Margaret Renkl is a contributing opinion writer in the South for the New York Times. In this article, she notices that access to civil rights increasingly depends on which state you live in. Red state legislatures exert extreme control over private decisions. Those who live in Tennessee are not free to make their own decisions about medical care.

NASHVILLE — Two weeks ago, while the rest of America was absorbed by the hunt for a doomed submersible, people in Tennessee discovered that their attorney general was conducting a witch hunt.

As part of a “run-of-the-mill” inquiry into possible billing fraud — as officials described their investigation — the attorney general’s office demanded that Vanderbilt University Medical Center hand over a vast array of documents from its clinic for gender-affirming care. According to Tennessee Lookout, a nonprofit journalism site, those documents include, among others:

  • complete medical records for an undisclosed number of patients
  • Resumes of clinic physicians
  • information about the clinic’s Trans Buddy volunteers
  • emails sent to and from a public portal for questions about L.G.B.T.Q. health
  • the names of people referred to the gender-affirming clinic for care

Tell me this isn’t a witch hunt. Tell me this isn’t an open campaign of terror against already vulnerable citizens who had every reason to believe that their medical records — their medical records! — were confidential and every reason to believe that the medical clinic of a major university hospital was a safe space.

During the Juneteenth holiday weekend, Vanderbilt notified patients whose confidential medical records were now in the possession of the state attorney general. The hospital has not detailed which documents it provided the state. When two Tennessee Lookout reporters, Sam Stockard and Anita Wadhwani, asked whether Vanderbilt had complied with every state request in connection with the investigation, a hospital spokesman said, “The short response to your question is no.”

State officials contend that they are investigating only the hospital and certain providers, not the patients they serve, and that all the data they’ve gathered will be kept private. But given the sweeping nature of the documents and the obsessive and relentless way that the Republican supermajority in this state — and in virtually every state governed by a Republican supermajority — has persecuted trans people, it’s impossible to trust such claims…

Though the courts have generally sided with transgender families when these laws have faced legal challenges, the behavior of red-state lawmakers and officials remains in lock step with intimidation campaigns conducted against transgender people by right-wing media figures like the Daily Wire’s Matt Walsh, who staged an anti-trans rally in Nashville last fall…

Increasingly, this is exactly what it’s like to live in a red state, and not just for vulnerable minorities. The age at which it is possible to marry, the testing required to drive a car, the conditions under which it is possible to carry a firearm — such matters have always varied a bit from state to state. But this is a whole new reality.

Now that Republican-appointed justices dominate the U.S. Supreme Court, we can’t count on the courts to protect us from the most extreme agendas being enacted in Republican-dominated statehouses. Essential civil liberties that citizens of other states can take for granted are no longer liberties that we in the red states enjoy.

Maybe you can count on being able to make health care decisions yourself, following the advice of your doctor. No such luck here, whether you’re seeking transgender care or the safe end to an unsafe or unwanted pregnancy.

Maybe you’re a physician, trained and board-certified in an area of expertise that exactly zero legislators in your state share. You may be under the impression that your education and experience give you the right to recommend medical treatment for your patients. Not in many places here. Even in the case of life-threatening situations, your hands are tied.

Maybe you feel relatively confident that your children are safe in their schools because you live in a state that has enacted measures to keep firearms out of the hands of dangerous people. My state has done nothing of the kind.

Maybe you are represented in Congress by an elected official whose political positions align with the political positions of a vast majority of people who live in the city they represent. In Nashville, as in other blue cities whose voting districts were determined by a Republican legislature, we don’t.

Maybe classrooms and school libraries in your community offer books and other materials that experienced teachers and librarians have chosen for their excellence and their relevance to children’s lives. In the red states, that’s not something parents can count on, for our school boards are being bullied by a minority of conservative parents, and our Republican legislators believe they know better than education professionals which books students are ready to read.

Maybe the full range of birth control options is now available to you in planning whether, or when, to have a baby. Many anti-abortion activists erroneously define birth control measures like intrauterine devices and the medication known as Plan B as abortifacients. If you live in a state where such groups have the ear of legislators, you’d better start paying attention to what’s happening in your statehouse because these folks are coming for you.

We live in two countries now: one in which basic civil and human rights are recognized and enshrined in law, and another in which ideological extremists can decide how everyone else lives.