The U.S. Supreme Court has upheld Tennessee’s ban on gender-affirming surgery for transgender youth in a ruling that’s likely to reverberate across the country. Most Republican-controlled states already have similar bans. Since President Donald Trump returned to office this year, the federal government has been trying to restrict access.

The U.S. Supreme Court backed a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors on Wednesday in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people.