Brian Lehrer: It's The Brian Lehrer show on WNYC. Good morning everyone. No beating around the bush for an intro today. The legal assault on the rights and even the existence of transgender Americans is reaching crisis proportions. Just in the last two days, the governors of Indiana and Idaho signed bills prohibiting any medical intervention known as gender-affirming care to minors, even with parental consent.

The state senate in Tennessee passed a bill codifying sex as an immutable trait identified at birth. The Kansas legislature just yesterday overrode their governor's veto of a bill that bans transgender girls and women from girls and women's sports. That ban now becomes law, and there are so many more examples. Now, an analysis on Vox says it's a nationally coordinated Republican effort to boost conservative evangelical turnout in the 2024 elections by keeping this issue front and center.

It's curious on the issue of no gender-affirming care for minors even with their parents consent when Republicans are also running on parental rights as a central platform. Parental rights to have it reported to them by schools if their child starts going by new gender pronouns in particular. Here are two parents advocating for that in a CBS News report from Virginia last fall.

Parent 1: My parental rights don't stop where your feelings begin.

Parent 2: You cannot have good quality of education or of mental health excluding the parent from the process.

Brian Lehrer: Parental rights when they're seen as limiting trans expression, no parental rights when they're seen as supporting it. Another ban on any gender-affirming care for minors is being filibustered in Nebraska by a state senator named Machaela Cavanaugh. Don't know if I'm saying her first name right. Who's getting national attention. Here's Cavanaugh on a local ABC affiliate there on Tuesday.

Machaela Cavanaugh: If this legislature collectively decides that legislating hate against children is our priority, then I am going to make it painful, painful for everyone because if you want to inflict pain upon our children, I am going to inflict pain upon this body.

Brian Lehrer: Now, this is happening in state after state. Machaela Kavanaugh there, as the pronunciation of her first name was confirmed to me. Let's talk about it in national context as an assault on one group of Americans legitimacy to be the individuals or even the families that they are. With us now, Alejandra Caraballo, clinical instructor at Harvard Law School's Cyber Law Clinic. Prior to joining the clinic, Alejandra was a staff attorney at the Transgender Legal Defense and Education Fund and a staff attorney at the LGBTQ Law Project at New York's Legal Assistance Group. Alejandra, thanks for joining us. Welcome to WNYC.

Alejandra Caraballo: Thanks for having me.

Brian Lehrer: What's the big national politics picture as you see it? Let's just start right there.

Alejandra Caraballo: Yes. What we're seeing is just basically an entire assault on trans people's right to exist publicly at all. We've already seen 14 states ban gender-affirming care in various different ways. There's two injunctions in Alabama and Arkansas that are preventing those laws from going into effect. The ACLU is planning at least eight lawsuits against states that are planning on banning this care.

We could see by the end of this legislative cycle about 20 different states banning gender-affirming care for trans youth and adding restrictions for care for adults as well but from the political picture, this has become a complete obsession on the rightS particularly, i's not just gender-affirming care, it's also now drag bans. Drag bans that are so broad. In Florida, there's a bill that the sponsor said could essentially ban Rocky Horror Picture Show if it's played live in front of an audience as a musical.

Brian Lehrer: Can I just stop on that for a second?

Alejandra Caraballo: Yes.

Brian Lehrer: For our listeners who hadn't heard that story yet, that probably made a lot of people's ears perk up and go, what? You said the sponsor of the bill said it could ban public showings of The Rocky Horror Picture Show, correct?

Alejandra Caraballo: Yes, because they word these bills so vaguely and the penalties are so high with criminal penalties. There has to be a child present but essentially, if you bring your 17-year-old to a showing of Rocky Horror Pictures, the live stage version, it could end up in the venue being shut down, losing their license, and potentially some of the manager being criminally charged.

Brian Lehrer: Do you agree with the hypocrisy I was framing on the issue of parental rights?

Alejandra Caraballo: Absolutely, in these instances the Republicans have run on parental rights for years now, since the pandemic with regards to kids wearing masks in schools, all of the COVID precautions, and then now this moral panic around critical race theory and what's being taught around issues of race. They say that it has an absolute parental right to block these lessons or to put other kids in danger of catching COVID but when it comes to accessing medical care, that is the standard of care endorsed by every single major medical association, that is supported by both parents and is assented to by the child.

They say, no, your parental rights don't exist there. The legal cases in Arkansas and Alabama have both brought claims of violation of due process of the parents' rights, and it absolutely is a violation of their substantive due process rights as parents to decide the medical care that their child receives.

Brian Lehrer: Listeners, we want to center trans voices on this. If you identify as trans, do you have connections to any state passing or seriously considering any of these kinds of laws? Call and tell your story. The stories of people you know, 212-433-WNYC, 212-433-9692. We'll take calls from other people, too, but trans voices themselves, trans people's voices, don't get into the news as much as people talking about trans people.

One of the things we try to do on this show with all kinds of groups, as you know, is center the people directly affected by whatever and so trans listeners, 212-433-WNYC. You will get first priority, 212-433-9692 with Alejandra Caraballo from Harvard. Alejandra Caraballo, forgive me. 212-433-WNYC, 212-433-9692. How much are we dividing into red and blue countries on this issue? Can we tell a trans-attacking state by the majority and its legislature?

Alejandra Caraballo: Yes, absolutely. Yesterday, Kansas passed a ban on kids participating in sports if they're trans by the gender they identify as, and they overrode the governor's veto. We saw a similar override in North Dakota. Essentially where Republicans have a supermajority, these are passing overwhelmingly but I think one of the things I always try to do is tie this into the broader issue of bodily autonomy.

If you look at the states that are passing this and the states that have passed this, it's almost entirely if you overlay where there are abortion restrictions or bans on abortion and the states that are banning gender-affirming care, it's almost the same exact states. What this really is, is this is a broader attack on bodily autonomy, basically, the states wanting to dictate what you can and can't do with your body. It really is. There hasn't been any states that have protections for abortion rights or overwhelmingly, Democrat that have even really considered these bills.

It's entirely a Republican effort. We've seen about 450 plus bills in these legislatures to restrict rights of trans people, and we're talking about a population that's less than 1%. Right? Overwhelmingly a priority for these legislators. With over 450 bills, oftentimes their first bill introduced. You mentioned Tennessee, the bill banning gender-affirming care was SB1. It was their first bill that they introduced to the legislature. It was their top priority.

Despite the fact that gun deaths and gun violence is the leading cause of children in this country, they decided to spend their time focusing on gender-affirming care instead of things that are actually hurting our children.

Brian Lehrer: Are you familiar enough with the Nebraska situation and the filibuster by Senator Cavanaugh there to describe what's happening in Nebraska?

Alejandra Caraballo: Yes. Machaela Cavanaugh, she's essentially ground the entire legislature to a halt by actually doing a filibuster because she has a trans kid. This would actually affect her directly. That's one of the reasons why she's doing this and leading this. She has particularly said she will be petty about this. She said explicitly, "Don't talk to me in the hallways. Don't send me a holiday card. Don't say, 'How are you doing?'" Because this is personal for her.

This is one of the reasons why she's going to these lengths and she's holding basically all of the legislation in Nebraska hostage. Nebraska's very unique because it has a unicameral legislature and it's, I believe, nonpartisan as well. It's a very unique situation. She's been able to hold off. The Republicans there have tried to limit that by limiting the number of amendments that can be introduced, but her colleagues have introduced amendments themselves to use for filibustering. It looks like she may end up being successful and run out of the clock this year.

Brian Lehrer: Let's take a phone call. Michelle in Monmouth County, you're on WNYC. Hi, Michelle.

Michelle: Hi, Brian. I'm very concerned about the rights of trans people across America. I'm very thankful that Governor Murphy is addressing these issues by giving me the ability to have gender-affirming care be covered by my health insurance provider. I'm very concerned about the rights of trans people in Tennessee. Of course, there's the anti-drag show ban that also covers trans people because they can't express themselves either, as it seemed like, as a person that is of the other gender.

Brian Lehrer: Did you say NC, North Carolina on that one?

Michelle: Yes, in North Carolina. It seems like a lot of Republican-led states are harping on the rights of trans issues and are almost making us seem like a boogeyman or a boogie woman. I just--

Brian Lehrer: Why-- Go ahead, Michelle. Sorry. Finish your thought. Sorry.

Michelle: Oh, no. I wish they could recognize that their actions are anti-freedom. They're not trying to be anti-woke. The idea that you're silencing us is just the same as cancel culture. This culture of anxiety is not helping us, and it's not helping anyone because you're only hurting yourself if you feel that trans people do not belong in society. You have to accept change for what it is.

I feel that states like Tennessee, Arkansas, Texas which is trying to ban parents from having children, from knowing that trans people exist, from having those children be taken from the parents, it's horrible. It's not right. I wish that they can see that a governor like Phil Murphy is someone that should be furloughed with all the governors like Governor Bill Lee in Tennessee. It's been alleged that he dressed in drag back in the '70s, and he should acknowledge that. He shouldn't be a hypocrite and try [unintelligible 00:14:04] and think that he's all macho. It's silly.

Brian Lehrer: Michelle, you're in Monmouth County, New Jersey. You're praising New Jersey Governor Murphy. You're obviously paying attention from New Jersey to what's going on in many other states based on this phone call. Is there anything you are doing about it or feel like people from outside those states can do about it? Or just sit and stew and worry in frustration and fear?

Michelle: There is a way to address this. Everyone has the right to register and vote. What I did during the gubernatorial election is reelect Phil Murphy as governor over-- I forget his opponent's name. What every person has to do, especially people that are young, they have to register to vote. Everyone needs to vote and express their opinions, their voices so that we aren't silenced in the future.

Obviously, there is a effort among election deniers who think Trump won the 2020 election to try and silence us like Kari Lake in Arizona. We can't let that happen. We need to elect people who support our democracy, who support our right to vote, and we have to elect anyone that supports trans rights, that respects freedom, our freedoms.

Brian Lehrer: Michelle, thank you very much for your call. Funny enough, one of the responses to Michelle's call as Michelle was talking, is it looks like from a doctor who thinks that Governor Murphy in New Jersey actually isn't going far enough for all the praise that Governor Murphy just got from the last caller. Russ in Lawrenceville, you're on WNYC. Hi, Russ. Thank you for calling in.

Russ: Thank you for having me. Longtime listener, first-time caller. I'm calling to suggest that New Jersey and support Senate bill S3592 which was introduced by Senator Zwicker in I think District 15. At any rate, what his bill will do will codify what Governor Murphy did the other day. The problem with executive orders, as you know, is they can be temporary. If we get the next governor who may be a Republican, he can undo it. Then, we're back to jump street.

I'm a doctoral-level clinical social worker who specializes in treating and evaluating transgender adolescents and their parents. Your guest made a very good point. Parents have the right to get healthcare for their kids, and the kids I see are in a lot of distress. The healthcare they need is medically necessary. If you listen to the language of the anti-transgender health movement, it's totally distorted, suggesting that kids are getting mutilated or kids are able to walk into an endocrinologist's office and demand hormones.

It's just not what's happening. The World Professional Association of Transgender Health just released their eighth Standards of Care. I'm certified by them. Their standards for kids are thorough. People complain is gatekeeping, and it's really not gatekeeping. It's no different than getting bariatric surgery, but it's thorough. We have to make sure these kids need medically-necessary care. We have to educate their parents about what the care involves, what gender incongruity and gender dysphoria is. Most parents I work with, they get it and they're on board 100% with their kids. It is a beautiful thing to see when that happens, but--

Brian Lehrer: Can you describe at all-- Go ahead. You want to finish the thought you said, but what?

Russ: Just one thought. Gone is the day when I can tell a kid and their parents that, "You'll be okay in the northeast. Nothing's going to happen here." I can't say that anymore because New Hampshire's moving in this direction. Plus we're part of a country, and the kids know that, and they hear about another state going in this radical direction, and they get worried. They get visibly frightened.

Brian Lehrer: Can you give us an example of an interaction with parents? Because as you've been hearing, some of our conversation has been focused on these states that are not only banning the gender-affirming care that you help provide to minors if they come in asking for it themselves but even if they come in with their parents asking for it, so much for parental rights. Can you give us an example of interactions with parents or an interaction with a parent and how that tends to go and how parents make informed decisions for their minor children on this?

Russ: Sure. By the time a family gets to me, they're open to the idea that their child is gender incongruent. Or in some cases, kids have been in and out of inpatient psych programs and they're on psychiatric meds that they shouldn't be on. No one in the hospital listens to them when they talk about their gender identification. The parents come in, they're skeptical, but they're frightened, and the first thing I do is give them a book, for them to take home and look at. I validate their skepticism, and I tell them, this is a big decision. I try to win them over, and then I meet along with the kids.

I tell the kid, "Look, I'm going to help you with this. I don't want you to go back to a hospital, but you got to work with me. You have to understand that my job is to get your parents to really grasp what you're going through, and you have to help me do that," because these kids, they're afraid to talk to their parents, because it's all about their bodies. It's not about something like fighting about identity, it's just about what it feels like to live in a body that they consider to be alien.

Brian Lehrer: What are some of the standards that you were referring to before that are generally adhered to in deciding whether to provide gender-affirming care, such as puberty blockers or hormone treatment?

Russ: Are you there?

Brian Lehrer: Yes. Did you hear the question? Were you able to hear the question?

Russ: I heard half of it. You were talking about puberty blockers.

Brian Lehrer: I'm asking, what are the kinds of standards that you referred to before, that the medical profession adheres to when deciding whether it is appropriate for a particular minor?

Russ: Well, it depends on the age. If you see a minor who comes in early on puberty, and the gender dysphoria is profound, then it is appropriate to consider puberty-blocking medication. I can't prescribe it, the doctors I referred to can, and that just buys time. It buys time for everyone to figure out what's going on. Once we figure it out, then maybe move to gender-confirming hormones, but the standards of care require that I be thorough, that I educate the parents fully. I get to know the child well enough to be sure that, A, what they're reporting can't be accounted for by any other mental health condition.

Is this simply gender and congruence, which is not psychiatric, by the way, gender dysphoria is not psychiatric, is coded in the ICD as a medical situation. They call it dysphoria because they have to attach a word to it that implies distress, so that a prescription can be written for the appropriate care, but my job is to make sure that there isn't something psychiatric co-occurring, that might be accounting for.

Dysphoria looks like depression. You have to rule out if there's depression. Here's an example. One kid I worked with recently was on three different psych meds, primary diagnosis of depression. The parents couldn't take it anymore. Their kid was still suicidal, and they were willing to try hormones. I did the evaluation, I called the endocrinologist. Within four months, the kid was off all the psych meds, and these were toxic psych meds.

Brian Lehrer: Russ, bottom line for the political context of this segment, do you think it should be the place of the state to say that everything you just described, including the involvement and the ultimate authority of the parents should be prohibited?

Russ: Are we still connected?

Brian Lehrer: Yes.

Russ: Okay. I think that government period, should never be involved in a relationship between a healthcare provider and the patient. I think that if corporations are going to provide health insurance and get tax breaks, everything has to be covered. Everything that has an ICD diagnosis has to be covered.

Brian Lehrer: Russ, thank you so much for your call, and your detailed explanation of your role in gender-affirming care. Let's go back to our guest Alejandra Caraballo, clinical instructor at Harvard Law School's Cyber Law Clinic. What were you thinking as you heard those two callers?

Alejandra Caraballo: It strikes with what I know. Obviously, I'm an adult but having worked with providers, I helped run the legal clinic, Mount Sinai's Center for Transgender Medicine and Surgery. All these connections are incredibly thoughtful. Nobody is being rushed through any of this, and in many ways, there's waitlists. There's oftentimes huge waits to get to this care.

I know when I was seeking to have surgery, there was a waitlist of nearly a year. That was more of an accurate portrayal of what this is actually like than this kind of caricature that is being portrayed of the far-right where they make it seem like gender-affirming care is like going up to McDonald's, and you just show up and get hormones on day one, and that's absolutely not the truth.

Brian Lehrer: Number of attacks in many states in the United States on the legal rights of transgender people, the parents of transgender minors, and other transgender-related individuals who are Americans. Here's how far they're going in Tennessee. The State Senate there, and we'll see if this actually becomes law, but the state senate there has passed a bill that actually codifies sex, they use the word sex, as an immutable trait that was identified at birth. Here's Tennessee State Senator, Kerry Roberts.

Kerry Roberts: If defining sex, as it has traditionally meant for years in the dictionary, cost us federal funds, there's something wrong with Washington, DC.

Brian Lehrer: We continue with Alejandra Caraballo, clinical instructor at Harvard Law School's Cyber Law Clinic. Prior to joining the clinic, Alejandra was a staff attorney at the Transgender Legal Defense and Education Fund and a staff attorney at the LGBTQ Law Project at the New York Legal Assistance Group. Alejandra, can you talk about the Tennessee bill, and if anything like that, is actually becoming law anywhere in America because that would literally put into law a denial of the right to exist of transgender people?

Alejandra Caraballo: Yes. This year what we've seen as this new type of, I would say, it's definitely coming from some kind of model bill by an anti-LGBTQ org, but essentially, what it does is it writes the legal recognition of trans people out of the law entirely. Those kinds of laws can basically make it so a trans person get a gender marker that aligns with their gender identity. They can't amend their birth certificate to align with their gender identity, and they cannot be addressed in government functions or settings by the gender that they identify as.

What it literally means at the end of the day, is it means that any part of the state cannot recognize you as the gender that you identify as. Essentially, what it means is state-sponsored bullying, but also all kinds of horrible outcomes for trans people. When I worked at New York Legal Assistance Group, I had clients that did not have matching identity documents, and one of the things that we try to do is help them get a legal name change, get their gender marker changed.

What that allows there is for discrimination. If you have to turn over a driver's license that has a gender marker that does not match your gender identity, and someone perceives you as. If you're a trans man, and you walk in, you have like a full beard and a very deep voice, and your driver's license says female, someone's going to be like, "What's going on here," and recognize that you're trans. It's going to forcefully out people.

There are states that are already doing this, there's a case in Alabama about this exact issue, and it's a safety issue as well because if you're outed in that way, could put you at risk for violence and harm, but in other ways, it's perverse because it also can result in indignity and death as well. Even from a hate crime, if a trans person is murdered, because of their gender identity, the state would not be allowed to recognize them as the gender that they are, which was basically pouring salt in the wounds.

We saw this happen in the UK with Brianna Ghey who was a 16-year-old trans girl who was murdered by two other teenagers in a park. Because of the panic in the UK, the government formally said they would not recognize her as a trans girl. Even the fact that she was murdered because of her gender identity, a 16-year-old girl because they can't amend her birth certificate until 18, she was denied the dignity in death to recognize her as the person that she is. These are incredibly harmful, and just dangerous for trans people.

Brian Lehrer: Going back to the beginning of that answer, you're saying there are actually places in America today where you could have gone through the full medical transition and be living as the gender other than the one you were identified as at birth. You could be fully transitioned and living as that person, but your driver's license by law has to identify you the other way.

Alejandra Caraballo: Yes. I believe Ohio, there's very few states that still have that, an absolute bar, but many require surgery, which is very difficult for people to obtain, particularly either they're low income, they don't have health insurance, they don't have access to regular providers of care. Also just that concept of basically if you have to have what's colloquially unknown as bottom surgery, it sterilizes you.

Essentially, the state is saying you have to be forcefully sterilized to be able to get recognized as the gender that you say you are. States are now increasingly just banning changes at all. Florida, where I'm from has a bill now HB 1421 that would ban amendments on gender markers on birth certificate. Although I've had mine changed, I'm worried that they may try to invalidate it, go back and invalidate everyone who's had their gender marker changed, then it prevents people in the future from doing so.

Even though my passport, my driver's license, literally every government document that I have recognizes me as a female or as a woman, my birth certificate could potentially say that I'm not and that's inconsistent. They say that it's doing so to increase clarity or to increase consistency, and in actuality, they're not. They're making it inconsistent because for every other government that recognized me, I'm recognized as female, for Florida to say, "No, you're male for this purpose." It's inconsistent.

Brian Lehrer: That's an area, the birth certificate, since you were identified as one thing at birth, would the birth certificate indicate a change? Would it be an inaccurate record if it identified you as what you became later not at birth?

Alejandra Caraballo: Usually, they'll say amended, it depends from state to state. Some states just literally cross out and then just put with a stamp. It's really different from state to state. Some just issue a new one with the same one. It's all documented where the birth certificates are. This is a particular issue because certain government agencies sometimes absolutely need a birth certificate, is aid-approved citizenship so eligibility for public benefits.

When I was in New York and worked at NYAC, one of the issues that was here in New York City that was constantly an issue, is that HRA required that to treat the person by the birth certificate that they were issued, which here in New York City and New York State, now, you can get amended by attestation so it's easier to do. If people are coming from other states where they can't amend their birth certificate, HRA is forced to treat them as they are.

Brian Lehrer: That's the City's Human Resources Administration which administers all kinds of benefits. Megan in Maplewood, you're on WNYC. Hi, Megan. Thank you for calling in.

Megan: Hi, Brian. Thanks for taking my call. I've actually called before as a parent of a transgender child in New Jersey. I just wanted to speak to everything that's been said, all the points. Thank you so much to the doctor and your guest and the previous caller, I think their name was Michelle. As the parent of a transgender child that's been receiving gender-affirming care in New Jersey, I can attest it's not easy to receive. It is not like going up to McDonald's and getting a takeout order as your guest joked.

Our daughter identified as female in seventh grade and she's now 16. Basically, I have spent every day of the past four to five years working on getting her care. She will not be fully transitioned until the summer after she graduates high school and has essentially opted out of existing as a teenager because of her dysphoria and her depression and her anxiety.

As a parent to watch your child not be able to fully be who they are. You know your kid's amazing, you know they're a great person that has so much to contribute to the world, but they literally go inside of themselves because they're so incredibly uncomfortable.

We are a supportive family. We live in a supportive community. We have a wonderful care team of doctors but yet every day when my child wakes up, their body reminds them that they are not who they believe that they are. She doesn't go to after-school club, she drops out of dance class, doesn't do the school musical, doesn't want to make new friends, doesn't want to go to the school dance, all because of the emotional and mental pain she is caused by not being able to be who she is. As it is she's so excited to have her transitions, we have them all scheduled out.

Again, it's still two years from now, two more very long years of waiting. We are so grateful to live in New Jersey, so grateful for Governor Murphy's leadership and I think a doctor who called in before mentioned Senator Zwicker of his leadership in putting forth these bills. We've actively been advocating, but we are also very, very scared for the future, for our child's future, and all these children and families' future across the country. Something my husband and I started talking about is what can we do for other families.

Families in Tennessee, families in Florida, Texas? Again, now that New Jersey's a safe haven state, do we open our home to other families because we completely understand the mental and emotional struggle that they are going through? Welcome them here and say, "Come here. Stay with us. Try to get your care. What can we do?" We know what we can do for our own child.

I can get her to all of her appointments. I can make sure everything's taken care of because I have the capacity to do that. I have good health insurance. I have money to pay out of pocket. I have a car. We have great doctors. If you don't have any of those things, what do you do? We're trying to think about, what can we do more outside of our family and for the whole transgender youth community?

Brian Lehrer: Megan, thank you so much for your call and your compassion as a parent and how eloquent you were in describing everything you're going through and your child is going through. The framing of New Jersey as a safe haven state, this is what it's coming to. I guess a similar thing is happening with abortion rights, but the country is really dividing up in this respect. Let's take another caller. Another caller from New Jersey, big issue in New Jersey, apparently, Trenton, hello. You're on WNYC. You're calling under the name A, is that right?

A: Correct. Thanks, Brian. I want to reiterate, I really appreciate you having this program and having actual experts and people with lived experience. The reason why I called in is because oftentimes when I see a lot of these bills getting passed with the language that the lawmakers are using, they illustrate that they don't know very much about the issue, that they haven't met a trans-person or families with trans-kids.

Some lawmakers are actually expressing that they were unsure about the bill or didn't think that it was right and then they voted for it anyway. I really hope that lawmakers will pause and talk to the experts, talk to families, the people that you're having on your show right now before they continue passing these detrimental bills.

Brian Lehrer: Thank you for your call. Alejandra Caraballo, you can react to those last two calls. Interesting that the last caller there from Trenton is talking about legislators in these many states that are passing many trans-bans, maybe even being personally opposed to the bans, or feeling uncomfortable about them, or unsure about them, or not really being informed, how much do you think that's the case?

Alejandra Caraballo: What we've seen is an absolute flooding of the zone in terms of anti-trans legislation. We have 450 plus bills. I help run a legislative tracker and we have some automated tools that help update our tracker. It's nearly impossible to keep track of all of them because nearly every day there are legislative hearings, there are different bills moving in different states. What happens is there's no oxygen to basically be able to raise the alarm and bring this to the national attention, like what happened in 2016 with North Carolina when they passed HB 2, which was a trans-bathroom ban.

There was such national outcry and outrage that basically the states didn't attempt anything like that for years. Now what we've already seen are bathroom bans that passed in several states already such as Arkansas and Idaho. Already states are passing bills that would not have been possible just even two year or three years ago. Part of it is this news cycle. It's the way that everyone is so exhausted by the news.

It's COVID, it's Trump, it's all of this stuff that has been going on that it makes it very impossible for advocates to get out the word. Oftentimes when I tell people, "Hey, this is what's going on." They're like, "What? I haven't heard of this. How is this not bigger news?" That's a common thing that I hear. It's even common among the trans or the LGBTQ community. In Florida, there's a bill, SB 254, that passed this week that would basically disrupt care for adults. A lot of people have said these bills have only been targeting trans youth.

Brian Lehrer: How?

Alejandra Caraballo: They're increasingly targeting trans adults.

Brian Lehrer: How?

Alejandra Caraballo: This would make it a misdemeanor crime for a nurse practitioner to provide gender-affirming care to a trans adult. It would also make it a misdemeanor crime if a doctor provided gender-affirming care via telehealth. If you know anything about gender-affirming care, most of the time the primary care provider who's prescribing the hormones is a nurse practitioner or a physician's assistant.

This is going to severely disrupt access for adults and criminalize aspects of their healthcare in a way that no other healthcare other than abortion is treated. When I've mentioned this, I've been trying to raise the alarm about this bill about how it's going to severely disrupt care for adults. I've had trans people message me and be like, "What's going on? Is this going to impact me?" I'm like, "Yes, it is." They don't realize what's happening.

Brian Lehrer: It sounds to me like those bills in some anti-abortion states that say any doctor performing an abortion needs to have admitting rights at a local hospital. They frame it as something that's in the interest of the woman seeking an abortion, that they have a certain quality of care, but really, it's just trying to throw up another barrier to receiving abortion care. This sounds like the exact same thing. "Oh, we're doing this in the interest of the patient. Only an MD and only an MD you're seeing in person, not a nurse practitioner who--" Nurse practitioners, for people who know, do a lot of the things that primary care physicians do these days, and only in person, not telehealth. You see that parallel, right?

Alejandra Caraballo: Absolutely. They're pulling a lot of the same stuff from anti-abortion laws and they're saying, "Oh, well, we want to make sure that they're actually getting great care and make sure that the people know what they're doing." Nurse practitioners, especially ARMPs, can actually help to treat cancer. There are oncology NPs. They could help provide treatment for some of the most serious diseases and you're telling them they can't provide gender-affirming care. It's inconsistent.

They know that this is going to disrupt care because they know that most low-income trans folks, and probably most trans folks. I have great health insurance. I'm very privileged, I'm very fortunate to have that, but all my primary care providers for the last seven years since I came out as trans, have all been nurse practitioners.

Brian Lehrer: Let me jump in because we're way over time. I do still want to ask you one final political question. What you were saying and what the last caller was saying about so much of this still flying under the radar, this is why we made it our lead segment today, not put somewhere else where it might be considered a feature story or a trans story or something. I think it doesn't break through as a lead all that much because it's happening in state after state that might seem far away if you're in a place like New York where we are, or that might not seem like national news in the same way if you're a network. Because, "Oh, this is going on in Idaho today," or something like that.

There's such a critical mass of states passing these laws. This is a lead story. This is crisis proportion and it's happening right now. The examples I gave at the top of the show, so many recent examples just this week. A final political question. To the Vox framing that I mentioned earlier of this being a get-out-the-vote tool for conservative Evangelicals for 2024. I'm thinking of the politics of 2004 when George W. Bush was running for reelection in a very tight race against John Kerry and the Republicans made sure to put an anti-gay marriage referendum on the ballot in the ultimate swing state that year, which was Ohio.

That anti-gay marriage referendum did win with around 60% of the vote. By all accounts, it did increase conservative religious turnout. For people who remember that election, Bush was reelected by a whisker and because he was reelected by a half of a whisker in the state of Ohio. This works in many cases. Yet, I saw you were tweeting out how it did not work in Wisconsin this week when they elected a liberal state Supreme Court justice despite anti-trans campaigning on the part of the conservative one.

My last question is do you think this will be the case in the Purple States next year, the same states that Trump tried to overturn the election in? The states that will probably decide who the next president is? Are we going to see this in the same swing states, Arizona, Michigan, Wisconsin, Georgia, those swing states?

Alejandra Caraballo: Yes. Glad you brought up the example in Wisconsin because I think the irony here is that this is a motivating issue for voters, is such a low motivating issue. While Republicans are obsessed with this, even their own voters, it may animate some portions of their base, but this isn't driving them to the polls. This is unpopular nationally.

I believe the American Principles Project spent over $50 million.

We have examples of this happening in Michigan and Arizona last year during the midterms. They were running ads on this issue attacking trans people in these swing states and they lost. I always try to tell people, no one cares about trans people. They don't care about us. That's not great if we're trying to get equitable access to healthcare, housing, and all of those things that address discrimination. On the flip side, when people try to stoke this moral panic and try to restrict our rights, people still don't care.

They just are like, "This doesn't affect me. This isn't part of my life. I don't really care. I have kids to feed. I have a family to support and provide for. I don't really care about this." That's the crux of this. It's baffling that after the midterms, after consistent election after election where they lose on this issue, it is not a winning issue for them, they continue to make it the number one issue. Mike Pence is spending $1 million in Iowa as part of his campaign specifically on trans issues. He's betting his campaign on this. It's baffling.

Brian Lehrer: I guess we will find out. Folks, it's drip, drip, drip, state after state if you're in the New York area, the LA area, the San Francisco area, the Chicago area, and not aware of what's going on. Alejandra Caraballo, clinical instructor at Harvard Law School's Cyber Law Clinic, thank you so much for being our guest today.

Alejandra Caraballo: Thanks for having me.

 

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