources, working conditions, housing, environment, race, and gender may be “fundamental causes” of health outcomes. These same SDOHs shape elder health, independence, and overall wellbeing, where intersecting factors and elder social identities may compound poor legal and health outcomes for elders. For example, a low income, older woman of color experiencing housing instability may face intersecting barriers that healthcare nor legal interventions alone can adequately address. Recognizing this, MLP interventions should be multi-pronged to address underlying social factors like structural racism and critically assess their own role in reinforcing systemic inequities. Elders are not a monolithic group, and ‘non-essentializing’ this population is critical in delivering equitable care.

Overall, the MLP framework could be more widely utilized to benefit the elder population and promote their health and justice. Having stronger societal supports like numerous MLPs tailored to elder needs may furthermore assist incrementally in the caregiving crisis, given that elder issues are only becoming increasingly relevant as our population continues to age. The MLP model thus may be a promising method to expand on caregiver and elder supports in the United States.