With that opening line, West Virginia's solicitor, Caleb B. David, urged a panel of the U.S. Court of Appeals for the Fourth Circuit to reverse its own ruling and reinstate the state's categorical Medicaid ban on gender-affirming surgery for transgender adults. The case, Anderson v. Crouch, had returned to the court after the U.S. Supreme Court vacated its ruling and remanded it for reconsideration following the high court's 2025 decision in U.S. v. Skrmetti, a case focused narrowly on restrictions for minors.