Rep. Nancy Mace (R-S.C.) has proven time and time again that she will do nearly anything to make headlines.

But on Monday, she reached a new low, introducing a resolution seeking to bar transgender members and employees in the House of Representatives from using the bathrooms that correspond to their gender identity in the Capitol building. Echoing Republican talking points grounded in paranoia, the resolution alleges that allowing trans women to use women’s bathrooms “jeopardizes the safety and dignity” of cisgender women. It would task the House Sergeant-at-Arms with enforcing the resolution if passed.

The move comes just weeks after Rep.-elect Sarah McBride (D-Del.) became the first openly transgender person to serve in Congress. Though it does not directly mention McBride, the bill represents a clear attempt to attack her: Mace told reporters this explicitly on Tuesday, confirming that the bill is “absolutely” meant to target McBride. And in a post on X after announcing the resolution, Mace said McBride “does not get a say in women’s private spaces.”

McBride appeared to respond to the resolution in a post on X, stating: “Every day Americans go to work with people who have life journeys different than their own and engage with them respectfully, I hope members of Congress can muster that same kindness.” In a follow-up post, McBride called Mace’s effort “a blatant attempt from far right-wing extremists to distract from the fact that they have no real solutions to what Americans are facing. We should be focused on bringing down the cost of housing, health care, and child care, not manufacturing culture wars.”

Other Democratic members also blasted the effort: Rep. Becca Balint (D-Vt.), the first openly gay person to represent her state in Congress and co-chair of the Congressional Equality Caucus, said in a post on X that Mace’s effort was a “petty, hateful distraction,” adding, “There’s no bottom to the cruelty.” Rep. Alexandria Ocasio (D-N.Y.) said: “This is not just bigotry, this is just plain bullying.” Laurel Powell, spokesperson for the Human Rights Campaign, called Mace’s resolution “a political charade by a grown-up bully” and “another warning sign that the incoming anti-equality House majority will continue to focus on targeting LGBTQ+ people rather than the cost of living, price gouging or any of the problems the American people elected them to solve.” And GLAAD CEO Sarah Ellis said in a statement: “Everyone in Congress might try focusing on solutions to improve people’s lives and leading with kindness, and see what progress you might make for every American.”

“Manufacturing culture wars,” as McBride put it, is, indeed, an apt way to describe the transphobic paranoia Mace and supporting members in the GOP appears to be stoking with this resolution—an especially ironic development given that Democrats have been chastised for having been too concerned with trans issues since losing the election.

When it comes to GOP panic about trans people using bathrooms alongside cisgender people, the evidence around the issue does not support the panic. A 2018 study published in the journal Sexual Research and Social Policy found there is no link between trans-inclusive bathroom policies and safety, and that reports of “privacy and safety violations” in bathrooms, changing rooms, and locker rooms are “exceedingly rare.” This is probably why most states—37, plus DC—do not have any laws on the books regulating trans peoples’ use of bathrooms or other facilities, according to the Movement Advancement Project. (Mace’s office did not immediately respond to a request for comment on that research or other questions for this story.) But these facts have not stopped the GOP from pumping millions of dollars into anti-trans ads and filing hundreds of anti-trans bills in state legislatures across the country.

And as for the claim that it’s trans people who pose a danger to cisgender people in bathrooms? The GOP appears to be the party who poses a physical threat. Rep. Marjorie Taylor Greene (R-Ga.) went so far as to reportedly say in a private House GOP Conference meeting that she would fight a transgender woman if she tried to use a women’s bathroom in the House.

For all the drama this is stirring up, though, Mace’s latest effort may not go any further than the headlines: At a press conference Tuesday, House Speaker Mike Johnson (R-La.) said, “This is an issue that Congress has never had to address before and we’re going to do that in a deliberate fashion…and we will accommodate the needs of every single person.” He added that he would not commit to including the language of Mace’s resolution in the rules package the House will vote on in early January. A spokesperson for Johnson did not immediately respond to a question about the consequences if Greene fought another member of Congress or the lack of evidence to support Mace’s resolution.

Update, November 19: This post was updated with a statement from GLAAD.

Rep. Nancy Mace (R-S.C.) has proven time and time again that she will do nearly anything to make headlines.

But on Monday, she reached a new low, introducing a resolution seeking to bar transgender members and employees in the House of Representatives from using the bathrooms that correspond to their gender identity in the Capitol building. Echoing Republican talking points grounded in paranoia, the resolution alleges that allowing trans women to use women’s bathrooms “jeopardizes the safety and dignity” of cisgender women. It would task the House Sergeant-at-Arms with enforcing the resolution if passed.

The move comes just weeks after Rep.-elect Sarah McBride (D-Del.) became the first openly transgender person to serve in Congress. Though it does not directly mention McBride, the bill represents a clear attempt to attack her: Mace told reporters this explicitly on Tuesday, confirming that the bill is “absolutely” meant to target McBride. And in a post on X after announcing the resolution, Mace said McBride “does not get a say in women’s private spaces.”

McBride appeared to respond to the resolution in a post on X, stating: “Every day Americans go to work with people who have life journeys different than their own and engage with them respectfully, I hope members of Congress can muster that same kindness.” In a follow-up post, McBride called Mace’s effort “a blatant attempt from far right-wing extremists to distract from the fact that they have no real solutions to what Americans are facing. We should be focused on bringing down the cost of housing, health care, and child care, not manufacturing culture wars.”

Other Democratic members also blasted the effort: Rep. Becca Balint (D-Vt.), the first openly gay person to represent her state in Congress and co-chair of the Congressional Equality Caucus, said in a post on X that Mace’s effort was a “petty, hateful distraction,” adding, “There’s no bottom to the cruelty.” Rep. Alexandria Ocasio (D-N.Y.) said: “This is not just bigotry, this is just plain bullying.” Laurel Powell, spokesperson for the Human Rights Campaign, called Mace’s resolution “a political charade by a grown-up bully” and “another warning sign that the incoming anti-equality House majority will continue to focus on targeting LGBTQ+ people rather than the cost of living, price gouging or any of the problems the American people elected them to solve.” And GLAAD CEO Sarah Ellis said in a statement: “Everyone in Congress might try focusing on solutions to improve people’s lives and leading with kindness, and see what progress you might make for every American.”

“Manufacturing culture wars,” as McBride put it, is, indeed, an apt way to describe the transphobic paranoia Mace and supporting members in the GOP appears to be stoking with this resolution—an especially ironic development given that Democrats have been chastised for having been too concerned with trans issues since losing the election.

When it comes to GOP panic about trans people using bathrooms alongside cisgender people, the evidence around the issue does not support the panic. A 2018 study published in the journal Sexual Research and Social Policy found there is no link between trans-inclusive bathroom policies and safety, and that reports of “privacy and safety violations” in bathrooms, changing rooms, and locker rooms are “exceedingly rare.” This is probably why most states—37, plus DC—do not have any laws on the books regulating trans peoples’ use of bathrooms or other facilities, according to the Movement Advancement Project. (Mace’s office did not immediately respond to a request for comment on that research or other questions for this story.) But these facts have not stopped the GOP from pumping millions of dollars into anti-trans ads and filing hundreds of anti-trans bills in state legislatures across the country.

And as for the claim that it’s trans people who pose a danger to cisgender people in bathrooms? The GOP appears to be the party who poses a physical threat. Rep. Marjorie Taylor Greene (R-Ga.) went so far as to reportedly say in a private House GOP Conference meeting that she would fight a transgender woman if she tried to use a women’s bathroom in the House.

For all the drama this is stirring up, though, Mace’s latest effort may not go any further than the headlines: At a press conference Tuesday, House Speaker Mike Johnson (R-La.) said, “This is an issue that Congress has never had to address before and we’re going to do that in a deliberate fashion…and we will accommodate the needs of every single person.” He added that he would not commit to including the language of Mace’s resolution in the rules package the House will vote on in early January. A spokesperson for Johnson did not immediately respond to a question about the consequences if Greene fought another member of Congress or the lack of evidence to support Mace’s resolution.

Update, November 19: This post was updated with a statement from GLAAD.

In the lead-up to the 2020 presidential election, GOP consultants were fighting over strategy: Would going all-in on anti-trans messaging deliver then-President Donald Trump the suburbs in his race against former Vice President Joe Biden? Or should his campaign stay away from the issue, given widespread support among the electorate for LGBTQ rights like same-sex marriage? “This might become a hot cultural issue, but it’s not a thing yet,” one Republican consultant told Politico in the summer of 2020. “Right now, it’s just an easy issue for the other side to attack us on. They will call us bigots.”

So much has changed, as a network of conservative and religious-right groups coordinated to push hundreds of bills to wipe out trans youth health care, bar them from sports teams that match their gender identity, and censor discussion of LGBTQ issues in schools. With more than 129 anti-LGBTQ laws passed across the country in the last two years, GOP candidates now are betting that they’ve seeded enough anti-trans sentiment among voters to use transphobia as a motivating issue. It doesn’t seem to matter to Republicans that trans issues still tend to rank last among voters’ priorities: From August through early October, GOP candidates dropped $65 million on anti-trans advertising, according to a New York Times analysis. The hateful rhetoric has been deployed all the way down the ballot, in Senate races, statehouse contests, and state constitutional amendment campaigns.

Now, as the presidential race draws to a close, Trump’s campaign has made anti-trans ads the biggest focal point of its spending. The TV spots and social media posts spread falsehoods about medical care for trans youth, cast trans athletes as predators, and link support for trans people with support for (nonexistent) “partial-birth abortions.” Sports fans will recognize the constant refrain—“Kamala is for they/them. President Trump is for you.”—from game-day commercial breaks.

None of this bodes well for trans rights under either Trump or Harris, no matter what happens on Election Day, or in the weeks afterward. “​​I’ve been calling this the most anti-LGBTQ election since 2004,” says Sean Meloy, vice president of political programs at the LGBTQ+ Victory Fund, which works to elect queer and trans candidates. In 2004, George W. Bush used same-sex marriage as a wedge issue in his reelection campaign, betting it would drive conservatives to the polls. (As it turns out, right-wing voters were motivated by other priorities.) “They’re doing exactly the same thing now,” Meloy says. “Gay and lesbian people are understood and represented, and now they’re trying to dehumanize and use trans people and their experiences to get votes.”

Trump has pledged to defund gender-affirming care—and to ban it for minors.

Just being exposed to hateful political rhetoric can harm trans youth. Last year, in a Trevor Project survey, 86 percent of trans and nonbinary youth said debates about anti-trans bills negatively affected their mental health; half said they experienced cyberbullying; and a third didn’t feel safe going to the doctor. And when states pass anti-trans laws, the consequences for mental health are devastating: A study published in Nature Human Behavior in June found suicide attempts by trans youth ages 13 to 17 rose by as much as 72 percent a year after anti-trans laws were enacted.

Such laws are now the norm in Republican-dominated states. “In either scenario in November, we’re still facing that reality, where transgender people’s and also LGBTQ people’s rights more broadly depend almost entirely on what state they happen to live in,” says Logan Casey, director of policy research for the Movement Advancement Project. Already, trans people and their families are facing a “really difficult choice,” he says. “Stay in the place that they call home, seek healthcare somewhere else, or move out of state for potentially safer environments.”

If Trump wins the presidency, Casey says, the attacks succeeding now on the state level can be expected to graduate to the federal government. In his first term, Trump already provided a model for targeting transgender people. He banned them from the military; permitted anti-trans discrimination in health care; rolled back protections for trans students; and created a broad license for businesses to discriminate based on “religious objections”—often against LGBTQ people. More clues for a second term come from Project 2025, much of which was written by former Trump administration members, which equates “transgender ideology” with pornography and declares that it should be banned. The blueprint for a second Trump administration proposes wiping the terms “sexual orientation” and “gender identity” completely out of all federal policy.

And if the GOP wins both Congress and the White House, Trump has pledged to go further than before—cutting off federal funding for gender-affirming medical care and making it illegal nationwide for doctors to provide such care to minors.

But even without Congress, Trump would still have immense power to target transgender people through executive agencies. First on the list: reinterpreting federal laws in ways that eliminate protections for transgender people. That includes the Affordable Care Act, as well as Title IX, which forbids sex discrimination in education. Are schools and doctors expected to treat people according to their gender identity? The Obama and Biden administrations said yes. But in the years between, Trump appointees reversed those rules. “What they mean in terms of bathrooms, what they mean in terms of sports, what those regulations look like is very dependent on, is [Betsy] DeVos in charge or not?” says Jess Braverman, legal director at Gender Justice. 

Legal and policy experts who specialize in LGBTQ rights also warn that Trump appointees could create broad religious exemptions to federal nondiscrimination rules. One potential consequence: Government contracts going to organizations that exclude queer and trans people or insist on misgendering them. For example, during the first Trump administration, Catholic Charities was the only organization in Texas contracted to provide foster care placements for refugee children. The organization disqualified a lesbian couple, allegedly because they did not “mirror the Holy Family.” (Lambda Legal sued, and won.) Jennifer Pizer, Lambda Legal’s chief legal officer, says she’s particularly concerned about federal agencies giving contractors free rein, because the people they serve are often in dire need. “Whether it’s providing shelter or food or disaster relief, when they discriminate, then the people who are entitled to receive services, they don’t necessarily stay,” she explains.

The Project 2025–obsessed loyalists and ideologues who will staff a second Trump administration will not only set a tone for the massive federal workforce—one likely to be hostile to LGBTQ employees—but they’ll also be in charge of deciding how federal program money is distributed. “That money can go to responsible, community-based organizations and professional institutions that provide services consistent with professional standards, in a nondiscriminatory way,” Pizer says, “or to expand the religious infrastructure that we have in this country.”

“No matter which way the regulations go, no matter what they say, there’s always going to be litigation.”

Pretty much any agency moves are guaranteed to wind up in the courts, where lawsuits are already raging over trans-inclusive interpretations of Title IX and the ACA. Even when the Supreme Court weighs in—as it did in 2020 when it ruled that Title VII, the federal law banning sex discrimination in employment, protected transgender workers—the underlying issues aren’t put to rest. “No matter which way the regulations go, no matter what they say, there’s always going to be litigation,” Braverman says.

So it matters immensely who’s on the bench—another presidential power. During Trump’s first term, he appointed nearly 200 judges, reshaping the federal judiciary all the way up to the Supreme Court. As a result, those justices didn’t just overturn Roe v. Wade, they widened religious exemptions to civil rights law in ways that let more business owners refuse to serve LGBTQ clients. And, with all the recent state laws targeting transgender youth, a profusion of litigation over trans issues is making its way through the federal court system. In the most prominent case, United States v. Skrmetti, the DOJ has teamed up with trans families and has asked the court to decide if states can ban puberty blockers and hormone therapy for trans youth while permitting the same treatments for cisgender patients.

Oral argument for Skrmetti is scheduled for December—meaning the case should be submitted before the next president takes office. Pizer notes that it remains to be seen whether a Trump White House would try to reverse the DOJ’s current position on the case, and whether the justices would allow it.

In some ways, the backsliding in support for trans people is bipartisan. Democratic candidates this cycle have often appeared tentative or afraid of how conservative messaging about trans issues has already shaped public opinion. 

Some Democrats have adopted anti-trans rhetoric defensively, referring to trans people not by their gender identity but by the sex they were assigned at birth. “Let me be clear, I don’t want boys playing girls’ sports,” said Democratic Senate candidate Texas Rep. Colin Allred, running against Ted Cruz in Texas, in his response to a right-wing attack ad. Some LGBTQ-rights advocates chalked Allred’s response up to “messy” allyship; others called it a “dog whistle.” Either way, anti-trans activists were thrilled: “Beautiful Ted gets a major W here,” American Principles Project president Terry Schilling posted.

Even Kamala Harris, who dedicated an entire interview to describing her support for trans people during her first run for president in 2019, and who otherwise has a strong record advocating for the queer community, has stopped short of giving a robust defense of trans rights in her campaign. When attacked for allowing incarcerated people to access gender-affirming care, she shot back that such care was offered in federal prisons under the Trump administration. Gender-affirming care “is a decision that doctors will make in terms of what is medically necessary,” Harris elaborated under further questioning by NBC anchor Hallie Jackson. 

“It feels like that’s a long way from ‘we see you and we love you,’ which was your message to trans Americans in May,” Jackson pushed back. “What do you want the LGBTQ+ community to know as they’re looking for a full-throated backing from you for trans Americans?”

“I believe that all people should be treated with dignity and respect, period, and should not be vilified for who they are, and should not be bullied for who they are,” Harris replied. 

To some queer and trans observers, Harris’ general rebuttal about a need for inclusion is a disappointment, failing to meet the intensity of the anti-trans backlash. Others see it as an appropriate calculation for a dangerous political moment. “There are attacks against multiple groups of people, and so a counter-message that says, ‘Targeting people is not good, we need to come together as a country, we need to be inclusive as a country’—that is an apt message for these times,” Pizer says.

The stakes of the rhetoric are extremely high. While the average American’s opinions about transgender policies—from bathroom bans to gender-affirming care restrictions—are largely unformed and in flux, according to research from the University of Minnesota, politicians’ anti-trans messages have broadened support for restrictive policies. “As public opinion continues to evolve in this area,” the researchers concluded, “much will depend on the behavior and framing offered by elites.”

And the anti-trans rhetoric from Trump and his allies has already had a profound impact on queer people—none more so than the trans women and drag queens featured in the ads without their consent. “I haven’t been able to sleep,” Gabrielle Ludwig, a trans woman whose college basketball career was exploited in multiple ads, told The Hill. “I don’t want my family affected. I have granddaughters, daughters who are in college. I only did this because I love to play basketball. That’s all it ever was.”

With so much ultimately being up to the courts—and political battles sure to continue in the states, if not the federal government—Braverman believes a Harris win could be a chance to change the narrative. “The demonization and the discussion and the ‘let’s just debate people’s humanity’—that is the thing that is really making life hard for people,” they say.

Harris cannot unilaterally reverse the tide of anti-trans legislation in states; beyond her ability to affect policy areas like health and education, her greatest power lies in her words. “Laws and regulations are really important,” Braverman says, but “there needs to be more. There needs to be education, there needs to be understanding. There needs to be support from people in power.”

Paris Alexander had been in a destructive relationship for over a decade, learning to tolerate the intolerable even as the abuse progressed—first mental and emotional torment, then physical and sexual torture. Like many survivors, Alexander, who is nonbinary, stayed in the relationship hoping that it would improve. “We stick it out,” they said, “because we think that they’re going to change and come to their senses.” 

Then, one day in September 2020, Alexander’s male partner beat them up and dragged them outside their Providence, Rhode Island, home by their hair. Wandering their neighborhood, covered in blood and desperate to flee, Alexander felt haunted by the years of forced isolation: “I had nowhere to go, no one to turn to,” they recall. A Google search on their phone led them to Sojourner House, which runs the state’s only shelter specifically for LGBTQ victims of intimate partner violence. Almost miraculously, there was some space. Finally, Alexander had caught a break. 

At the shelter, known as RISE, Alexander focused on taking “baby steps” toward independence. They got a library card. They started individual therapy. They joined a weekly virtual LGBTQ support group, where they heard terms like “nonbinary,” “gender-queer,” and “gender fluid” for the first time. Back then, Alexander identified as a transgender woman and felt pressured to “look female as much as possible.” The support group taught them, “You don’t have to be [male or female]—you can just simply be who you are, and that’s okay.” 

RISE is one of three shelters operated by Sojourner House, named for the 19th-century slave-turned-abolitionist Sojourner Truth, who was also an ardent advocate for women’s rights. Since its founding in 1976, the organization has served more than 60,000 people—1,800 last year alone. A small but critical part of this past year’s $7.4 million budget comes from the federal Crime Victims Fund, a pot of money created by the 1984 Victims of Crime Act, also known as VOCA. Across the country, VOCA helps pay for the hotlines survivors call in crisis, the shelters they flee to, and the advocates who accompany them to court and help them heal.

VOCA-supported programs helped almost 8 million people in fiscal year 2022–2023, funding nearly 3 million shelter beds and 2.3 million crisis-hotline calls, according to the Department of Justice. Those services have become more critical since the pandemic, as rates of intimate partner violence have soared, a housing crisis has made it even harder for survivors to flee, and the overturning of Roe v. Wade has given abusers another way to threaten pregnant survivors. But even as the need is growing, VOCA funding has been plummeting—and Congress has failed to act on what many advocates say may be the best hope for a legislative fix.

The current funding crisis is rooted in changes in DOJ policy that date back years. The Crime Victims Fund gets most of its money from financial penalties levied in corporate criminal cases, according to the department. Those fees and fines have been falling as federal prosecutors have pursued more deferred and non-prosecution agreements, which allow defendants more time to pay up or avoid charges entirely if they cooperate with the government. As a result, deposits into the pot shrank from a high of $6.6 billion in 2017 to $1.39 billion in fiscal year 2023. (Because of congressional caps, the actual amount of money disbursed is even lower.) These declines have trickled down to state agencies—which receive VOCA funds based on their state’s population size—and then to eligible programs. Rhode Island, which has one of the smallest populations, has seen a 54 percent drop in VOCA funds since 2017, to $2.9 million in the last fiscal year. California, the most populous state, went from receiving $218.9 million in VOCA funds in 2017 to $87 million over the same period.

Most states, including California, have managed to come up with some funding to offset the federal cuts, but the money is mostly temporary—lasting a year or two max. Fourteen states, including Rhode Island, did not appropriate any money in their most recent budgets to offset the VOCA cuts, I found in my reporting. This past spring, Rhode Island lawmakers proposed $2 million in supplemental funding, but the bill died in committee.

I’ve spent four months trying to understand how these extreme VOCA cuts are affecting domestic violence programs across the United States, doing more than two dozen interviews and tracking down budget data from every state. The picture that has emerged is deeply troubling: Lifesaving services for survivors are struggling to stay afloat, and experts fear what might happen if a long-term funding solution isn’t found.

Law enforcement groups are equally worried. “Without Congressional action, victim service providers will be forced to cut critical services, and many will be forced to close,” more than 700 prosecutors wrote in an open letter to lawmakers in February. “Millions of victims, including abused children and battered women, will be left without access to safety, justice and healing.” But with the November elections looming, Congress’ attention has been focused elsewhere.

The VOCA Fix Act, which President Biden signed into law in 2021, diverted revenue from deferred and non-prosecution agreements to the Crime Victims Fund—but this turned out to be inadequate. This term, Sen. Dick Durbin (D-Ill.) and Sen. Lisa Murkowski (R-Alaska) have proposed a bill to supplement VOCA with funds collected through the False Claims Act, which penalizes defrauding of the government. The legislation has attracted 170 bipartisan co-sponsors in the House but languished in the Senate Judiciary Committee, which Durbin chairs. A spokesperson for Sen. Lindsey Graham (R-S.C.), the committee’s highest-ranking Republican, did not respond to questions about whether the bill will get a hearing. Congress has also punted on Biden’s proposal for a $7.3 billion infusion into the Crime Victims Fund for next year. (The White House did not respond to repeated requests for comment.)

“Victims of crime, and specifically, victims of domestic and sexual violence, just are not priorities.”

At a virtual event this week commemorating the 40th anniversary of VOCA, the mood was less than celebratory. “I’m hearing about programs shutting down, positions being cut, victim services being impacted,” Claire Ponder Selib, executive director of the National Organization for Victim Advocacy, told more than 250 attendees. To Vanessa Volz, Sojourner House’s president and CEO, the funding crisis illuminates a harsh reality: “Victims of crime, and specifically, victims of domestic and sexual violence, just are not priorities.” 

Domestic violence hotlines like the one that led Paris Alexander to Sojourner House are among the most critical services that VOCA funds. Because hotlines are the point of entry to a support system that can mean the difference between life and death, slashed budgets can be especially disastrous. Rhode Island’s statewide 24/7 helpline has historically relied almost entirely on VOCA funding—about $118,000 last year, less than half what it received in 2019. More cuts would likely hit the helpline’s overnight shifts hardest. For people who are abused in the dead of night, or who have a small window to seek help while their abusers are sleeping or working, this could be catastrophic.

The Rhode Island helpline routinely gets calls from people in Massachusetts and Connecticut who can’t access services in their own areas—even though both of those states, unlike Rhode Island, have appropriated supplemental funds to offset VOCA cuts. Connecticut’s additional money came from the pandemic-era American Rescue Plan Act, which disappears at the end of this year. Without a new infusion of money, the statewide domestic violence hotline, Safe Connect—which is 100 percent funded by VOCA—will have to drastically cut services, lay off advocates, or even shut down, says Meghan Scanlon, president and CEO of the Connecticut Coalition Against Domestic Violence, which staffs the hotline. “The reality is, as much as we are advocates who don’t want to say ‘no,’ at some point, we’re gonna have to,” she laments. “And that doesn’t feel great.” 

Some of the greatest effects are likely to be felt in programs that serve transgender clients and undocumented immigrants, such as Sojourner House’s RISE shelter and THEIA Project, which supports victims of human trafficking. Hot-button politics around LGBTQ+ and immigrant clienteles make such programs especially difficult to fundraise for, Volz says.

Yet as Alexander’s story shows, immigrant survivors are particularly vulnerable to abuse from partners who exploit their status as another form of control. Despite their strong New England accent that makes them sound as if they had been born and raised in Boston, Alexander originally hails from São Miguel, a lush island in the Azores archipelago of Portugal. When they were 5 years old, they arrived in New Bedford, Massachusetts, with their parents—but without documentation. Their mother secured US citizenship when Alexander was a teenager—a process that automatically made them a citizen, too. But after getting kicked out of the house at 16, and no parental contact over the years, Alexander lacked both identification and proof of their citizenship status. “I became like a ghost,” they recall. In their 20s, they told me, essentially undocumented, they dropped out of cosmetology school and the regular labor force and drifted into sex work.

Sojourner House didn’t just get Alexander out of an abusive relationship. Its VOCA-funded team of immigration advocates helped Alexander secure identification, represented them in immigration proceedings, and prepped them for their citizenship test—a process that took over a year; in March 2022, Alexander was officially sworn in as a US citizen. “We’re really at risk of not being able to continue providing these services at the same level,” Volz notes.

In some places, cuts affecting VOCA-funded legal advocacy services have already been devastating. Judge Shelley Santry, a family court judge in Louisville, Kentucky, used to have advocates in her courtroom every Tuesday, the day she hears domestic violence cases involving people seeking emergency protective orders against their abusers. The advocates—employed by the statewide Center for Women and Families—would bring survivors into a private room after their hearing and explain a new set of risks: “Once the order is entered, it’s really the most dangerous time,” Santry told me. “The perpetrator is losing that control, and that’s when the lethality red flags are elevated.” Recently in Hardin County, 60 miles from Louisville, a man fatally shot his ex-girlfriend and her mother near the courthouse where they had a hearing about an emergency protective order against him. (He also killed himself.)

In Santry’s courtroom, the advocates would help survivors come up with practical strategies to safeguard themselves and their families: keep gas in their cars, charge up their phones, pack emergency bags in case they had to flee. Their in-person presence was essential, says Elizabeth Martin, the center’s president and CEO: “If you aren’t where people are, they’re not necessarily going to reach out to you.”

But over time, the number of advocates in Santry’s courtroom dwindled, and since August 2021, they’ve been completely gone. With VOCA funding for the center plummeting more than 60 percent since 2019, to just over $437,000 last year, Martin was forced to cut her domestic violence staff in half and remove advocates from courtrooms. Now, a court staffer hands out pamphlets and business cards to survivors bearing the center’s name, website, and phone number. Martin only sends an advocate if a survivor asks for one. “They don’t know what they don’t know,” Martin says. “The contact, that personal touch, that involvement has been watered down significantly.”

Lawmakers “need to understand this isn’t a personal problem, this isn’t a family problem—this is all of our problems, and we’ve got to work to eradicate it.” 

Domestic violence groups were grateful when Kentucky legislators allocated $7.1 million in their latest budget to offset VOCA cuts, but say the one-time grant isn’t enough. Without advocates to provide support, “the consequence may be death,” Santry says. In 2020, Kentucky ranked 10th in the nation for domestic violence homicides, according to the Violence Policy Center, with men murdering 46 women across the state. Lawmakers “need to understand this isn’t a personal problem,” Martin says, “this isn’t a family problem—this is all of our problems, and we’ve got to work to eradicate it.” 

California is another state where advocates say lawmakers haven’t done enough to address a steep decline in VOCA funds—down 60 percent since fiscal year 2017. Now domestic violence organizations there are facing a new crisis as they grapple with the repercussions of this summer’s decision in Grants Pass v. Johnson, in which the Supreme Court’s conservative supermajority essentially greenlit the criminalization of homelessness.

After a months-long advocacy campaign that drew the support of actress Angelina Jolie, Gov. Gavin Newsom’s office scrounged up $103 million in June to supplement the $87 million in federal VOCA funds. That one-year reprieve helped to avert what could have been a catastrophe for VOCA-funded organizations. But then in July, Newsom ordered state agencies to clear out homeless encampments following the Grants Pass ruling. Advocates warned that the decision could be devastating for survivors of intimate partner violence, who struggle to access shelter and housing nationwide—and especially in California, which has the largest population of unhoused people in the United States.

“The reality before [Newsom’s] executive order was that there were not enough DV-specific shelter beds, and just in general, there’s not enough emergency shelter beds,” says Jennifer Willover, housing policy analyst at the California Partnership to End Domestic Violence. Since Newsom’s mandate, Willover adds, domestic violence programs across the state have reported increased calls to their hotlines requesting shelter. In some parts of the state, advocates report that they are spending more time visiting encampments and informing unhoused people of domestic violence-specific services they offer, Willover says. (Newsom’s Office of Emergency Services did not respond to requests for comment.)

Experts see the situation there as a harbinger of what’s to come nationwide: As the National Network to End Domestic Violence and other advocacy groups said after the Grants Pass ruling, “Gender-based violence is a cause and consequence of homelessness, and this ruling will further trap people who are homeless, including survivors, in cycles of poverty and housing insecurity.”

In a report about homelessness in the state published in January by researchers at the University of California, San Francisco, nearly one-fifth of cisgender women surveyed said they had experienced intimate partner violence in the six months prior to homelessness, and 40 percent said violence was a reason for leaving their last housing. Many were homeless because of the far-reaching effects of domestic abuse: living in isolation from family and friends and unable to work, their financial resources controlled by their abusers, resulted in intractable poor credit and records of eviction. “There’s a lack of awareness, still, of the fact that there is that intersection of domestic violence and homelessness,” says Leticia Campos, chief programs officer at the Marjaree Mason Center, which serves victims of domestic violence in Fresno County, where the population tops 1 million and the poverty rate is well over the national average. 

Marjaree Mason—established in 1979 and named after a 36-year-old woman murdered by her ex-boyfriend, a sheriff’s deputy with the county—offers a case study of the problems facing VOCA-funded organizations in California post–Grants Pass. Fresno County has the highest number of calls to law enforcement for domestic violence per capita in California, and Marjaree Mason is the county’s only 24/7 domestic violence shelter and service provider. The Fresno City Council allocated $300,000 earlier this year to help the organization fend off the impacts of the years-long decline in VOCA funds, but staff members say they still struggle to meet the needs of survivors.

In June, I visited the VOCA-funded emergency shelter, which can accommodate 140 people. The rooms have bunk beds with colorful, patterned bedspreads, and televisions mounted on the walls, and outside there’s a playground shaded by palm trees. But even before the Supreme Court ruling, getting a bed there wasn’t easy. Empty beds are often filled within hours, Campos says; when I visited, the shelter had been at capacity for three weeks. Survivors who are turned away often have no choice but to return to their abusers. A spokesperson told me that last year, 80 percent of the organization’s clients had no income of their own, and of the ones who did, two-thirds made under $15,000. 

After Newsom issued his executive order, the Fresno County Board of Supervisors unanimously approved an ordinance making “unlawful camping” a misdemeanor punishable by a $500 fine and up to six months in jail. The city of Fresno passed a ban that was even more aggressive: a $1,000 fine and a year behind bars, which took effect in late September. The mayor has said that arrests will be limited to “habitual offenders” and that people will first be offered supportive services, though it’s unclear whether those include referrals for domestic violence treatment.

Staff at Marjaree Mason saw an impact within days of Newsom’s executive order, when the sheriff’s office dropped off an unhoused woman and two children at the drop-in center in the middle of the night after clearing an encampment, according to Joseph Hickman, the center’s interim crisis response manager. “It was very eye-opening to see that it happened that quickly,” Hickman says. “It definitely kind of lit a fire under us.”

The problem, as Campos says, is this: “What should we do when we’re at capacity? Where should we send victims of domestic violence?” Laura Moreno, program manager at the Fresno County Department of Social Services, says those questions point to a broader, county-wide issue. “We don’t have enough shelter beds, period, for the number of people we have on the streets,” she told me. A federally mandated one-day census in Fresno and neighboring Madera counties in January 2023 found nearly 4,500 unhoused people, up 7 percent from the year before. A county spokesperson said outreach teams provide homeless people with relevant resources, including information about Marjaree Mason’s services.

Helping survivors find assistance elsewhere when the shelter is full is a task left to Diana Hernandez, a former 911 dispatcher who joined Marjaree Mason’s staff in September 2021. In her previous job, she told me, she hated having to hang up on callers who were clearly in need but not in the throes of an emergency. Now, as a client navigator, she can talk to survivors who call the hotline for as long as they want, providing them with emotional support and resources. But she can’t always give them what they need most, which is usually a bed.

While we were chatting in her cubicle in June, she received a hotline call from a woman who said she’d been physically assaulted by her boyfriend. She had been living in a car, and needed a safe place to stay. Marjaree Mason’s shelter was full, so Hernandez offered to call homeless shelters in the area to see if they had room. But she also cautioned that those shelters wouldn’t offer advocacy support and legal services specifically for domestic violence victims. Nor would their locations be confidential, like domestic violence shelters’ are. Add to that, most likely they would require residents to leave during the day; Marjaree Mason lets them stay. 

Hernandez gave the woman phone numbers for other local organizations that could provide services, and suggested that she change her passwords on her email and social media accounts, make sure her phone’s location-sharing feature was turned off, and call back on the hotline at any time if she wanted to talk. In such instances, “I try to exhaust my resources,” Hernandez told me after the call ended, “so I know I did everything I could.”

After seven months at RISE, Sojourner House’s LGBTQ shelter, Paris Alexander might have ended up like so many other survivors of intimate partner violence: homeless and back on the street. But because Alexander had been a victim of sex trafficking, they were eligible for assistance through another Sojourner House program offering transitional housing for survivors of human trafficking. The program paid the rent and utilities on a third-floor apartment where Alexander lived while they were sorting through their citizenship problems and unable to work. Without a Social Security number, they couldn’t apply for food stamps or government assistance. Every few weeks, Alexander recalls, a Sojourner House advocate showed up with some food—bread, peanut butter, canned beans. “And that was pretty much what I had to live off of.” 

Alexander finally secured their citizenship in March 2022 and was able to begin searching for permanent housing. Once more, Sojourner House provided vital support. Robin Greene, an advocate who had once been unhoused, also works with trafficking survivors through the organization’s THEIA Project, which includes a VOCA-funded shelter. Greene helped Alexander find an apartment and even convinced the landlord to renovate the space by replacing the floors and covering up cracks and holes in the walls. 

For Greene, ensuring her clients live in comfort is key to helping them stay on the road to recovery. Greene recalls spending time in homeless shelters that were “gross,” “vermin-ridden,” “humiliating,” and “degrading.” At the shelter for trafficking victims, she painted the walls and floors with pops of green, yellow, and purple and adorned the office space with house plants. She mows the front lawn herself. “I want it to look not like a shelter,” she told me when I visited. “I want it to look like a home.” 

Two years after Alexander moved in, their apartment—the same one that Greene helped secure—has become their “sanctuary,” where they live with their two cats, Bast and Isis. They painted the walls yellow, green, and blue; hung up their own artwork; and put some of the house plants Greene brought to life in front of the bay windows in their living room, a daily reminder of someone who helped transform their life.

According to Greene, Alexander represents “the epitome” of what Sojourner House and domestic violence organizations like it can do, if they have the vision, the people—and the funding to support survivors. “Paris was determined to just sit in their little apartment and never come out with their cats,” Greene told me, “but not now.” 

Today, Alexander volunteers with Sojourner House and spreads word of its services within the community. They also volunteer with a trans youth mentorship program, through which they meet weekly with a younger trans mentee, and they host events—including a recent makeup workshop, drawing on their cosmetology background—for trans and nonbinary young people. In November, they’ll host a virtual Friendsgiving hangout—meant to be “a safe and loving space during Thanksgiving,” they said, adding, “the holidays can be a tough time of the year for queer folks.”

Alexander knows firsthand the negative thoughts that can run rampant through survivors’ minds: “We feel like we’re not worthy. We feel like no one cares. We feel like no one understands. You don’t trust that there’s genuine empathy out there.” Empathy, though, tends to be abundant among people who support survivors of domestic violence; what’s in short supply is cash. This is partly why Alexander was eager to tell their story: They want lawmakers to know that VOCA funds have “the power and the ability” to save lives. “I wouldn’t be here today,” they told me, “if it weren’t for the Sojourner House program.”

If you or someone you care about is experiencing or at risk of domestic violence, contact the National Domestic Violence Hotline by texting “start” to 88788 or calling 800-799-SAFE (7233) or going to thehotline.org. The Department of Health and Human Services has also compiled a list of organizations by state.

This article was produced with the support of the USC Annenberg Center for Health Journalism’s 2024 Domestic Violence Impact Reporting Fund.

When the US Department of Health and Human Services finalized a rule in May asserting that gender dysphoria can be considered a disability under federal anti-discrimination laws, it codified what the overwhelming majority of courts have found for nearly a decade. The new rule put states on notice: Discrimination against transgender people in employment, education, health care, child care, housing, and elsewhere may violate federal disability protections, and the Biden administration was prepared to fight it.

Now, in a lawsuit led by Texas Attorney General Ken Paxton, 17 states are asking a federal court to strike down the rule in its entirety, including numerous provisions that have nothing to do with trans people. This isn’t a random collection of states; 15 of them have passed restrictions on gender-affirming care, and all have embraced myriad anti-trans policies. 

Among the states’ objections to the new federal rule: They would have to “expend time, money, and resources” to accommodate employees with gender dysphoria, including using the pronouns that align with their identities, eliminating sex-specific dress codes, and letting employees use gender-aligned bathrooms or locker rooms. Nebraska’s attorney general is concerned that his state’s restrictions on gender care put it at risk of disability rights complaints and federal investigations. South Dakota objects to the rule “essentially add[ing] a new category of potentially disabled individuals” whose gender care must be covered by Medicaid.

But gender dysphoria is just part of the 130-page federal rule. It also protects disabled parents’ rights in child welfare cases and prevents hospitals from using disability as a factor in determining who gets care in crisis situations, such as equipment shortages during a pandemic. It adds Long Covid to the list of conditions that may constitute a disability and strengthens protections against unnecessary institutionalization, requiring that care be offered in the least restrictive setting and, ideally, in a patient’s community. 

“The attack is really about the regulatory process of the federal government, and this will impact almost every interaction that a disabled person has with the services and supports that they receive.”

Striking down the entire rule would have wide-reaching implications for all disabled Americans and other marginalized groups who rely on federal agencies’ interpretations of decades-old laws to enforce their rights, says Mia Ives-Rublee, senior director of the Center for American Progress’ Disability Justice Initiative. “They’re utilizing LGBTQ issues as a wedge,” Ives-Rublee says. “The attack is really about the regulatory process of the federal government, and this will impact almost every interaction that a disabled person has with the services and supports that they receive.”

The new rule pertains to two federal statutes passed decades ago to protect people with disabilities on multiple fronts. The Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by the federal government, federal contractors, and—in its Section 504—by any organizations or employers that receive federal funds. The Americans with Disabilities Act (ADA), signed into law in 1990, broadened disability protections into most aspects of public life, including education, access to businesses open to the public, and public transportation. Both statutes define a disability as “a physical or mental impairment” that “substantially limits” one or more major life activities. 

When the Rehabilitation Act and ADA were passed, gender dysphoria was not a recognized medical condition, and both statutes expressly excluded “transvestism, transsexualism,” and “gender identity disorders not resulting from physical impairments” from the definition of disability. But over the decades, medical experts and courts have come to understand that for many people who identify with a gender different from the one assigned to them at birth, there can be profound psychological distress and other major negative effects in their work and social lives. In 2013, gender dysphoria was added to the Diagnostic and Statistical Manual of Mental Disorders.

Since then, lawsuits by individuals—the primary way the ADA is enforced—have forged a body of legal decisions that recognize gender dysphoria as a protected health condition and its exclusion from disability protections as discriminatory, says Ben Klein, senior director of litigation and HIV law at GLBTQ Legal Advocates and Defenders. The exclusion of gender dysphoria “was based on obvious animus toward a disfavored group. That is a concept that judges who look at petitions have easily understood—the bias is so clear,” Klein says. 

The 4th Circuit Court of Appeals broke legal ground in 2022 when it became the first federal appeals court to rule on the issue of whether gender dysphoria could be considered a disability under federal disability protection statutes. The court determined that the basis of a gender dysphoria diagnosis—whether it causes a noticeably negative impact on daily life—distinguishes it from the ADA’s definition of gender identity disorder. (The US Supreme Court declined to hear the case in June 2023, letting the decision stand.) Lower federal courts have found, similar to the 4th Circuit, that gender dysphoria is distinct from gender identity disorder. Others have found that even if gender dysphoria is a gender identity disorder, it results from a physical impairment: a mismatch between a person’s physical body and gender identity that can be remedied through gender care. 

In finalizing its new rule—the first administrative update to Section 504 in half a century—the Department of Health and Human Services alluded to this body of case law, which it said has “shifted the legal landscape of disability discrimination protections.” But none of that matters much to the states that joined the Texas lawsuit, which was filed with little national media attention in late September. 

The lawsuit seizes upon the original exclusionary language in the ADA, claiming that what the medical community now considers gender dysphoria falls under the law’s concept of gender identity disorder. “The Biden Administration is once again abusing executive action to sidestep federal law and force unscientific, unfounded gender ideology onto the public,” Paxton said in a press release announcing the suit. “Texas is suing because HHS has no authority to unilaterally rewrite statutory definitions and classify ‘gender dysphoria’ as a disability.”

Beyond the gender dysphoria issue, the lawsuit also makes broad claims about “new regulatory burdens” and “substantial costs” associated with the rule’s impacts to state Medicaid programs. Alaska, Montana, and Nebraska, for instance, argue that the rule’s “least restrictive setting” requirement will be difficult to implement because of health care worker shortages and their states’ unique geographies. 

“One of the goals of the ADA is to address discrimination and stereotypes, particularly about stigmatized health conditions. Gender dysphoria is the quintessential stigmatized health condition.”

Klein and Ives-Rublee emphasized that both the Rehabilitation Act and ADA were written vaguely with the intent that, over the years, experts working for federal agencies would reexamine and refine the regulations implementing the statutes, as scientific and public understanding of disability evolves. When the ADA was passed, trans identity was pathologized, Klein says. “One of the goals of the ADA is to address discrimination and myths and stereotypes, particularly about stigmatized health conditions,” he tells me. “Gender dysphoria is the quintessential stigmatized health condition.”

The new Texas case is just one of many avenues GOP officials are using to enforce their anti-trans beliefs. As I’ve reported, Republican attorneys general—many from the same states as in the Paxton lawsuit—are also threatening major medical associations with criminal investigations for promoting trans youths’ access to gender care.

Ives-Rublee warns that the Texas suit is also part of a multifaceted attack on the power of federal agencies to interpret civil rights laws, including protections for pregnant workers and access to reproductive health care. This broad conservative effort to rip the teeth out of the administrative state was emboldened by a series of Supreme Court decisions last term, including one that ended courts’ expected deference to federal agency interpretations of vague laws. 

Because the gender dysphoria lawsuit was filed in the federal district court in Lubbock, Texas, any appeal will go to the 5th Circuit Court of Appeals, home to some of the most radically conservative decisions in recent legal history. If the 5th Circuit sides with the states in this case, it would create a conflict with the 4th Circuit decision that could force the Supreme Court, with its far-right supermajority, to weigh in. “I am almost 100 percent sure this is their intention,” Ives-Rublee says.

In late August, on the fringes of a press conference outside New York City Hall, a man wearing a “Kill your local pedophile” T-shirt and a “Babies Lives Matter” pin screamed at a transgender woman who had shown up to protest the speeches. “Is it a boy or a girl?” the man yelled at the protester, gripping a rainbow Trump flag in his fists. “She shaves her armpits, so it must be a man,” he spat, cursing and hurling epithets. 

On the podium, the transphobic messaging was less vile but no less overt. Speakers were urging the small crowd to vote against Proposal 1, a measure on the November ballot that would strengthen protections for abortion in New York state—and much more. Prop 1 is a statewide version of the Equal Rights Amendment (ERA), the 101-year-old feminist effort to guarantee equal rights for women in the US Constitution. While the federal ERA has been largely stalled since the 1970s, many states have adopted their own versions. New York’s constitution, however, currently bans discrimination based only on race and religion, not sex. That could change if voters accept Prop 1’s expansive vision of equality, which includes protections for segments of the population that historically have been marginalized and demonized, including LGBTQ people.

In a year in which support for abortion rights could determine control of statehouses, Congress, and the presidency, Prop 1 seemed like a shoo-in, especially in the blue state of New York. Yet with a little over a month before the election, the effort to pass the New York ERA has been stumbling. An opposition campaign, calling itself the Coalition to Protect Kids, has fixated on the amendment’s protections for trans people, exaggerating its impact on women’s sports and pushing misleading claims about its effects on parental rights. “By solidifying new constitutional rights based on gender identity, Prop 1 is sacrificing the rights of girls,” Amaya Perez, the New York chapter leader of Gays Against Groomers, a right-wing group known for pushing extremist anti-LBGTQ narratives, said at the press conference. 

Those tactics appear to be working. Leaked polling from the pro-Prop 1 campaign shows that voters find the opposition’s messages extremely persuasive. Months ago, Democrats saw the amendment as a means of motivating liberal turnout in November. Now, state Democratic politics are in a precarious state following the indictment of New York Mayor Eric Adams, and Republican candidates are turning the tables, using opposition to Prop 1 as a rallying cry for their own voters.

“They’re trying to use [trans rights] as a wedge issue,” says Faris Ilyas, policy counsel at the New Pride Agenda, an LGBTQ rights group supporting Prop 1. “Even in New York, it’s a working strategy. We’re a little bit scared of what might happen in November.”

It’s an old trick in conservative politics to argue that equal rights are bad for women. The federal ERA, which says equal rights cannot be denied “on account of sex,” was first drafted by leaders of the women’s suffrage movement in 1923 and introduced in every session of Congress for the next five decades. After it finally passed both the House and Senate in 1972, the next step was to go to the states: An amendment must be ratified by three-quarters of state legislatures before it can be added to the US Constitution. But conservative lawyer Phyllis Schlafly mounted a successful guerrilla campaign claiming the amendment would erase all differences between men and women in the law, thus forcing women into military combat, permitting same-sex marriage, and allowing men to use women’s restrooms. The ERA failed to reach the ratification threshold within the seven-year deadline, though efforts to revive and certify it continue.

Even without the ERA, Schlafly’s predictions have more or less come true: The culture already was shifting toward the kinds of gender equality the amendment attempted to codify. Yet her arguments still hold power. Warnings about mixed-gender bathrooms were used to defeat Houston’s Equal Rights Ordinance in 2015—around the same time conservative legal and political organizations, including the Schlafly-founded Eagle Forum, began whipping up the contemporary anti-trans panic, starting with bills restricting trans students’ bathroom access.

The version of the ERA that will appear on New York ballots doesn’t include the word “abortion,” but it was designed first and foremost to protect the right to choose. The effort started in 2019, when Democrats took control of the state Senate for the first time in a decade. They swiftly passed the Reproductive Health Act, removing abortion from New York’s criminal code—where it had been largely forgotten during the Roe v. Wade era—and protecting access to the procedure through 24 weeks’ gestation. (The new law also allowed abortion later in pregnancy if the fetus was not viable or if the pregnant person’s life or health was in danger.) But soon after, state Sen. Liz Krueger of Manhattan, who had spent a decade shepherding the new law, decided the work wasn’t done. “I realized, nope, not good enough,” Krueger says. “We’ve got to actually start to open up our constitution and modernize it.”

With the confirmation of Justice Brett Kavanaugh to the US Supreme Court in 2018, anti-abortion strategists finally had the far-right majority they needed to overturn Roe. “We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law,” Krueger says. If New York enshrined abortion rights in the state constitution, she figured, those protections would be harder to repeal if the political winds eventually shifted.

So Krueger and Assembly Member Rebecca Seawright, also from Manhattan, convened scholars and reproductive law experts to craft an amendment. Rather than simply writing protections for abortion seekers into the constitution, they decided to swing for the fences: a measure modeled on the federal ERA but even broader. In addition to existing protections for race, color, and religion, Prop 1 would ban government discrimination based on disability, age, ethnicity, national origin, and sex—including sexual orientation, gender identity, and gender expression. The resulting amendment, now known as Prop 1, would make New York’s anti-discrimination protections the “most extensive” in the nation, says Ting Ting Cheng, director of the ERA Project at Columbia Law School, who consulted with the drafters. 

“We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law.”

There are nine other abortion rights ballot initiatives across the country this year, but when it comes to reproductive rights, New York’s ERA is unique. While most of the other measures essentially restore Roe, New York’s approaches abortion “as a matter of gender equality,” says Katharine Bodde, policy co-director of the New York Civil Liberties Union, one of the amendment’s chief backers. To accomplish this, it explicitly says discrimination based on pregnancy status, pregnancy outcomes, and reproductive health care and autonomy count as “sex discrimination” and are forbidden. The idea is to leave little room for judges to interpret the ERA in ways that wouldn’t protect abortion rights or pregnant people in the future. After all, courts have wide latitude to interpret ambiguous language, and they sometimes reconsider their old interpretations—as the US Supreme Court did when it reversed Roe. This past spring, Florida’s Supreme Court overturned a prior decision that said the state constitution protected abortion—after being stacked with judges appointed by Republican Gov. Ron DeSantis. And the Iowa Supreme Court has upheld a six-week abortion ban despite the state’s ERA, which broadly enshrines gender equality but doesn’t get into specifics. “We’re taking no chances in New York with courts interpreting ‘sex discrimination’ narrowly,” Bodde says. 

That scares abortion opponents. New York’s Catholic bishops told their 35,000 mailing list subscribers in September that Prop 1 would “permanently legalize abortion without restriction” and “render impossible any change to the law if the hearts and minds of New Yorkers were ever to shift toward protecting the child in the womb.”

Prop 1 follows an ERA in Nevada two years ago, which passed with 58 percent of the vote after being pitched to the state’s fiercely independent residents as a means of protecting individual liberty. The Nevada ERA overcame opposition from anti-abortion forces—including the religious-right legal firm Alliance Defending Freedom—which predicted that the measure would void Nevada’s ban on Medicaid coverage for abortion. (It was right.) Next up: An expansive ERA is slated for the 2026 ballot in Minnesota, and another is on the table in Oregon. “It’s incremental,” Cheng says. “Every state that does something new, it creates a new bar or a new precedent for other states to go beyond that.”

These amendments work in two ways. First, they harden the state’s existing constellation of anti-discrimination laws by adding them to the state constitution. And second, they give individuals strong constitutional grounds to challenge discrimination by the government. In New York, Prop 1’s  protections for different “pregnancy outcomes” might be used to defend women from criminal prosecution after self-managed abortions or losing a pregnancy in a car accident—both of which have happened in New York, says Dana Sussman, senior vice president of Pregnancy Justice, a nonprofit legal advocacy group. And it might be used to challenge state hospitals that drug test pregnant women, sometimes without their knowledge or consent—policies that can lead to child protection cases and family separation.

Other activists hope the ERA could be used to overturn the state’s 24-week gestational limit, which forces some New Yorkers to travel out of state if—for one of the many reasons women can face delays in accessing care—they need a later abortion. Randi Gregory, vice president of political and legislative affairs at the National Institute for Reproductive Health Action Fund, believes Prop 1 would protect abortion rights “at all trimesters.” “We hope that it will be a framework for other states,” Gregory adds. “We’re really excited to be running an expansive and proactive amendment.”

But that’s only if they can get it passed—a task that looks increasingly daunting.

The coalition behind Prop 1 made big promises in June 2023, after New York Democrats’ embarrassing showing in the 2022 election. Their losses had helped flip control of the US House of Representatives back to the GOP, while former US Rep. Lee Zeldin, an anti-abortion Republican, came within 6 points of winning the governorship.

State Democrats evidently had an excitement problem—one they hoped the ERA could solve. Gov. Kathy Hochul and Sen. Kirsten Gillibrand told the New York Times that they wanted to use the amendment to motivate 2024 turnout. Progressive groups formed New Yorkers for Equal Rights, a committee that pledged to spend $20 million ginning up enthusiasm.

Yet in early September, Politico reported that the committee had raised less than $3 million to counter an opposition that had proven surprisingly well-organized and effective. Suddenly, Democrats were afraid of how Prop 1 might affect their candidates in tight races. In the ensuing scramble, Hochul announced $1 million for TV ads and direct mail and issued a statement: “It’s critical voters know that an abortion amendment is on the ballot in New York this year,” she said. “New Yorkers deserve the freedom to control their own lives and health care decisions, including the right to abortion regardless of who’s in office.”

The opposition campaign, the Coalition to Protect Kids, is largely funded by an upstate anti-abortion activist, Carol Crossed, who is vice president of Feminists Choosing Life of New York. Yet it has leaned heavily on anti-trans rhetoric, arguing the amendment would increase trans people’s access to girls’ sports, women’s bathrooms, and gender-affirming medical care—and that these things would be dangerous. “Anti-abortion extremists are pushing a harmful and cruel agenda,” says Sasha Ahuja, campaign director for New Yorkers for Equal Rights. “They’re lying about a small handful of innocent kids to divide New Yorkers and distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

“They’re lying . . . [to] distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

According to New York politics magazine City & State, internal polling shared with ERA proponents in late August found that 64 percent of voters would definitely, likely, or lean toward voting yes on the amendment when presented with its ballot language. But support plummeted by 24 percentage points after voters heard an attack message focused on girls’ sports, transgender protections, and immigration. (Another blatant lie spread by opponents is that Prop 1 would allow undocumented immigrants to vote.)

Ilyas believes the anti-trans messaging gains credence because many voters don’t have personal experience or relationships with trans people. “When you don’t know a trans person, you have this well-funded messaging at you, and people that you trust are saying the same exact thing and reiterating it, it makes sense for even the average New Yorker who’s middle of the road to believe it,” Ilyas says.

Anti-trans attacks have become a go-to strategy for conservative groups fighting abortion rights ballot initiatives. Opponents to Ohio’s abortion rights measure last year claimed it would permit minors to undergo gender-affirming surgery “without parents’ knowledge or consent” and dubbed it an “anti-parent amendment.” (Such surgeries for minors are very rare, and consent from parents or guardians is required.) In Missouri, a last-ditch lawsuit in September tried to block an abortion rights measure from this fall’s ballot by arguing that it might affect laws around single-sex bathrooms and that the voter petition should have disclosed that. (The state Supreme Court didn’t buy it.)

In New York, Prop 1 supporters have repeatedly pointed out that the amendment says nothing directly about trans participation in sports. In fact, trans inclusion in sports is already New York’s status quo, thanks to existing anti-discrimination laws and a state policy allowing trans students to participate on sports teams matching their gender identity. But like Phyllis Schlafly, Prop 1’s opponents love a dire warning: Lawn signs saying, “Save Girls Sports, Vote No Prop 1,” have become a regular sight in some areas. Republican politicians have been picking up on the theme, including Zeldin, the former congressman, and Gina Arena, a GOP candidate for the state Senate from the lower Hudson Valley.

On Long Island, Nassau County Executive Bruce Blakeman and the Republican-dominated county legislature passed a law this past summer blocking permits for women’s sports teams that include trans women, preventing them from using more than 100 county-run parks and athletics facilities. In response, the New York Civil Liberties Union sued the county on behalf of a women’s roller derby league, citing existing New York civil and human rights laws that forbid discrimination based on gender identity, sex, and disability. If the ERA was in the state constitution, lawyers for the league would doubtless argue that Nassau County had violated it as well. “Transgender athletes have been competing and allowed to compete in the state for a really long time now,” Cheng says. “That’s not going to change because of the ERA.”

“Transgender athletes have been competing and allowed to compete in the state for a really long time now. That’s not going to change because of the ERA.”

Still, uncertainty around which laws the ERA might challenge has been a boon to opponents. On its website, the Coalition to Protect Kids claims that banning age discrimination, for instance, would gut laws governing the drinking age, statutory rape, and parental consent for minors to receive medical treatments—especially gender-affirming care. Bodde dismisses these arguments as “misinformation” meant to “stir fear.” Courts have been clear that constitutional rights apply differently to minors and adults, she says, even despite laws forbidding age discrimination. “The state has long been able to create different rules when it comes to young people, whether that’s ensuring a certain age before people can learn how to drive or vote or purchase alcohol.”

But fear and confusion are powerful tools. Prop 1’s opponents have dubbed the ERA the “Parent Replacement Act.” On social media, the Coalition to Protect Kids has repeatedly cited the American College of Pediatricians, a misleadingly named fringe group of anti-LGBTQ doctors whose frequent declarations against gender-affirming care run counter to the conclusions of dozens of major medical associations. Sometimes the claims slip into self-parody: “If Prop One passes…children will mutilate themselves without the benefit of parental guidance,” reads a mailer sent to voters by the New York Republican State Committee. 

For Ilyas, who is transmasculine, the extremist rhetoric feels very personal—and deeply worrisome. “People don’t think that it could happen in New York, just because it’s New York,” Ilyas says. “These people do exist in New York, and they just maybe haven’t had an outlet.”

In late August, on the fringes of a press conference outside New York City Hall, a man wearing a “Kill your local pedophile” T-shirt and a “Babies Lives Matter” pin screamed at a transgender woman who had shown up to protest the speeches. “Is it a boy or a girl?” the man yelled at the protester, gripping a rainbow Trump flag in his fists. “She shaves her armpits, so it must be a man,” he spat, cursing and hurling epithets. 

On the podium, the transphobic messaging was less vile but no less overt. Speakers were urging the small crowd to vote against Proposal 1, a measure on the November ballot that would strengthen protections for abortion in New York state—and much more. Prop 1 is a statewide version of the Equal Rights Amendment (ERA), the 101-year-old feminist effort to guarantee equal rights for women in the US Constitution. While the federal ERA has been largely stalled since the 1970s, many states have adopted their own versions. New York’s constitution, however, currently bans discrimination based only on race and religion, not sex. That could change if voters accept Prop 1’s expansive vision of equality, which includes protections for segments of the population that historically have been marginalized and demonized, including LGBTQ people.

In a year in which support for abortion rights could determine control of statehouses, Congress, and the presidency, Prop 1 seemed like a shoo-in, especially in the blue state of New York. Yet with a little over a month before the election, the effort to pass the New York ERA has been stumbling. An opposition campaign, calling itself the Coalition to Protect Kids, has fixated on the amendment’s protections for trans people, exaggerating its impact on women’s sports and pushing misleading claims about its effects on parental rights. “By solidifying new constitutional rights based on gender identity, Prop 1 is sacrificing the rights of girls,” Amaya Perez, the New York chapter leader of Gays Against Groomers, a right-wing group known for pushing extremist anti-LBGTQ narratives, said at the press conference. 

Those tactics appear to be working. Leaked polling from the pro-Prop 1 campaign shows that voters find the opposition’s messages extremely persuasive. Months ago, Democrats saw the amendment as a means of motivating liberal turnout in November. Now, state Democratic politics are in a precarious state following the indictment of New York Mayor Eric Adams, and Republican candidates are turning the tables, using opposition to Prop 1 as a rallying cry for their own voters.

“They’re trying to use [trans rights] as a wedge issue,” says Faris Ilyas, policy counsel at the New Pride Agenda, an LGBTQ rights group supporting Prop 1. “Even in New York, it’s a working strategy. We’re a little bit scared of what might happen in November.”

It’s an old trick in conservative politics to argue that equal rights are bad for women. The federal ERA, which says equal rights cannot be denied “on account of sex,” was first drafted by leaders of the women’s suffrage movement in 1923 and introduced in every session of Congress for the next five decades. After it finally passed both the House and Senate in 1972, the next step was to go to the states: An amendment must be ratified by three-quarters of state legislatures before it can be added to the US Constitution. But conservative lawyer Phyllis Schlafly mounted a successful guerrilla campaign claiming the amendment would erase all differences between men and women in the law, thus forcing women into military combat, permitting same-sex marriage, and allowing men to use women’s restrooms. The ERA failed to reach the ratification threshold within the seven-year deadline, though efforts to revive and certify it continue.

Even without the ERA, Schlafly’s predictions have more or less come true: The culture already was shifting toward the kinds of gender equality the amendment attempted to codify. Yet her arguments still hold power. Warnings about mixed-gender bathrooms were used to defeat Houston’s Equal Rights Ordinance in 2015—around the same time conservative legal and political organizations, including the Schlafly-founded Eagle Forum, began whipping up the contemporary anti-trans panic, starting with bills restricting trans students’ bathroom access.

The version of the ERA that will appear on New York ballots doesn’t include the word “abortion,” but it was designed first and foremost to protect the right to choose. The effort started in 2019, when Democrats took control of the state Senate for the first time in a decade. They swiftly passed the Reproductive Health Act, removing abortion from New York’s criminal code—where it had been largely forgotten during the Roe v. Wade era—and protecting access to the procedure through 24 weeks’ gestation. (The new law also allowed abortion later in pregnancy if the fetus was not viable or if the pregnant person’s life or health was in danger.) But soon after, state Sen. Liz Krueger of Manhattan, who had spent a decade shepherding the new law, decided the work wasn’t done. “I realized, nope, not good enough,” Krueger says. “We’ve got to actually start to open up our constitution and modernize it.”

With the confirmation of Justice Brett Kavanaugh to the US Supreme Court in 2018, anti-abortion strategists finally had the far-right majority they needed to overturn Roe. “We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law,” Krueger says. If New York enshrined abortion rights in the state constitution, she figured, those protections would be harder to repeal if the political winds eventually shifted.

So Krueger and Assembly Member Rebecca Seawright, also from Manhattan, convened scholars and reproductive law experts to craft an amendment. Rather than simply writing protections for abortion seekers into the constitution, they decided to swing for the fences: a measure modeled on the federal ERA but even broader. In addition to existing protections for race, color, and religion, Prop 1 would ban government discrimination based on disability, age, ethnicity, national origin, and sex—including sexual orientation, gender identity, and gender expression. The resulting amendment, now known as Prop 1, would make New York’s anti-discrimination protections the “most extensive” in the nation, says Ting Ting Cheng, director of the ERA Project at Columbia Law School, who consulted with the drafters. 

“We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law.”

There are nine other abortion rights ballot initiatives across the country this year, but when it comes to reproductive rights, New York’s ERA is unique. While most of the other measures essentially restore Roe, New York’s approaches abortion “as a matter of gender equality,” says Katharine Bodde, policy co-director of the New York Civil Liberties Union, one of the amendment’s chief backers. To accomplish this, it explicitly says discrimination based on pregnancy status, pregnancy outcomes, and reproductive health care and autonomy count as “sex discrimination” and are forbidden. The idea is to leave little room for judges to interpret the ERA in ways that wouldn’t protect abortion rights or pregnant people in the future. After all, courts have wide latitude to interpret ambiguous language, and they sometimes reconsider their old interpretations—as the US Supreme Court did when it reversed Roe. This past spring, Florida’s Supreme Court overturned a prior decision that said the state constitution protected abortion—after being stacked with judges appointed by Republican Gov. Ron DeSantis. And the Iowa Supreme Court has upheld a six-week abortion ban despite the state’s ERA, which broadly enshrines gender equality but doesn’t get into specifics. “We’re taking no chances in New York with courts interpreting ‘sex discrimination’ narrowly,” Bodde says. 

That scares abortion opponents. New York’s Catholic bishops told their 35,000 mailing list subscribers in September that Prop 1 would “permanently legalize abortion without restriction” and “render impossible any change to the law if the hearts and minds of New Yorkers were ever to shift toward protecting the child in the womb.”

Prop 1 follows an ERA in Nevada two years ago, which passed with 58 percent of the vote after being pitched to the state’s fiercely independent residents as a means of protecting individual liberty. The Nevada ERA overcame opposition from anti-abortion forces—including the religious-right legal firm Alliance Defending Freedom—which predicted that the measure would void Nevada’s ban on Medicaid coverage for abortion. (It was right.) Next up: An expansive ERA is slated for the 2026 ballot in Minnesota, and another is on the table in Oregon. “It’s incremental,” Cheng says. “Every state that does something new, it creates a new bar or a new precedent for other states to go beyond that.”

These amendments work in two ways. First, they harden the state’s existing constellation of anti-discrimination laws by adding them to the state constitution. And second, they give individuals strong constitutional grounds to challenge discrimination by the government. In New York, Prop 1’s  protections for different “pregnancy outcomes” might be used to defend women from criminal prosecution after self-managed abortions or losing a pregnancy in a car accident—both of which have happened in New York, says Dana Sussman, senior vice president of Pregnancy Justice, a nonprofit legal advocacy group. And it might be used to challenge state hospitals that drug test pregnant women, sometimes without their knowledge or consent—policies that can lead to child protection cases and family separation.

Other activists hope the ERA could be used to overturn the state’s 24-week gestational limit, which forces some New Yorkers to travel out of state if—for one of the many reasons women can face delays in accessing care—they need a later abortion. Randi Gregory, vice president of political and legislative affairs at the National Institute for Reproductive Health Action Fund, believes Prop 1 would protect abortion rights “at all trimesters.” “We hope that it will be a framework for other states,” Gregory adds. “We’re really excited to be running an expansive and proactive amendment.”

But that’s only if they can get it passed—a task that looks increasingly daunting.

The coalition behind Prop 1 made big promises in June 2023, after New York Democrats’ embarrassing showing in the 2022 election. Their losses had helped flip control of the US House of Representatives back to the GOP, while former US Rep. Lee Zeldin, an anti-abortion Republican, came within 6 points of winning the governorship.

State Democrats evidently had an excitement problem—one they hoped the ERA could solve. Gov. Kathy Hochul and Sen. Kirsten Gillibrand told the New York Times that they wanted to use the amendment to motivate 2024 turnout. Progressive groups formed New Yorkers for Equal Rights, a committee that pledged to spend $20 million ginning up enthusiasm.

Yet in early September, Politico reported that the committee had raised less than $3 million to counter an opposition that had proven surprisingly well-organized and effective. Suddenly, Democrats were afraid of how Prop 1 might affect their candidates in tight races. In the ensuing scramble, Hochul announced $1 million for TV ads and direct mail and issued a statement: “It’s critical voters know that an abortion amendment is on the ballot in New York this year,” she said. “New Yorkers deserve the freedom to control their own lives and health care decisions, including the right to abortion regardless of who’s in office.”

The opposition campaign, the Coalition to Protect Kids, is largely funded by an upstate anti-abortion activist, Carol Crossed, who is vice president of Feminists Choosing Life of New York. Yet it has leaned heavily on anti-trans rhetoric, arguing the amendment would increase trans people’s access to girls’ sports, women’s bathrooms, and gender-affirming medical care—and that these things would be dangerous. “Anti-abortion extremists are pushing a harmful and cruel agenda,” says Sasha Ahuja, campaign director for New Yorkers for Equal Rights. “They’re lying about a small handful of innocent kids to divide New Yorkers and distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

“They’re lying . . . [to] distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

According to New York politics magazine City & State, internal polling shared with ERA proponents in late August found that 64 percent of voters would definitely, likely, or lean toward voting yes on the amendment when presented with its ballot language. But support plummeted by 24 percentage points after voters heard an attack message focused on girls’ sports, transgender protections, and immigration. (Another blatant lie spread by opponents is that Prop 1 would allow undocumented immigrants to vote.)

Ilyas believes the anti-trans messaging gains credence because many voters don’t have personal experience or relationships with trans people. “When you don’t know a trans person, you have this well-funded messaging at you, and people that you trust are saying the same exact thing and reiterating it, it makes sense for even the average New Yorker who’s middle of the road to believe it,” Ilyas says.

Anti-trans attacks have become a go-to strategy for conservative groups fighting abortion rights ballot initiatives. Opponents to Ohio’s abortion rights measure last year claimed it would permit minors to undergo gender-affirming surgery “without parents’ knowledge or consent” and dubbed it an “anti-parent amendment.” (Such surgeries for minors are very rare, and consent from parents or guardians is required.) In Missouri, a last-ditch lawsuit in September tried to block an abortion rights measure from this fall’s ballot by arguing that it might affect laws around single-sex bathrooms and that the voter petition should have disclosed that. (The state Supreme Court didn’t buy it.)

In New York, Prop 1 supporters have repeatedly pointed out that the amendment says nothing directly about trans participation in sports. In fact, trans inclusion in sports is already New York’s status quo, thanks to existing anti-discrimination laws and a state policy allowing trans students to participate on sports teams matching their gender identity. But like Phyllis Schlafly, Prop 1’s opponents love a dire warning: Lawn signs saying, “Save Girls Sports, Vote No Prop 1,” have become a regular sight in some areas. Republican politicians have been picking up on the theme, including Zeldin, the former congressman, and Gina Arena, a GOP candidate for the state Senate from the lower Hudson Valley.

On Long Island, Nassau County Executive Bruce Blakeman and the Republican-dominated county legislature passed a law this past summer blocking permits for women’s sports teams that include trans women, preventing them from using more than 100 county-run parks and athletics facilities. In response, the New York Civil Liberties Union sued the county on behalf of a women’s roller derby league, citing existing New York civil and human rights laws that forbid discrimination based on gender identity, sex, and disability. If the ERA was in the state constitution, lawyers for the league would doubtless argue that Nassau County had violated it as well. “Transgender athletes have been competing and allowed to compete in the state for a really long time now,” Cheng says. “That’s not going to change because of the ERA.”

“Transgender athletes have been competing and allowed to compete in the state for a really long time now. That’s not going to change because of the ERA.”

Still, uncertainty around which laws the ERA might challenge has been a boon to opponents. On its website, the Coalition to Protect Kids claims that banning age discrimination, for instance, would gut laws governing the drinking age, statutory rape, and parental consent for minors to receive medical treatments—especially gender-affirming care. Bodde dismisses these arguments as “misinformation” meant to “stir fear.” Courts have been clear that constitutional rights apply differently to minors and adults, she says, even despite laws forbidding age discrimination. “The state has long been able to create different rules when it comes to young people, whether that’s ensuring a certain age before people can learn how to drive or vote or purchase alcohol.”

But fear and confusion are powerful tools. Prop 1’s opponents have dubbed the ERA the “Parent Replacement Act.” On social media, the Coalition to Protect Kids has repeatedly cited the American College of Pediatricians, a misleadingly named fringe group of anti-LGBTQ doctors whose frequent declarations against gender-affirming care run counter to the conclusions of dozens of major medical associations. Sometimes the claims slip into self-parody: “If Prop One passes…children will mutilate themselves without the benefit of parental guidance,” reads a mailer sent to voters by the New York Republican State Committee. 

For Ilyas, who is transmasculine, the extremist rhetoric feels very personal—and deeply worrisome. “People don’t think that it could happen in New York, just because it’s New York,” Ilyas says. “These people do exist in New York, and they just maybe haven’t had an outlet.”

Last August, the American Academy of Pediatrics renewed its guidance supporting the use of puberty blockers, hormone therapy, and other medical care for transgender children and teens. At a time when trans issues have moved to the center of the culture wars, the AAP—the main medical association representing US pediatricians, with 67,000 members—said its action was aimed at supporting trans minors amid new waves of anti-trans laws.

Now, Republican officials from 21 states have accused the medical group of violating state consumer protection laws by supporting gender-affirming care for trans youth. More ominously, they’re demanding that the AAP turn over extensive records about how it developed its policy. 

In a letter signed by Idaho Attorney General Raúl Labrador and sent to the medical group this week, the GOP officials claim that the AAP is misleading parents and the public about the reversibility of puberty blockers and hormone therapy. The letter calls gender-affirming care “medical experimentation” and demands the AAP produce years’ worth of communications and documents related to its guidance for treating trans youth.

“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country.”

The letter was signed by the usual array of Republican suspects, including the top lawyers of Texas, Ohio, Florida, and nearly every state with laws restricting gender-affirming care. As state bans face legal challenges and injunctions, these attorneys general appear to be laying the groundwork for a new strategy to further their ideological agendas over the objections of medical experts.

The AAP is the leading US authority on pediatric health care, regularly releasing policy statements on a slew of topics, including medical treatment of LGBTQ youth. Last year, in addition to reaffirming its 2018 guidance on gender-affirming care, the AAP board of directors also authorized a systematic review of existing research to develop an “expanded set of guidance” for pediatricians. The 2018 policy statement supports a “collaborative, multidisciplinary approach” to treating gender dysphoria in trans youth that includes the ongoing, informed consent of the child and parents. 

The GOP officials’ latest salvo disregards the AAP’s expertise and presents a bad-faith interpretation of the association’s gender-care policy. “Children with gender dysphoria need and deserve love, support, and medical care rooted in biological reality,” Labrador asserted in a statement announcing the letter. “Parents should be able to trust that a doctor’s medical guidance isn’t just the latest talking point from a dangerous and discredited activist agenda.”

Labrador’s letter leans heavily on a dispute over whether puberty blockers are reversible, citing the UK-commissioned Cass Review, issued this past April, which experts have criticized for its methodology and biased assertions about gender identity. “Telling parents and children that puberty blockers are ‘reversible’ at the very least conveys assurance that no permanent harm or change will occur,” the letter reads. “But that claim cannot be made in the face of the unstudied and ‘novel’ use of puberty blockers to treat gender dysphoria.” 

In fact, AAP itself emphasizes that there are risks associated with the use of puberty blockers to treat gender dysphoria—mostly the potential for distress caused by social stigma. Research on long-term effects is limited and varied, with some studies suggesting impacts on bone density and fertility. As the Mayo Clinic points out, bone density concerns are typically addressed with calcium and vitamin D supplements. Meanwhile, organizations including AAP and the World Professional Association for Transgender Health (WPATH) recommend that before initiating treatments, providers and patients extensively discuss the fertility implications and options. Indeed, the gap in long-term research on gender-affirming care is precisely why AAP and other experts advocate for the continued study of evidence-based practices.

The Republican officials gave the AAP until October 8 to hand over all its communications with WPATH related to standards of care, dating back to 2020; all communications with the White House regarding gender-affirming care, and “substantiation” for many aspects of the AAP’s 2018 guidance. That policy statement already includes nearly 100 citations, including systematic reviews, AAP committee findings, and other organizations’ standards of care.

The AAP did not respond to Mother Jones’ request for comment.

Twenty-six states have passed laws restricting gender-affirming care for trans youth, according to the health policy think tank KFF. In Idaho—where Labrador is the top law enforcement official—medical providers face felony charges and up to 10 years in prison for prescribing puberty blockers and hormone therapy to trans minors. Most state bans, including Idaho’s, are facing legal challenges, but so far, only Arkansas’ law has been permanently blocked. (Florida’s ban, which also restricts care for trans adults, is in effect while the state appeals.) The US Supreme Court will hear a case this term regarding the constitutionality of Tennessee’s ban on the use of puberty blockers and hormones in trans youth. 

Meanwhile, the effect of laws targeting transgender youth and adults is becoming increasingly evident. A new study by researchers from The Trevor Project, published in the journal Nature Human Behavior, suggests a causal link between anti-trans laws and suicide attempts in trans people. The study of 61,000 transgender and nonbinary kids and young adults, conducted from 2018 to 2022, found that attempted suicide among trans children increased by as much as 72 percent in states that passed restrictions on gender-affirming care.

“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country,” says Jaymes Black, CEO of The Trevor Project. “It’s not necessary to fully understand their experience to acknowledge that they—like all young people—deserve dignity, respect, and the ability to lead healthy and full lives.”

Last August, the American Academy of Pediatrics renewed its guidance supporting the use of puberty blockers, hormone therapy, and other medical care for transgender children and teens. At a time when trans issues have moved to the center of the culture wars, the AAP—the main medical association representing US pediatricians, with 67,000 members—said its action was aimed at supporting trans minors amid new waves of anti-trans laws.

Now, Republican officials from 21 states have accused the medical group of violating state consumer protection laws by supporting gender-affirming care for trans youth. More ominously, they’re demanding that the AAP turn over extensive records about how it developed its policy. 

In a letter signed by Idaho Attorney General Raúl Labrador and sent to the medical group this week, the GOP officials claim that the AAP is misleading parents and the public about the reversibility of puberty blockers and hormone therapy. The letter calls gender-affirming care “medical experimentation” and demands the AAP produce years’ worth of communications and documents related to its guidance for treating trans youth.

“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country.”

The letter was signed by the usual array of Republican suspects, including the top lawyers of Texas, Ohio, Florida, and nearly every state with laws restricting gender-affirming care. As state bans face legal challenges and injunctions, these attorneys general appear to be laying the groundwork for a new strategy to further their ideological agendas over the objections of medical experts.

The AAP is the leading US authority on pediatric health care, regularly releasing policy statements on a slew of topics, including medical treatment of LGBTQ youth. Last year, in addition to reaffirming its 2018 guidance on gender-affirming care, the AAP board of directors also authorized a systematic review of existing research to develop an “expanded set of guidance” for pediatricians. The 2018 policy statement supports a “collaborative, multidisciplinary approach” to treating gender dysphoria in trans youth that includes the ongoing, informed consent of the child and parents. 

The GOP officials’ latest salvo disregards the AAP’s expertise and presents a bad-faith interpretation of the association’s gender-care policy. “Children with gender dysphoria need and deserve love, support, and medical care rooted in biological reality,” Labrador asserted in a statement announcing the letter. “Parents should be able to trust that a doctor’s medical guidance isn’t just the latest talking point from a dangerous and discredited activist agenda.”

Labrador’s letter leans heavily on a dispute over whether puberty blockers are reversible, citing the UK-commissioned Cass Review, issued this past April, which experts have criticized for its methodology and biased assertions about gender identity. “Telling parents and children that puberty blockers are ‘reversible’ at the very least conveys assurance that no permanent harm or change will occur,” the letter reads. “But that claim cannot be made in the face of the unstudied and ‘novel’ use of puberty blockers to treat gender dysphoria.” 

In fact, AAP itself emphasizes that there are risks associated with the use of puberty blockers to treat gender dysphoria—mostly the potential for distress caused by social stigma. Research on long-term effects is limited and varied, with some studies suggesting impacts on bone density and fertility. As the Mayo Clinic points out, bone density concerns are typically addressed with calcium and vitamin D supplements. Meanwhile, organizations including AAP and the World Professional Association for Transgender Health (WPATH) recommend that before initiating treatments, providers and patients extensively discuss the fertility implications and options. Indeed, the gap in long-term research on gender-affirming care is precisely why AAP and other experts advocate for the continued study of evidence-based practices.

The Republican officials gave the AAP until October 8 to hand over all its communications with WPATH related to standards of care, dating back to 2020; all communications with the White House regarding gender-affirming care, and “substantiation” for many aspects of the AAP’s 2018 guidance. That policy statement already includes nearly 100 citations, including systematic reviews, AAP committee findings, and other organizations’ standards of care.

The AAP did not respond to Mother Jones’ request for comment.

Twenty-six states have passed laws restricting gender-affirming care for trans youth, according to the health policy think tank KFF. In Idaho—where Labrador is the top law enforcement official—medical providers face felony charges and up to 10 years in prison for prescribing puberty blockers and hormone therapy to trans minors. Most state bans, including Idaho’s, are facing legal challenges, but so far, only Arkansas’ law has been permanently blocked. (Florida’s ban, which also restricts care for trans adults, is in effect while the state appeals.) The US Supreme Court will hear a case this term regarding the constitutionality of Tennessee’s ban on the use of puberty blockers and hormones in trans youth. 

Meanwhile, the effect of laws targeting transgender youth and adults is becoming increasingly evident. A new study by researchers from The Trevor Project, published in the journal Nature Human Behavior, suggests a causal link between anti-trans laws and suicide attempts in trans people. The study of 61,000 transgender and nonbinary kids and young adults, conducted from 2018 to 2022, found that attempted suicide among trans children increased by as much as 72 percent in states that passed restrictions on gender-affirming care.

“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country,” says Jaymes Black, CEO of The Trevor Project. “It’s not necessary to fully understand their experience to acknowledge that they—like all young people—deserve dignity, respect, and the ability to lead healthy and full lives.”

Valentina Gomez, the 25-year-old former Missouri Secretary of State candidate known for crass posts—like calling her opponents “weak and gay” while jogging in a tactical vest—lost her eight-way primary last night.

Gomez rose to national (or maybe just very online) prominence by posting wildly. She declared that she would protect Missourians from the “transgender industry,” using a flamethrower to burn books in a campaign advertisement. She parted ways with her former employer, the dog food company Purina, and then told her fans to “feed your dogs something that is not weak and gay.” She instructed Black Americans to leave the country in a Juneteenth message. She recently said the Olympics were catering to “faggots.” 

On Tuesday, Gomez discovered that Twitter is not real.  She lost—and badly—with only about 7 percent of the vote.

@LupeFiasco is weak and gay. You should thank me for making you relevant again, after 15 years of not producing a hit. @elonmusk thank you for buying @X Long Live Freedom thanks @Sony for being a fan pic.twitter.com/9RZ5cf1tn8

— Valentina Gomez (@ValentinaForSOS) May 17, 2024

Gomez’s minor celebrity, however, may distract from what actually happened in Missouri. The Republican nomination for Secretary of State was won by Denny Hoskins, a Missouri legislator and State Freedom Caucus member who wants to reform state election law in order to “ensure that none of the electoral fraud that took place in 2020 and stole the election from President Trump happens here,” as reported by the Missouri Independent.

Beyond his election trutherism, Hoskins is staunchly anti-trans and anti-immigrant, railing in the Missouri senate chambers against gender-affirming care, which he describes as “little kids having their private parts cut off.” 

He is currently embroiled in a federal defamation lawsuit over posts he made misidentifying a Kansas City area mass shooter as an undocumented immigrant. (Hoskins posted a picture of a man at the scene and claimed that he was both the shooter and undocumented—neither claim was true: the man, according to reporting, was both uninvolved and from Kansas.) 

There was never any serious chance that Gomez would win the primary. But her brand of outlandish meme-politicking serves to make equally hard-right politicians look almost reasonable. Would she have been, in office, that far off from Hoskins?

The campiest bigot with the funniest tagline lost her job, her election, and, it seems, her brother’s job (he worked for the Jersey City government and reportedly refused to denounce his sister’s actions).

But that doesn’t mean the Missouri Republican party meaningfully rebuked any of her actual policy positions. On her pet issue, which is transphobia, she seems to say bluntly what others imply.

Andrew Bailey, the incumbent Attorney General who won yesterday’s primary on a Trump endorsement, has described trans healthcare as “a bloody scourge intended to defile innocents.” He shares some of those views with Mike Kehoe, the Republican nominee for governor, who is likely to win in November. No flamethrowers, no tactical vests—but the likely outcome, absent Valentina Gomez’ memeability, is exactly the same: A Missouri Republican party pushing towards the exclusion of trans people from public life. 

Gomez’s small time in the spotlight was a rawer, clearer articulation of ideas that more professional politicians must couch in acceptable language.

One thing to remember though: When Gomez put her beliefs out there bluntly, they were rejected by red-state residents—including and especially those of Gomez’s own hometown.

One writer from the Soulard neighborhood, the gay-friendly area Gomez used as a video backdrop, responded: “Soulardians might be called many things. Gay? Sometimes. But weak? Never. The weak are Gomez’s target audience, who are presumably hunkered down somewhere, anxiously peeking through their blinds at any noise while waiting for the government to come for their guns. By contrast, Soulardians aren’t afraid of shit.”  

Valentina Gomez, the 25-year-old former Missouri Secretary of State candidate known for crass posts—like calling her opponents “weak and gay” while jogging in a tactical vest—lost her eight-way primary last night.

Gomez rose to national (or maybe just very online) prominence by posting wildly. She declared that she would protect Missourians from the “transgender industry,” using a flamethrower to burn books in a campaign advertisement. She parted ways with her former employer, the dog food company Purina, and then told her fans to “feed your dogs something that is not weak and gay.” She instructed Black Americans to leave the country in a Juneteenth message. She recently said the Olympics were catering to “faggots.” 

On Tuesday, Gomez discovered that Twitter is not real.  She lost—and badly—with only about 7 percent of the vote.

@LupeFiasco is weak and gay. You should thank me for making you relevant again, after 15 years of not producing a hit. @elonmusk thank you for buying @X Long Live Freedom thanks @Sony for being a fan pic.twitter.com/9RZ5cf1tn8

— Valentina Gomez (@ValentinaForSOS) May 17, 2024

Gomez’s minor celebrity, however, may distract from what actually happened in Missouri. The Republican nomination for Secretary of State was won by Denny Hoskins, a Missouri legislator and State Freedom Caucus member who wants to reform state election law in order to “ensure that none of the electoral fraud that took place in 2020 and stole the election from President Trump happens here,” as reported by the Missouri Independent.

Beyond his election trutherism, Hoskins is staunchly anti-trans and anti-immigrant, railing in the Missouri senate chambers against gender-affirming care, which he describes as “little kids having their private parts cut off.” 

He is currently embroiled in a federal defamation lawsuit over posts he made misidentifying a Kansas City area mass shooter as an undocumented immigrant. (Hoskins posted a picture of a man at the scene and claimed that he was both the shooter and undocumented—neither claim was true: the man, according to reporting, was both uninvolved and from Kansas.) 

There was never any serious chance that Gomez would win the primary. But her brand of outlandish meme-politicking serves to make equally hard-right politicians look almost reasonable. Would she have been, in office, that far off from Hoskins?

The campiest bigot with the funniest tagline lost her job, her election, and, it seems, her brother’s job (he worked for the Jersey City government and reportedly refused to denounce his sister’s actions).

But that doesn’t mean the Missouri Republican party meaningfully rebuked any of her actual policy positions. On her pet issue, which is transphobia, she seems to say bluntly what others imply.

Andrew Bailey, the incumbent Attorney General who won yesterday’s primary on a Trump endorsement, has described trans healthcare as “a bloody scourge intended to defile innocents.” He shares some of those views with Mike Kehoe, the Republican nominee for governor, who is likely to win in November. No flamethrowers, no tactical vests—but the likely outcome, absent Valentina Gomez’ memeability, is exactly the same: A Missouri Republican party pushing towards the exclusion of trans people from public life. 

Gomez’s small time in the spotlight was a rawer, clearer articulation of ideas that more professional politicians must couch in acceptable language.

One thing to remember though: When Gomez put her beliefs out there bluntly, they were rejected by red-state residents—including and especially those of Gomez’s own hometown.

One writer from the Soulard neighborhood, the gay-friendly area Gomez used as a video backdrop, responded: “Soulardians might be called many things. Gay? Sometimes. But weak? Never. The weak are Gomez’s target audience, who are presumably hunkered down somewhere, anxiously peeking through their blinds at any noise while waiting for the government to come for their guns. By contrast, Soulardians aren’t afraid of shit.”