The structural problem is not new. Since at least 2022, a coalition of Republican state attorneys general and governors has pursued what scholars of federalism would recognize as an aggressive theory of extraterritorial jurisdiction, the notion that a state’s substantive criminal law can reach across borders to govern medical decisions made legally in another jurisdiction. The Trump administration’s Department of Justice has accelerated this project, issuing at least 20 administrative subpoenas to providers of gender-affirming care, seeking the confidential health records of trans youth. Federal judges have, with remarkable consistency, called these efforts what they are: a “fishing expedition” designed to “harass” and “intimidate.” The Ninth Circuit, regrettably, broke ranks this week and upheld one such subpoena against a Washington State telehealth clinic. The legal architecture of medical privacy is under coordinated assault.
United States Congress (Public domain) via Wikimedia CommonsInto this landscape steps New Jersey Governor Mikie Sherrill, who on Thursday signed S2260/A2218, a bill that expands the state’s existing Shield Law to expressly include gender-affirming care within the definition of protected reproductive healthcare services. The legislation, which passed both chambers in June on party-line votes and takes effect immediately, does three things worth noting. It bars state entities from cooperating with out-of-state investigations targeting care that is legal in New Jersey. It creates a new criminal charge for individuals who physically block or intimidate patients seeking such care. And it empowers patients and providers to sue those who interfere with access.
Chuck Homler, Focus On Wildlife (CC BY-SA 4.0) via Wikimedia CommonsSherrill, to her credit, did not mince words about the adversaries. “If Greg Abbott or Ron DeSantis tries to investigate someone who came to New Jersey to access care, we will protect anyone seeking care that is legal here in New Jersey from investigations in other states,” she said at the signing ceremony. This is the correct posture. The governors of Texas and Florida have spent years attempting to export their jurisdictions’ hostility to reproductive and gender-affirming care into states that have made different democratic choices. The proper response is not hand-wringing about comity but statutory fortification.
https://kaboompics.com/ / PexelsWhat is particularly notable here is the legislative decision to yoke gender-affirming care to reproductive healthcare within a single statutory framework. This is not merely symbolic. It reflects a structural insight that the legal attacks on trans healthcare and on abortion access share a common jurisprudential root: the claim that the state possesses a compelling interest in overriding individual bodily autonomy that supersedes both medical consensus and the principle of patient-provider confidentiality. Every major medical association in the United States