A Nebraska law that combined abortion restrictions with another measure to limit gender-affirming health care for minors does not violate a state constitutional amendment requiring bills to stick to a single subject, the Nebraska Supreme Court ruled Friday.

The state's high court acknowledged in its ruling that abortion and gender-affirming care "are distinct types of medical care," but the law does not violate Nebraska's single-subject rule because both abortion and transgender health fall under the subject of medical care.

The ruling came in a lawsuit brought by the American Civil Liberties Union representing Planned Parenthood of the Heartland. The high court rejected arguments by ACLU attorneys which argued the hybrid law passed last year violates Nebraska's single subject rule.

Republican lawmakers in the officially nonpartisan Nebraska Legislature had originally proposed separate bills: An abortion ban at about six weeks of pregnancy and a bill restricting gender-affirming treatment for minors. The GOP-dominated Legislature added a 12-week abortion ban to the existing gender-affirming care bill only after the six-week ban failed to defeat a filibuster.

The combination law was the Nebraska Legislature's most controversial in the 2023 session, and its gender-affirming care restrictions triggered an epic filibuster in which a handful of lawmakers sought to block every bill for the duration of that session — even ones they supported — in an effort to stymie it.

A district judge dismissed the lawsuit last August, and the ACLU appealed.

In arguments before the high court in March, an attorney for the state insisted the combined abortion- and transgender-care measures did not violate the state's single subject rule, because both fall under the subject of health care.

But an attorney for Planned Parenthood argued that the Legislature recognized abortion and transgender care as separate subjects by introducing them as separate bills at the beginning of last year's session.

"It pushed them together only when it was constrained to do so," ACLU attorney Matt Segal argued.

At least 25 states have adopted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. Federal judges have struck down the bans in Arkansas and Florida as unconstitutional. Judges' orders are in place temporarily blocking enforcement of the ban in Montana and aspects of the ban in Georgia.

Since the overturning of Roe v. Wade by the U.S. Supreme Court in 2022, ending a nationwide right to abortion, most Republican-controlled states have started enforcing new bans or restrictions and most Democrat-dominated ones have sought to protect abortion access.