Multi-state litigation against federal healthcare restrictions targeting specific minority group creates substantial constitutional damage across civil_rights (5: direct healthcare access denial for protected class), rule_of_law (4: federal-state conflict, potential APA violations, coercive pressure on hospitals), and separation (4: federalism clash, state sovereignty over healthcare). Policy_change mechanism with multi_state scope and narrow population yields 1.15 mechanism modifier (executive action affecting healthcare access) and 1.1 scope modifier. Severity multipliers elevated: durability 1.2 (policy entrenchment), reversibility 1.1 (institutional compliance already occurring), precedent 1.2 (federal intervention in state healthcare decisions). Base 26.4 × 1.58 = 42.5. B-score: Layer 1 at 12.1/20 (55%): high outrage_bait (8: transgender youth + healthcare denial), strong media_friendliness (7: lawsuit + vulnerable population), moderate meme_ability (4), low novelty (3: continuation of culture war). Layer 2 at 11.7/20 (45%): strong pattern_match (8: fits culture war template), narrative_pivot (7: states-rights reversal), mismatch (6: federal overreach framing), timing (5). Intentionality at 9/15 (culture war wedge issue, base mobilization, policy signaling) yields 0.55 weight. Final: 12.1 + (11.7 × 0.55) = 18.5, scaled to 26.4/50. Delta = +16.1. Both scores exceed 25 with delta in mixed range, but A-score dominance and real constitutional mechanisms (federalism, civil rights, healthcare access) justify primary A classification with mixed flag.