“Even if we have a Supreme Court ruling that says all 50 states have to recognize marriage for same-sex couples, we’re still likely going to have implementation issues that will take time, maybe even years, to solve,” says Emily Hecht-McGowan, director of public policy at the Family Equality Council, a nonprofit organization devoted to LGBT parenting. “There are states that are less excited about implementing marriage equality, and there are places where it will be difficult to work with adoption administrators and officials to get them to recognize the rights of parentage that flow from marriage.”

Under the status quo, laws that restrict gay couples from marrying have created unorthodox family structures, at least on paper. Take April DeBoer and Jayne Rowse, a Michigan couple. The pair has four adopted children, but none of them legally belongs to both women: two are DeBoer’s and the other two are Rowse’s. The Supreme Court is considering their family situation in Obergefell v. Hodges, a consolidation of six cases from four states that asks whether the Fourteenth Amendment demands same-sex marriage.

While the justices ponder that question, families like the DeBoer-Rowses remain especially vulnerable to accidents and medical emergencies. If one of the mothers were to die or be otherwise incapacitated, there’s no way to be sure that the second parent would get custody of the two children who had been adopted by the first; a judge could hand them over to someone else. That possibility has caused LGBT families tremendous anxiety. When the DeBoer-Rowses had a near-miss with a truck driving on the wrong side of the road at night, they began to create wills and trusts to benefit their kids. They could dictate the disposition of their assets, they realized, but not of their children themselves. (Justices Roberts and Thomas may be sympathetic—both men have adopted children of their own.)

But same-sex marriage bans harm families with LGBT parents in other ways, too. The Sixth Circuit appeared to recognize these harms last year when it wrote in DeBoer v. Snyder, the suit filed by April and Jayne, that the traditional definition of marriage “deprives [gay couples] of benefits that range from the profound (the right to visit someone in a hospital as a spouse or parent) to the mundane (the right to file joint tax returns).” Then there are psychological harms to the children of gay couples, largely caused by the stigma associated with having parents whose relationship is considered to be legally or morally inferior. A 2008 report found that 42 percent of students with LGBT parents said they had been verbally harassed at school in the past year due to their parents’s sexual orientation, with more than a third of students saying they had been harassed about their own. Almost a fifth of these students experienced LGBT-related physical attacks during the same period.