The U.S. Supreme Court said Tennessee did not violate the constitution by banning gender-affirming care for transgender minors.

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.