
How to make sense of the deluge of attacks on trans rights.
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Michael Leminger
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WNYC Studios Announcer
Around 1700 people in Kansas are about
Alejandra Caraballo
to have their driver's licenses declared invalid. Why? Because they're transgender.
Michael Leminger
A new Kansas law takes effect requiring transgender people to use public building bathrooms corresponding with their sex at birth.
Alejandra Caraballo
It lets any citizens sue someone they think is trans for $1,000 if they violate that rule.
Michael Leminger
In Tennessee, House Bill 754 would require
Alejandra Caraballo
clinics who perform gender transition surgeries to also perform detransition procedures. It would also require clinics and insurance companies to report the occurrence of these procedures to the Tennessee Department of Health, who would then record various statistics into a database.
Michael Leminger
And in West Virginia, the 4th Circuit Court of Appeals has reversed a lower court ruling, meaning that the state's Medicaid policy excluding coverage for gender affirming surgeries will be upheld. That last ruling was based on a Supreme Court decision from June. In a case called U.S. v. Scarmetti, the high court upheld a Tennessee law banning puberty blockers and gender affirming care for minors. In order to better understand these legal sett civil rights attorney Alejandra Caraballo has looked to legal scholar Ernst Frankl.
Alejandra Caraballo
He created what was called the dual state.
Michael Leminger
Brooks spoke to Alejandra earlier this month,
Alejandra Caraballo
and he divided it into two categories, the normative state and the prerogative state. The normative state is basically everything that you run into every day. You go and pay your taxes, you go to court. The state is pretty much acting as normal. And then there's the prerogative state, which acts with an arbitrary violence against a targeted minority group. That group cannot expect any sort of fair or consistent treatment by the state.
Interviewer (possibly Brooke or Michael Oinger)
My understanding is that Frankel saw this play out. He was a lawyer. Jewish lawyer. In housing.
Alejandra Caraballo
Yeah. Jews were being stripped of their homes, property rights, legal rights to own businesses. Nothing in the Weimar Constitution, which was still operative, allowed for that. But none of that mattered because they were part of the prerogative state. You do have a six year period before you get to the camps and whatnot. This period where Jews are increasingly being targeted. And also not just them, gays, lesbians, trans people in Nazi Germany were also targeted. And so you have this useful framework for how authoritarian states target particular minority communities and how the legal systems contort themselves to enable that persecution of that minority group. I don't necessarily mean to compare directly to the Holocaust.
Interviewer (possibly Brooke or Michael Oinger)
It's always dangerous.
Alejandra Caraballo
Yes. The reason why that resonates is that that's essentially what we're starting to see here in the United States with the ways that courts and the legal system are starting to abrogate the rights of trans people.
Interviewer (possibly Brooke or Michael Oinger)
Yeah. They can't go to the courts because the laws have changed. They live in what seems to be a fetal or maybe adolescent prerogative state, essentially.
Alejandra Caraballo
Yeah.
Interviewer (possibly Brooke or Michael Oinger)
You say there's a kind of dual state approach when it comes to medical care. The way the HHS treats trans people's health care versus other kinds of healthcare.
Alejandra Caraballo
Exactly. They're deregulating how drugs are approved, these kinds of supplements are being sold. RFK Jr. Hawking all kinds of snake oil all the time. Meanwhile, they are cracking down on gender affirming care for trans youth and launching investigations against providers of gender affirming care. They claim on one hand, especially with the right around vaccines, we want to ensure that parents have the rights to choose medical treatments for their children. And they do that in the instance of vaccines. But when it comes to gender affirming care, they say, well, parents don't have that right anymore.
Interviewer (possibly Brooke or Michael Oinger)
Parents have the right to withhold the care. They just don't have the right to provide the care.
Alejandra Caraballo
Yeah.
Interviewer (possibly Brooke or Michael Oinger)
In the Scarmetti case, when presented with a petition about parental rights to choose youth transmedical care, the Supreme Court didn't weigh in, but in an earlier decision it did to deny it.
Alejandra Caraballo
They punted. They didn't even bring up the parental rights question in Scrometti about whether or not parents have the right to choose the medical treatment for their child and not be barred by the state from seeking it. And ultimately the Supreme Court punted on that. But then there was a case out of California where the schools banned, forced out so that school officials could not forcefully out a trans youth to their parents, which could potentially result in harm to that youth from being kicked out, being disowned in an emergency shadow docket posture. They re enabled an injunction against that law because they believed that it was against the parental rights of those parents of those Students. And so you have the Supreme Court going above and beyond to protect the rights of one set of parents and then completely ignoring the rights of another set of parents when presented with that question in a formal cert petition.
Interviewer (possibly Brooke or Michael Oinger)
Let's go to Kansas, shall we? Governor Laura Kelly vetoed the bathroom bounty bill, which contained two provisions. The immediate invalidation of the driver's licenses of trans people if their gender marker doesn't match their gender assigned at birth. The second provision, the so called bathroom bounty, allows anyone to sue anybody they suspect of being transgender if they walk into the wrong quote unquote restroom in a government facility. Now, the governor vetoed it, calling it poorly drafted with overreaching consequences that would cost millions of taxpayer dollars to comply with when that money is already really tight in Kansas. And then the state legislature overturned her veto. Two trans residents in Kansas are suing. Now, this strikes me as textbook dual state stuff. They seem to be persecuted for simply existing.
Alejandra Caraballo
Exactly. They went without any sort of committee hearings. They did what was called a cut and go, where they essentially took another bill, completely cut out the text, put in this new bill that had the bathroom bounty bill and the revocation of licenses and birth certificates. The Kansas legislature rushed this through, and in less than three weeks, it went from basically no one knowing that this bill existed to being enacted and people were losing their driver's licenses. I mean, that's how quickly it went.
Interviewer (possibly Brooke or Michael Oinger)
Let's explain why these two things are a big deal, driver's licenses and bathrooms. Why we could go slowly padding up to the dual state structure of the Nazis with these relatively minor things like driver's licenses and bathrooms.
Alejandra Caraballo
If you can't use the bathroom, you can't participate in society. And a lot of people will just say, well, you could just use the bathroom of your sex assigned at birth. Well, if you're a trans person, you often don't look anything like your sex assigned at birth anymore. For trans women, if you go and use the men's restroom, that puts you at extreme risk of sexual assault, harassment, even viol. And this is not a theoretical this has happened. Trans men are really in a bind because oftentimes they have deep voices, beards, they look just like any other man. And they're being told they have to use the women's bathroom. So what's gonna happen if somebody who comes in with a very deep voice, burly, with a beard, walks into the women's restroom? Everyone is gonna freak out about it. That's exactly what this law requires. Ultimately, what that means for trans People is they can't participate in society because you can only hold going to the bathroom for so long. If you're at work for eight hours or 10 hours a day, you'll start getting bladder infections. And then there's the driver's license aspect.
Interviewer (possibly Brooke or Michael Oinger)
Right. The driver's licenses of trans people. In Kansas, there was no warning. They were suddenly invalid. That was it. They couldn't drive.
Alejandra Caraballo
They could risk arrest for driving with a suspended license. To just go to the DMV and get a new license, that puts people at immense risk. They have to ask friends or family to be able to drive them. They have to miss work. It's incredibly disruptive. So people say, well, you just have your driver's license that says your sex assigned at birth. And for trans people, that's oftentimes incredibly dangerous. Just even buying a six pack of beer the way you look is not going to match the sex listed on the driver's license, which could out you, subject you to harassment and violence.
Interviewer (possibly Brooke or Michael Oinger)
You might say, well, why don't you just go and get your driver's license in a state other than Kansas? But even that's not so easy.
Alejandra Caraballo
Yeah. So let's just say you were like, I'm done with this. I'm leaving Kansas. The state is hostile to trans people. If you were to move to New York or California and try to activate a license in those states, you would not be able to until you lifted the suspension on your Kansas license. So you can't even leave the state without the indignity of going to the dmv, getting a new license issued with a gender marker that does not align with your gender identity.
Interviewer (possibly Brooke or Michael Oinger)
Last December, the Texas newsroom obtained internal documents through records requests that showed that the Texas Department of Public Safety had compiled a list of 110 trans people who tried to update their license information between August 2024 and August 2025. So when pressed, the Department of Public Safety in Texas didn't say why. And Texas isn't alone here, but Indiana, you've said, may also be compiling a similar list. So connect this to the dual state framework. I mean, governments compiling lists of minority groups is never a great sign.
Alejandra Caraballo
Yeah, we don't know why they're compiling these lists. Kansas ultimately had a list of trans people that had changed their gender markers, and immediately they were able to suspend their licenses. Texas, Indiana, or these other states, if they're able to compile them, they could do similar things. We've heard the governor of Texas, Greg Abbott, saying that trans people should not be teachers in public schools in Texas, they could create a list of people who are not eligible for teaching licenses within the state of Texas if they're transgender. Any number of permutations that they could use these kinds of lists to target trans people and ensure that they cannot any sort of meaningful contribution to society. They can't work, they can't get driver's licenses, they can't get identification documents, and ultimately, with this push around, voter IDs, even be able to vote. Pretty much every aspect of this is trying to strip any semblance of normality from a trans person's life.
Interviewer (possibly Brooke or Michael Oinger)
I think there was one instance where someone who never changed their gender marker but changed their name still had their license invalidated.
Alejandra Caraballo
Yeah, that happened in Kansas as part of this, and they were unsure as to exactly how that happened. Kansas said that it was an error, but something still triggered them being added to that list. That's intensely scary. Idaho right now, they just passed through the House and it's going through their state Senate. A bill that would enact a five year felony charge for using the bathroom that aligns with your gender identity. I mean, this is where we're at.
Interviewer (possibly Brooke or Michael Oinger)
Now, you've noted that unless these lists are used in a discriminatory manner, they're legal. If they say, hey, we have this list of people we identified as trans and now they're barred from being teachers, that's unconstitutional, no matter what the Governor of Texas says. Your worry with regard to the law is that the Supreme Court is hinting that they don't view trans status as something that is immutable, something that just can't be changed with the wind.
Alejandra Caraballo
You could see this in Justice Barrett's questioning and her concurrence in Scremetti. And they view being trans essentially as a choice and something that can just be easily changed. And so as a result of that, they don't believe that it meets the requirements for protected class status. I do believe being trans is immutable, like it's not subject to external change. But even if it wasn't, we do protect other classes that don't have immutable status, and that includes religion. You can change your religion, and that is still protected under the Constitution. So that's kind of a frustrating double standard. But regardless, that is worrying, because if they don't believe that it's something that is immutable and can be changed, they can then endorse methods to try and force that change. And we're seeing that with the potential decision in Chiles v. Salazar, which may Invalidate bans on conversion therapy in over 21 states.
Interviewer (possibly Brooke or Michael Oinger)
Let's hop back quickly to medical care in Tennessee. The Attorney General was able to access and identify incredibly intimate medical records of trans people held by Vanderbilt Medical center that included therapy notes, photos, pre op and post op. No one knows why. Yeah.
Alejandra Caraballo
So the Tennessee Attorney General used the pretext of investigation for fraud against Vanderbilt University and issued subpoenas asking them for all of their medical records related to gender affirming care, not just for trans youth, but for all their transgender patients.
Interviewer (possibly Brooke or Michael Oinger)
That is a very familiar Trump administration pretext to intrude into places.
Alejandra Caraballo
This is exactly where the Trump administration got its playbook from. Tennessee, Missouri and Texas had been doing this for years where they were attempting to get at the medical records of trans people. Tennessee was the most successful, and Vanderbilt did not even fight those subpoenas. There was a lawsuit filed arguing that they violated the patient privacy rights of their patients, and that's still pending.
Interviewer (possibly Brooke or Michael Oinger)
The ninth Court of Appeals heard a case involving Queer Doc, a telehealth gender affirming care practice that the DOJ subpoenaed in July. It was seeking more than a dozen types of records dating back to 2020, demanding names, birth dates, addresses, Social Security numbers of Pat. DOJ said it needed this data to investigate whether Queer Doc was engaging in fraudulent insurance billing. What's going on there?
Alejandra Caraballo
This is part of the intimidation tactic by the Justice Department to try and force providers to stop providing gender affirming care, particularly to trans youth. The Justice Department sent out roughly over 20 different subpoenas to 20 different medical providers to some of the top children's hospitals around the country, alleging that they were engaged in fraudulent prison billing practices with insurance. They're claiming that using alternative billing codes in billing practice, which is utilized widely, I mean, but using any other sort of billing code other than ones that are directly tied to gender dysphoria is somehow fraudulent. So, for instance, when they're prescribing hormones, they'll say, endocrine disorder unspecified. And that just may be how the insurance companies prefer that to be billed. A single provider can have to bill potentially 20 different insurance companies at any given time. Medicaid, Medicare, and each one of those may have a different practice for how they accept the billing code. And so what they're saying is, is that you use something like endocrine disorder unspecified rather than treatment for gender dysphoria. It's fraudulent. There's not intent to deceive or defraud insurance companies here, but they're using that mismatch and abusing. Again, tying to the framework of the dual state. That's just everyday billing practices. But when it comes to trans people, suddenly that becomes fraud. And as a result of that, they are using that pretext to issue these subpoenas and claim broad authority to access not only medical records, but internal employee communications, external emails, all kinds of things. That is just basically a giant fishing expedition. Queer Doc 5 the subpoena. And they won. And the Trump administration is essentially appealing that they want the threat of the subpoenas to get people to stop provision of care voluntarily. And that's what we've seen with so many different providers who have voluntarily withdrawn, providing this care just out of pre compliance and fear.
Interviewer (possibly Brooke or Michael Oinger)
And this also connects back to the dual state in terms of isolating these disfavored members of society. Trans people would be less likely to seek medical care or be honest or truthful with their own providers.
Alejandra Caraballo
Exactly. If you're a trans person and you're worried that your provider will be subpoenaed by the federal government and all your medical records will be handed over to some DOJ flack, you're gonna be less willing to be upfront with your medical providers. If you have to go to the hospital, you may not disclose that you're transgender. You're concerned that that may be used against you.
Interviewer (possibly Brooke or Michael Oinger)
In a piece for the Dissident last September, you wrote that these structural attacks against trans people are the prerogative state in action. You called it a raw and undisguised exercise of power to eliminate a disfavored minority from the public sphere. Eliminate.
Alejandra Caraballo
This is straight up from Speaker Michael Knowles, who was at CPAC now three years ago.
Interviewer (possibly Brooke or Michael Oinger)
That's the conservative gathering that happens every year. That sort of sets the template for where the far right will move.
Alejandra Caraballo
Exactly. And he said to a giant audience, we must eradicate transgenderism from society. He's repeated that multiple times. Chris Rufo has recently retweeted that exact statement.
Interviewer (possibly Brooke or Michael Oinger)
Another sort of philosopher activist of the far right.
Alejandra Caraballo
Exactly. They use this disingenuous trolling where they say, well, we aren't saying we want to eradicate. We just want to eradicate transgenderism. And I don't know how you do one without doing the other, because you can't coerce people into not being trans. And you can't kill ideologies. You can't kill ideas. Ideas exist outside of people. The only thing you can do is kill people. Yeah. There's an old study that said that about 41% of trans people attempt suicide at some point in their life, which is a pretty stark number and is orders of magnitude higher than the rest of the population. And there's people online that go around making memes about it, saying, we've gotta raise that 41% to 100%.
Interviewer (possibly Brooke or Michael Oinger)
How common is. Is this? Just a couple of cranks.
Alejandra Caraballo
It's pretty widespread. On Twitter, there was a young girl, a trans girl who's 17, who took a picture of a bridge and said, it's so pretty from up here. And the next day it was found that she had taken her own life and jumped from the bridge. That image that she posted on Twitter went viral. Over 100 million views. The vast majority of the replies were celebrating it, celebrating that she took her own life and making jokes about it. Now the picture that she took, trolls are taking that and putting it in the replies of trans people and making a meme out of that picture. It's very clear they want to drive the factors that cause trans people to be suicidal. They don't have to do it themselves. They could just make everything so bad that they hope that trans people do it themselves.
Interviewer (possibly Brooke or Michael Oinger)
So what do we learn from other historical moments when the dual state framework has come into play? If you go back to the civil rights movement, you'll see white people at the time, some of them saying, these black activists are too aggressive. They're kind of scary. They need to play by the rules. Stop agitating so hard, stop offending people.
Alejandra Caraballo
I mean, civil rights movements are almost never popular in the moments when they are able to succeed and push through. But what's unique about trans people is that we're actually on the other side of this. A lot of the things that are happening to us were policy wins that we already won years or decades ago. The ability to change our gender markers, that was through quiet advocacy for over years. In many states. You've been able to do that for decades. You're able to change the gender marker on your passport since 1992. So that's 33 years that you were able to do that. And then that got taken away. Iowa became the first state ever to remove duly enacted civil rights protections for a group based on any protected class. And just yesterday, they enacted another bill that prevents cities from even enacting their own protections for trans people. So this is far beyond just backlash. This is now a regression, wiping out decades of what trans advocacy has been able to accomplish.
Interviewer (possibly Brooke or Michael Oinger)
Wow.
Alejandra Caraballo
To find parallels. I mean, there was obviously backlash to the civil rights movement and the feminist wave of the 70s.
Interviewer (possibly Brooke or Michael Oinger)
This is kind of more like what happened after reconstruction.
Alejandra Caraballo
Reconstruction is probably the closest I can think of where a group who had previously been able to secure substantial civil rights protections is systematically having them erased. That's the closest parallel, because even the backlash of the 80s to the civil rights movements, none of them were able to strip the kinds of rights that they are doing now.
Interviewer (possibly Brooke or Michael Oinger)
Elon Musk and other groups on the far right are pushing an idea that empathy is weakness. They call it suicidal empathy.
Alejandra Caraballo
Yeah.
Interviewer (possibly Brooke or Michael Oinger)
How does that relate to this?
Alejandra Caraballo
What they really mean by that is if you're concerned about immigrants, if you're concerned about trans people, if you're concerned about Muslims, you are contributing to the downfall of Western civilization. And if anything, it's the opposite. It's the lack of empathy, it's the lack of compassion for our fellow humans that is causing so much of the problems in our world.
Interviewer (possibly Brooke or Michael Oinger)
Alejandra, thank you very much.
Alejandra Caraballo
Of course. Thanks for having me.
Interviewer (possibly Brooke or Michael Oinger)
Alejandra Caraballo is a civil rights attorney and a clinical instructor at Harvard Law Cyber Law Clinic.
Michael Leminger
That's it for the midweek podcast. Don't forget to catch the big show on Friday. And while I have you, if you haven't already, go ahead and follow us on Instagram and TikTok. We also have a OTM subreddit where you can see some of the videos we've been making recently. Brooke and I talking about some of our favorite moments from the show. We'd love to hear what you think. I'm Michael Leminger.
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Air Date: March 25, 2026
Host: Michael (Micah) Loewinger (spelling varies; here, likely “Michael Leminger”), WNYC Studios
Guest: Alejandra Caraballo, civil rights attorney, Harvard Law Cyber Law Clinic instructor
This episode explores the mounting legal assaults on transgender rights across various U.S. states and examines the concept of the "dual state"—a framework coined by legal scholar Ernst Fraenkel to analyze government systems where a targeted minority is subject to arbitrary state violence and injustice. Through in-depth discussion with civil rights attorney Alejandra Caraballo, the episode details how recent and proposed laws in places like Idaho, Kansas, Tennessee, West Virginia, and Texas are stripping away rights and normalcy for trans people. The hosts and Caraballo draw comparisons to both historical civil rights regressions and rising authoritarian tactics, examining media narratives, legal precedents, and larger social implications.
Normative vs. Prerogative State:
Quote:
“The normative state is basically everything that you run into every day…[but] there's the prerogative state, which acts with an arbitrary violence against a targeted minority group. That group cannot expect any sort of fair or consistent treatment by the state.”
— Alejandra Caraballo [02:10]
“They claim on one hand, especially with the right around vaccines, we want to ensure that parents have the rights to choose medical treatments for their children…But when it comes to gender affirming care, they say, well, parents don't have that right anymore.”
— Alejandra Caraballo [04:10]
“The Supreme Court going above and beyond to protect the rights of one set of parents and then completely ignoring the rights of another set of parents…”
— Alejandra Caraballo [06:00]
Everyday exclusion:
Quote:
“If you can't use the bathroom, you can't participate in society…For trans women, if you go and use the men's restroom, that puts you at extreme risk…Trans men are really in a bind…deep voice, beards, look just like any other man. And they're being told they have to use the women's bathroom.”
— Alejandra Caraballo [08:04]
Compilation of lists:
Quote:
“Pretty much every aspect of this is trying to strip any semblance of normality from a trans person’s life.”
— Alejandra Caraballo [11:11]
Data collection/intimidation:
Quote:
“This is part of the intimidation tactic…to try and force providers to stop providing gender affirming care, particularly to trans youth.”
— Alejandra Caraballo [16:02]
From words to lethal climate:
Quote:
“You can't coerce people into not being trans. And you can't kill ideologies. You can't kill ideas…The only thing you can do is kill people.”
— Alejandra Caraballo [19:43]
The current rollback is compared to the post-Reconstruction era, where rights won were systematically erased. [23:02]
These attacks are described as not merely backlash, but a reversal of victories—hard-fought, often quiet wins (such as changing gender markers on documents) now revoked. [21:52]
Quote:
“Reconstruction is probably the closest I can think of where a group who had previously been able to secure substantial civil rights protections is systematically having them erased.”
— Alejandra Caraballo [23:07]
[02:10] Alejandra Caraballo on Fraenkel’s dual state:
“The normative state is basically everything that you run into every day... there’s the prerogative state, which acts with an arbitrary violence against a targeted minority group.”
[04:10] On medical care double standards:
“They claim on one hand, especially with the right around vaccines, we want to ensure that parents have the rights to choose medical treatments for their children. ...But when it comes to gender affirming care, they say, well, parents don’t have that right anymore.”
[08:04] On bans isolating people from daily life:
“If you can’t use the bathroom, you can’t participate in society…That’s exactly what this law requires.”
[10:28–11:11] On government lists:
“Governments compiling lists of minority groups is never a great sign.”
[13:27] On the Supreme Court and protected class status:
“They view being trans essentially as a choice...they don’t believe that it meets the requirements for protected class status.”
[16:02] On DOJ medical subpoenas:
“This is part of the intimidation tactic...to try and force providers to stop providing gender affirming care, particularly to trans youth.”
[19:43] On far-right “eradication” language:
“You can’t coerce people into not being trans. And you can’t kill ideologies. You can’t kill ideas. The only thing you can do is kill people.”
[20:30] On anti-trans suicide memes:
“It’s very clear they want to drive the factors that cause trans people to be suicidal. They don’t have to do it themselves. They can just make everything so bad that they hope that trans people do it themselves.”
[23:07] On historical parallels:
“Reconstruction is probably the closest I can think of where a group...is systematically having [civil rights protections] erased.”
[24:08] On empathy:
“It’s the lack of empathy, it’s the lack of compassion for our fellow humans that is causing so much of the problems in our world.”
This episode offers a sobering, historically grounded examination of how anti-trans laws and rhetoric in several U.S. states fit into a broader pattern of legal, administrative, and social regression. Through the lens of Fraenkel's "dual state" and informed by Caraballo’s legal expertise, it details both the macro and micro harms—to rights, safety, and societal structures—facing trans Americans, and highlights the urgent media, legal, and ethical questions raised by the current political moment.