From Courts to Clinics

Court Capture and the Rise of Authoritarianism

This moral panic about gender has laid the groundwork for laws and policies targeting reproductive and transgender rights, with Leonard Leo, a key figure in reshaping the judiciary, playing a pivotal role. Through his network, which raised at least $460 million between 2005 and 2021, Leo has funded ad campaigns, judicial advocacy, and conservative scholarship to shape public opinion and bolster Republican candidates.^[5] He helped establish the Judicial Crisis Network (now The Concord Fund) to leverage dark money and advance conservative judicial appointments, ultimately creating the U.S. Supreme Court’s conservative supermajority.^[6] Under Leo’s leadership in the Federalist Society, the nominations of Justices Gorsuch, Kavanaugh, and Barrett were secured, enabling the overturning of Roe v. Wade in the 2022 Dobbs decision, which returned abortion regulation to the states and fueled anti-gender campaigns through litigation and state-level legislation.

Leo’s influence extends beyond judicial appointments, as his network seeks to reshape cultural and legal norms to align with Christian nationalist ideology. In a 2024 letter, Leo, a devout Catholic, urged his grantees to “weaponize” conservative ideology at the “choke points of influence and power,” chiefly by targeting media and engaging in legislative battles to reshape public perception and policies on issues like healthcare for pregnant people and transgender people.^[7] In partnership with the Republican Attorneys General Association (RAGA), Leo’s network aligns federal and state strategies, influencing cultural and legal norms to advance Christian nationalist ideology.^[8] RAGA, funded by tens of millions in dark-money donations per year, plays a pivotal role in ensuring Republican attorneys general are elected.^[9] Attorneys general hold strategic importance as they can drive litigation and shape state-level legislation. One RAGA member has taken to the strategy employed by Leo, pushing anti-abortion and anti-trans legislation in service to his party’s decidedly far-right agenda: Texas Attorney General Ken Paxton.

Paxton’s Texas: A Laboratory of Autocracy

Despite being impeached by the Texas House in 2023 for securities fraud, Paxton was acquitted by the Senate and shielded by the Texas Supreme Court from testifying in the lawsuit. Since then, he has consolidated his power by endorsing primary challengers against Republican lawmakers who voted to impeach him, ensuring that key legislative positions are held by loyalists who will advance his far-right agenda unopposed.^[10] With Republican dominance across all three branches of state government—majorities in the Texas House and Senate, an entirely Republican Supreme Court, and control of both U.S. Senate seats—Texas serves as a critical example of how power consolidation creates fertile ground for advancing anti-abortion and anti-trans legislation.

Paxton’s consolidation of power and Texas’ Republican dominance have created fertile ground for advancing anti-abortion and anti-trans legislation such as “The Human Life Protection Act” (HB 1280), “The Texas Heartbeat Act” (SB 8), and SB 14—Texas’ law barring healthcare providers from prescribing puberty blockers and hormone therapy or performing gender-affirming surgeries on minors under threat of losing their licenses.^[11] These laws strip Texans of their bodily autonomy under the guise of protecting women and children. HB 1280, passed in 2021, bans nearly all abortions post-Dobbs, with exceptions only to save the pregnant person’s life, imposing penalties ranging from significant fines to life imprisonment. SB 8, passed in 2021, allows private citizens to sue anyone, including physicians, who “aids or abets” an abortion after six weeks. Procedures like dilation and curettage (D&C), essential for treating miscarriages, are now fraught with legal risks under Texas law, where performing a D&C can carry up to 99 years in prison.^[12] The vague language surrounding what circumstances would justify abortion procedures has left physicians hesitant to act, leading to delayed or denied care, reduced medical standards, and the deaths of at least three Texas women.^[13]

Under SB 14, some families have been forced to leave the state to access necessary care because of Paxton’s mobilization of anti-gender rhetoric claiming that gender-affirming care is “child abuse.”^[14] In 2022, Texas Governor Greg Abbott ordered the Department of Family and Protective Services (DFPS) to investigate the parents of trans kids, stating that “sex change procedures” for trans kids constitutes “child abuse” under state law.^[15] Paxton made his support of these investigations clear, framing gender-affirming care for minors as a dangerous adherence to “gender ideology” propagated by doctors and pharmaceutical companies responsible for “transing” kids, vowing to protect Texas children from such “abuse.”^[16] After the ACLU and Lambda Legal successfully sued the state to halt these investigations, Paxton appealed the decision and, though the Texas Supreme Court later ruled that neither Abbott nor Paxton had the authority to order these investigations, the decision only protected the plaintiffs in that case, leaving other families vulnerable.^[17]

As a result of this repression, abortion seekers and parents of trans kids unable to find care in Texas have increasingly turned to out-of-state providers or telehealth. Abortion pills—accounting for 63 percent of all abortions in the U.S. in 2023—have been crucial for Texans under these restrictions, with an average of 2,800 residents a month receiving pills by mail.^[18] Paxton has tried to expand his power through unprecedented legal overreach, targeting out-of-state providers who assist Texans seeking care. In December 2024, he sued a New York physician for prescribing abortion pills to a Texas resident, alleging violations of SB 8.^[19] Similarly, in January 2024, he demanded records from Qmed, a Georgia-based provider, accusing the organization of offering gender-affirming care to Texas minors in violation of SB 14.^[20] By challenging the shield laws that states like New York have designed to protect providers from out-of-state prosecution, Paxton’s lawsuits test whether states with restrictive laws can enforce them extraterritorially.

Resistance and What Comes Next

Organizations in Texas are resisting Paxton’s overreach by fighting these harmful bans. Lilith Fund joined other organizations to file a 2023 lawsuit against Paxton, securing a preliminary injunction to resume funding abortions for Texans forced to travel out of state.^[21] Equality Texas has supported efforts to block Paxton’s demands for private information about trans individuals and their healthcare providers.^[22] However, the stakes remain high. Cases like Skrmetti v. United States before the Supreme Court threaten to allow states to ban gender-affirming care for youth entirely, mirroring the Dobbs decision’s impact on abortion. With a Leonard Leo-influenced Supreme Court primed to hand such decisions to states, these campaigns risk expanding anti-gender strategies nationwide.

Combatting the authoritarian Right’s anti-gender attacks on women and queer and trans people requires political education to counter the disinformation that fuels them, as well as intersectional resistance. Organizations like Lilith Fund and Equality Texas point to one way forward. By challenging restrictive laws and providing vital support to vulnerable communities, they show how grassroots activism can resist far-right agendas. Their work underscores the importance of collective action in protecting democracy, human rights, and bodily autonomy for all—not just in Texas, but across the nation.