Health Care Freedom: The Amendment Ohioans Passed That Trans Families Now Invoke

Most Ohioans file abortion and transgender care in separate mental folders. One is a women's-health fight, the other a fight over kids and gender. Different coalitions, different headlines, different Sunday-show segments.

The lawyers challenging HB 68 filed them in the same folder, and they had a reason.

When two Ohio families sued to stop the state's ban on gender-affirming care for minors, in the case now known as Moe v. Yost, they did not build their argument on sympathy. They built it on the Ohio Constitution. Filed on March 26, 2024 by the ACLU, the ACLU of Ohio, and the law firm Goodwin, the case claims HB 68 violates two things: the state's Health Care Freedom Amendment, and the right of parents to direct their children's medical care. Both are about the same underlying idea, and it is an idea a lot of Ohio voters have already said yes to.

The idea under both fights

Strip the culture-war framing off and the principle is almost boring in its simplicity. A medical decision belongs to the patient, the family, and the doctor, not to the state.

That is the ground the families are standing on. The Health Care Freedom Amendment is a provision Ohioans wrote into their own constitution, aimed at keeping government out of personal health-care choices. The plaintiffs argue that a blanket ban on a category of care, overriding what a doctor recommends and a parent consents to, is exactly the kind of government intrusion that language was meant to forbid.

Now hold that next to what Ohio did in November 2023. Voters passed Issue 1, the reproductive-freedom amendment, by roughly 57 to 43. That measure enshrined a right to make one's own decisions about reproductive care, including abortion, and told the government to stay out of them. Same shape. A private medical decision, a family and a doctor on one side, the state told it does not get a vote.

The families in Moe v. Yost are asking the courts to apply that same logic to their children's care. If the constitution keeps the state out of one exam room, why not the other?

The reframe that does the work

This is where the frame flips.

The political story about HB 68 casts the state as protector. The law is pitched as shielding children from decisions they are too young to make, with the government standing guard. In that telling, the parents challenging it are the risk, and the state is the safeguard.

The constitutional argument turns that picture inside out. Under the Health Care Freedom claim, the family is the one making a careful, doctor-guided medical decision, and the state is the one barging in to override it. The intruder is not the parent. It is the legislature, reaching past the doctor and the family to ban a treatment outright.

Mike DeWine, the Republican governor who vetoed HB 68, reached for the same framing before the plaintiffs' lawyers ever did. He said the decision belongs to "the parents." The families took that instinct and gave it a constitutional address.

Why the pairing unsettles both sides

The link between the two fights is uncomfortable for the people who would rather keep them apart, and that discomfort runs in both directions.

For opponents of transgender care, the reproductive-rights amendment is a problem, because it committed Ohio, at the ballot box, to a principle of medical autonomy that is hard to switch off at the clinic door. You cannot easily argue the state must stay out of one deeply personal medical decision while insisting it belongs deep inside another.

For anyone who supported Issue 1 but has not thought much about trans care, the pairing is a prompt. The vote to keep government out of reproductive decisions was a vote for a principle, not just an outcome. Principles do not come with an exception clause for the medical decisions you find less familiar.

The courts will decide whether the legal argument holds. A trial court sided with the state; an appeals court struck the ban down; the Ohio Supreme Court stayed that and is now weighing the case. The Health Care Freedom claim is live, not settled.

But the political question sits with voters, and it is simpler than the litigation. Ohioans already voted, by a clear margin, that the government does not belong in a private medical decision.

So the question is whether that vote meant a principle or just a preference. If the state has no business between a woman and her doctor, does it have any more business between a family and the doctor treating their transgender child, and if the answer changes depending on who the patient is, was it ever really a principle at all?