Following a radical Supreme Court term that has had a devastating impact on abortion access, the separation of church and state, immigrants’ rights, privacy, and more, it’s easy to feel powerless. But we can still fight for our rights — starting in our communities, at the ballot box. We have the power to send a message to elected officials about what we value and what we want them to prioritize. Your vote can send a clear message to lawmakers and elected officials that they need to take bold action to stem the tide of attacks on abortion, and protect access to essential care — just as Kansas voters recently did when they defeated a measure that would have stripped the right to abortion from their state constitution.

Trust in American institutions has dramatically decreased in recent years, according to recent polling. Americans are losing confidence in the Supreme Court, politicians, and the media. But people still trust their family, friends, and neighbors.

That’s why your vote is so important this year, and why the ACLU wants to arm you with the knowledge you need to talk to your friends and family about the issues that matter. With just a conversation, you can use your existing networks to mobilize and activate your community.

Here, we break down some of the elected offices you may see on your ballot, so you can better understand how these officials wield the power to protect civil liberties and civil rights. Whether it’s for a district attorney election in your county or a supreme court judge race in your state, you have the power to change this country. This November, let’s remind our elected officials that they don’t have the final say when it comes to our rights — we do.

American Civil Liberties Union

Vote Your Values | American Civil Liberties Union

This election, join us by pledging to vote for your values, and fight for your rights by encouraging your friends and family to do the same.

State attorneys general are the top legal officers of their state. They have the ability to issue legal guidance or formal opinions to state agencies, including opinions on the constitutionality of abortion bans, restrictions on the right to learn, as well as choosing to not enforce education gag orders that restrict teachers and students from being able to learn and discuss issues related to race and gender in the classroom. They can advise their legislature and state agencies on ways to protect LGBTQ people from discrimination and ensure equal access to services, and can also join or initiate lawsuits challenging anti-LGBTQ laws or policies.

In many states, the secretary of state is the state’s chief elections officer with responsibility for oversight and administration of elections. The secretary of state can expand voting access by implementing measures such as automatic voter registration and universal mail-in voting, as well as advocating for a legislative agenda that pushes for greater access.

State supreme courts — often elected or retained by the people in statewide elections — can and often do find that state constitutions protect more rights than the U.S. Constitution, making them a powerful backstop protecting our rights against the attacks they face. They decide cases related to abortion, voting rights, the rights of LGBTQ people, free speech, and more. Now that the U.S. Supreme Court has overturned Roe v. Wade, state courts will likely be the final arbiters to decide whether reproductive freedoms are protected in the states, making this role especially crucial.

Also referred to as County Attorney, Prosecuting Attorney, or Commonwealth Attorney in some states, elected prosecutors are the most influential actors in the criminal justice system. They have the power to decide who should be charged with a crime, and can decline to press charges — including declining to prosecute a person accused of violating an abortion ban. Prosecutors’ decisions and their influence over local and state criminal justice laws have been one of the primary drivers of incarceration and racial disparities throughout the justice system. District attorneys can exercise prosecutorial discretion to not bring charges against those accused of violating classroom censorship laws and education gag orders that restrict teachers and students from being able to learn about issues related to race and gender in the classroom. They can also decline to prosecute crimes related to HIV status, sex work, and other criminalization that disproportionately affects LGBTQ people; train staff to respectfully manage cases involving hate crimes and domestic violence; and establish data collection to track treatment of LGBTQ victims and defendants.

In many states, county clerks act as the local election administrator and run the day-to-day operations of registration and voting. They may be responsible for recruiting and training election officials, mailing absentee ballots, and counting and canvassing election results. County clerks may be also responsible for issuing permits for LGBTQ parades or events, recruiting or training poll workers to ensure they are LGBTQ-friendly, or ensuring that same-sex couples can access marriage licenses.

School Board representatives can pass important policies to protect LGBTQ students from harassment, discrimination, and bullying, including ensuring students in their district have the right to access restrooms and play sports in accordance with their gender. They can also either endorse or fight back against attempts to restrict school curriculums limiting how race, sexual orientation, and gender identity may be talked about in school, and push back against attempts to remove books by and about LGBTQ people from school libraries.

The Board of Regents or Board of Governors are elected and approve curricula in some states, determining what students are allowed to learn or required to learn. They may be responsible for enforcing classroom censorship policies and education gag orders that restrict teachers and students from being able to learn about issues related to race and gender in the classroom. These officials have the power to protect the right to learn in higher education.

From limiting how and when we vote, to removing books by LGTBQ authors from library shelves, to criminalizing access to basic health care, politicians are attacking our fundamental rights. The midterm elections are a chance for all of us to say enough is enough.

Join us as we talk to our family and friends about why this election matters and pledge to vote our values.

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On Friday, August 5, the Florida Board of Medicine ignored the warnings of medical experts and parents with transgender children and voted to adopt a “standard of care” that opposes gender-affirming care for trans youth — a move that would put the licenses of medical professionals at risk for providing life-saving care. This vote does not immediately impose restrictions on gender-affirming care, but does begin a regulatory process to do just that.

This is the latest in a coordinated attack on the health care needs of transgender youth and adolescents. Below you’ll find an explanation of what is happening in Florida, what may happen next, and steps Florida residents can take to protect trans kids, their families, and their medical providers.

The Florida state Board of Medicine (BOM) is responsible for setting standards of care for all medical providers in Florida, and for enforcing their compliance with licensing and disciplinary review. Changing the standards of care requires (at a minimum) a formal rulemaking process under the Florida Administrative Procedure Act. On Friday, August 5, the board officially began the formal rulemaking process, which lasts up to 180 days and usually requires at least 90 days to complete, to consider proposed regulations that would restrict medically-necessary care for transgender youth. The proposed changes to state standards of care would do two things:

1. Threaten medical providers with penalties or fines if they provide gender-affirming care to anyone under the age of 18 as treatment for gender dysphoria.
2. Impose waiting periods on adults seeking gender-affirming care and require adults to sign an informed consent form that includes disinformation about the risks of gender-affirming care.

According to the U.S. Department of Health and Human Services, “Gender-affirming care is a supportive form of health care. It consists of an array of services that may include medical, surgical, mental health, and non-medical services for transgender and nonbinary people. For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the health care system.”

Gender-affirming care is a very individualized form of health care, and will look different for each person depending on their age, gender, and other physical and mental health needs. For prepubescent transgender youth, this care typically involves a “social transition” (changing clothes, hair, name, etc.) and never involves surgery or other irreversible medical treatments. During or after puberty, many transgender youth may receive reversible puberty blockers, hormone replacement therapy, or other medical interventions as overseen and prescribed by medical professionals. Some older transgender adolescents can and do access surgical care on a case-by-case basis as recommended by the World Professional Association of Transgender Health.

Gender-affirming care is widely recognized as the only evidence-based approach to addressing the health care needs of transgender youth, including severe mental health risks. For more:

• Health and Human Services: Gender-affirming Care and Young People
• The Endocrine Society: Transgender and Gender Diverse Adolescents
• American Academy of Pediatrics: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Youth & Adolescents

The medical community has already been very critical of Florida’s ongoing effort to ban gender-affirming care. In June, the Agency for Health Care Administration, which oversees Florida’s Medicaid program, published a report claiming the national standards of care for gender dysphoria are at odds with nationally accepted standards for Medicaid coverage. Medical and legal experts quickly condemned the proposed regulations as “thoroughly flawed and lacking scientific weight.” In April, the Florida Department of Health (DOH) issued a memo recommending against gender-affirming care for children and adolescents. Researchers cited in the memo by the surgeon general in an attempt to justify these restrictions accused him of misrepresenting their work, and denounced the proposed restrictions.

Three hundred Floridian health care providers who work with transgender youth then published an open letter in the Tampa Bay Times, condemning the proposed regulations. The guidance from the governor and surgeon general, the experts wrote, “misrepresents the weight of the evidence, does not allow for personalized patient and family-centered care, and would, if followed, lead to higher rates of youth depression and suicidality.”

Similar bans signed into law in Arkansas and Alabama are both blocked by federal courts.

The Florida State Board of Medicine vote was triggered by a “petition to initiate rulemaking” submitted to the board by the DOH at the behest of Surgeon General Joseph Ladapo, who heads the DOH. The move came at the direction of Gov. Ron DeSantis, who appoints the BOM’s members and has long pushed a broader extremist and anti-trans political agenda.

Now that the board has initiated rulemaking, they will work internally to draft a proposed regulation, submit it for formal review, comments, and public hearing, and eventually publish a final rule. Once they publish their proposed regulation, they must accept public comments for 21 days, then hold a public hearing. After the hearing, they must wait at least 14 days to publish the final version of the regulation. Once the final regulation is published, it goes into effect 20 days later.

If the board does in fact make a final regulation to ban gender-affirming care for minors (or something even more expansive), it would likely go into effect in October or November of 2022.

If a final regulation is adopted and goes into effect (and is not enjoined by a court), that would mean any providers who continue to provide this care to minors would be subject to professional discipline by the BOM. Disciplinary proceedings can be initiated by public complaint and by the surgeon general’s staff directly. That discipline could lead to suspensions or revocations of medical licenses.

Most likely, that would mean all providers would voluntarily stop providing such care, health care insurance plans would proactively stop covering it, and malpractice insurers would impose higher premiums or drop coverage for gender-affirming providers even if they don’t treat minors or the population covered by the ban.

Once the BOM publishes its proposed rule to change the standard of care to ban gender-affirming care for minors, the board will be required to accept written comments from the public for 21 days starting on the day the proposed rule is published in the Florida Administrative Register. When the 21 days have concluded, a public hearing will be held by the board. Comments submitted by the public by email or written letter will be included in the official record of the BOM proceedings.

Members of the public can also attend the public hearing, although the number of individuals who can speak at the public hearing can be limited and will be controlled by the BOM. During a public hearing in July 2022 concerning the Medicaid rule changes, the Agency for Health Care Administration filled their speaker slots predominately with speakers who were hostile to gender-affirming care. If the BOM takes the same approach, it may be difficult or futile to attempt to make public comments at the hearing.

One of the most important things you can do is register to vote before the October 11 registration deadline and help elect lawmakers who will work to protect the rights of transgender youth, their families, and their health care providers.

In addition to engaging in the rulemaking process, you can make a difference by getting to know your neighbors and being a part of your local community. Gender-affirming care is not well understood by the public, and hostile groups spread disinformation to scare and misinform people about gender-affirming care and the transgender community. Being visible and participating in the local community may help the public recognize that gender-affirming care is not a danger to society and should be allowed like other medical care.