The Supreme Court has sided with a Christian counselor challenging Colorado’s ban on LGBTQ+ “conversion therapy” for kids, ruling the law is a violation of her First Amendment rights.

In an 8-1 opinion, the majority of the justices found Colorado’s law regulates speech based on viewpoint and and sent it back to a lower court to decide if it meets a legal standard that few laws pass. Justice Ketanji Brown Jackson was the lone dissenter.

“Colorado may regard its policy as essential to public health and safety,” Justice Neil M. Gorsuch wrote for the majority. “But the First Amendment stands as a shield against any effort to enforce orthodoxy in thought or speech in this country.”

In a fiery dissent, Jackson warned of “potential long-term and disastrous implications” of the decision.

“In the worst-case scenario, our medical system unravels as various licensed healthcare professionals – talk therapists, psychiatrists, and presumably anyone else who claims to utilize speech when administering treatments to patients – start broadly wielding their newfound constitutional right to provide substandard medical care,” Jackson wrote.

She argued states should be free to regulate health care, even if that means incidental restrictions on speech. The decision, Jackson wrote, “opens a dangerous can of worms” that “threatens to impair states’ ability to regulate the provision of medical care in any respect.”

The case stems from a lawsuit filed by Kaley Chiles, with support from President Donald Trump’s administration, against laws passed in Colorado and more than 20 U.S. states that she argues wrongly bar her from offering voluntary, faith-based therapy for kids.

Colorado, on the other hand, says its measure simply regulates licensed therapists by barring a practice that’s been scientifically discredited and linked to serious harm.

During oral arguments in October, the court’s conservative majority didn’t seem convinced that states can restrict talk therapy aimed at changing feelings or behavior while allowing counseling that affirms kids identifying as gay or transgender. Justice Samuel Alito said the law “looks like blatant viewpoint discrimination.”

The arguments come months after the court found other states can ban transition-related health care for transgender youths, a setback for LGBTQ rights.

Chiles is represented by Alliance Defending Freedom, a conservative legal organization that has appeared frequently at the court in recent years. The group also represented a Christian website designer who doesn’t want to work with same-sex couples and successfully challenged a Colorado anti-discrimination law in 2023.

Colorado has not sanctioned anyone under the 2019 law, which exempts religious ministries. State attorneys say it still allows any therapist to have wide-ranging, faith-based conversations with young patients about gender and sexuality.

“The only thing that the law prohibits therapists from doing is performing a treatment that seeks the predetermined outcome of changing a minor’s sexual orientation or gender identity because that treatment is unsafe and ineffective,” Colorado state attorneys wrote.

Therapy isn’t just speech, they said — it’s health care that governments have a responsibility to regulate. Violating the law carries potential fines of $5,000 and license suspension or even revocation.

Linda Robertson is a Christian mom of four from Washington state whose son Ryan underwent therapy that promised to change his sexual orientation after he came out to her at age 12. The techniques led him to blame himself when it didn’t work, leaving him ashamed and depressed. He died in 2009, after multiple suicide attempts and a drug overdose at age 20.

“What happened in conversion therapy, it devastated Ryan’s bond with me and my husband,” she said. “And it absolutely destroyed his confidence he could ever be loved or accepted by God.”

Chiles contends her approach is different from the kind of conversion therapy once associated with practices like shock therapy decades ago. She said she believes “people flourish when they live consistently with God’s design, including their biological sex,” and she argues evidence of harm from her approach is lacking.

Chiles says Colorado is discriminating because it allows counselors to affirm minors coming out as gay or identifying as transgender but bans counseling like hers for young patients who may want to change their behavior or feelings. “We’re not saying this counseling should be mandatory, but if someone wants the counseling they should be able to get it,” said one of her attorneys, Jonathan Scruggs.

The Republican administration said there are First Amendment issues with Colorado’s law that should make the law subject to a higher legal standard that few measures pass.

Colorado Consumer Health Initiative says at least 700,000 Coloradans are in collections due to unpaid medical bills. Under state law, debt collectors can seize their wages and even put a lien on their house.

“It’s just pushing people over the edge,” says Democratic state Rep. Junie Joseph, who says the medical bills are personal to her. These types of bills affected her as the daughter of a single mother and as a college student. 

“They were constantly calling me, ‘Hey, Junie, you need to pay $1,000 here or $2,000 there,” Joseph explained. 

Joseph and Democratic state Rep. Javier Mabrey are proposing legislation that bars providers from collecting medical debt by garnishing wages, seizing assets below $30,000, or placing a lien on a person’s primary home.

“You should not be at risk of losing your home just because yo get sick in this country, Mabrey told CBS Colorado. 

Rocio Leal is among thousands of Coloradans in debt due to medical bills. She says she had a good job with insurance and thought she was financially secure. Then, her son got sick.

“When he was a toddler, around three, he had to have emergency surgery,” Leal told CBS Colorado. 

Leal was still paying the hospital that delivered her son when another hospital began billing her for the surgery. Despite being insured, she says she owed $7,000. When Leal couldn’t pay, she says, the hospitals began garnishing her wages.

“There was so many times my electricity was shut off,” Leal said. “There was times I was almost facing eviction.”

Desperate, Leal took out high-interest payday loans. Twenty years later, she’s still paying them off.

“Just for being sick,” she said. 

Mabrey says UCHealth is the biggest offender regarding wage garnishment.

But the health system insists it only garnishes wages as a last resort after repeatedly contacting patients, making sure they’re not eligible for assistance, and offering zero interest payment plans. 

UCHealth says it provided more than $760 million in uncompensated care in 2025 alone.

The Colorado Hospital Association — which opposes the bill — says state laws require all hospitals to screen patients for discounted care, wait six months before garnishing wages, and provide 30 days’ notice. It’s also barred from reporting medical debt to credit bureaus and required to erase debt in some cases.

The Hospital Association says the bill could cause some rural hospitals to close. But Mabrey says other states have similar laws and hospitals are still in business.

The bill goes before the House Health and Human Services Committee Tuesday.  

Leal, who is a diabetic, says she still worries about going in debt every time she goes to the doctor. 

“I don’t want anybody else to go through what I’ve been through,” Leal said.