For three months, a group of Nebraska lawmakers have ground nearly all legislative business in the state to a halt, grabbing the nation’s attention with a remarkable filibuster to stifle a bill that would end gender-affirming care for young transgender people. Late Tuesday 16 May, Republican lawmakers broke through, advancing a bill that not only bans gender-affirming care for trans people under 19 years old but also tacks on an amendment to outlaw abortion at 10 weeks of pregnancy and hands the state’s GOP-appointed medical officer the authority to set the rules for affirming care for trans youth. Lawmakers approved the amended version of legislative bill 574 by a vote of 33-14. The measure will go to a final round of votes before it heads to the desk of Republican Governor Jim Pillen, who intends to sign it into law. Hundreds of protesters filled the capital in Lincoln, standing outside the doors and in the gallery above lawmakers while chanting “one more vote to save our lives”; only one senator would have had to defect from supporters of the bill to kill the legislation. The vote – on the 78th day of a 90-day session – followed a series of maneuvers that opponents argued were bending and breaking the rules of the state legislature to hammer through the legislation and avert the filibuster, which would allow opponents to occupy their allotted time to speak the bill to death. “What you are attempting to do today is the lowest of the absolute lows,” state Senator Machaela Cavanaugh, who spearheaded the filibuster, told Republican lawmakers. “You literally have to cheat at every moment of this debate in every possible way. … You are allowing it to happen,” she added. “You do literally have blood on your hands, and if you vote for it, you will have buckets.” State Senator Megan Hunt, the first openly LGBT+ member of the state legislature and the mother of a trans child, lambasted lawmakers for their “escape routes” from the capitol to avoid facing protesters. “If you can’t go out and face them, you are not worthy,” she said. “Your legacy is filth.” In a statement following the vote, Governor Jim Pillen called the bill “an important step” to “protect” the future of the state’s children. Opponents of the bill forcefully opposed the inclusion of an abortion ban in a bill targeting gender-affirming care, two wholly separate issues combined into one, “but you all don’t care,” Ms Cavanaugh told Republican lawmakers. “You don’t care about due process, you don’t care about the people of Nebraska,” she added. “All you care about is the governor.” Abortion rights advocates and transgender rights advocates have frequently underscored the fact that anti-abortion measures and legislation targeting LGBT+ people are driven by the same lawmakers and activist groups, relying on similar arguments to restrict access to healthcare, with measures that have dominated state capitals across the country over the last few years. Lawmakers initially were set to only debate the gender-affirming care bill, which already went through two of three rounds of debate and votes. But legislative rules prohibit amendments on a final round, and opponents of the bill planned to filibuster through all two hours of debate to continue to block it. Last month, the filibuster blocked a measure from anti-abortion lawmakers to ban abortion at roughly six weeks of pregnancy. Attaching another anti-abortion measure, this time at roughly 10 weeks, gave proponents of the bill a second chance of both advancing an anti-abortion law and the gender-affirming care ban, marrying two controversial measures to get to the necessary 33-vote threshold to advance. In February, Ms Cavanaugh vowed to “burn the session to the ground” if the ban on gender-affirming care advanced, launching an epic filibuster that blocked every bill until the measure was withdrawn or defeated. State Senator Kathleen Kauth, an Omaha Republican who proposed the bill targeting gender-affirming care, said the amended version would protect children from what she called a “social contagion.” “Kids deserve the right to grow up and not deal with this until they are adults and can make informed decisions,” said Ms Kauth, who did not mention the fact that such decisions are made with families and their doctors. The anti-abortion measure provides no exceptions for pregnancies with fatal fetal anomalies and does not explicitly protect doctors who perform abortions from criminal prosecution. “What is wrong with you?” said Ms Hunt, calling the combined bill a “desperate attempt to institute an abortion ban that is unpopular, unnecessary, and unsafe.” More than a dozen states, mostly in the US South, have severely restricted or effectively outlawed abortion in the year after the US Supreme Court struck down Roe v Wade, which affirmed a constitutional right to abortion access. Nebraska’s legislation also joins a nationwide campaign that has seen hundreds of bills aimed at LGBT+ people, particularly at young trans people, filed in nearly every state within the last two years. At least 15 states have enacted laws or policies banning gender-affirming care for young trans people, and more than a dozen others are considering similar measures. Court injunctions have blocked bans from going into effect in three states. More than half of all trans youth in the US between the ages of 13 and 17 are at risk of losing access to age-appropriate, medically necessary and potentially life-saving gender-affirming healthcare in their home state, according to the Human Rights Campaign. The onslaught of legislation and volatile political debate surrounding the bills have also negatively impacted the mental health of an overwhelming majority of young trans and nonbinary people, according to polling from The Trevor Project and Morning Consult. A separate survey from The Trevor Project found that 41 per cent of trans and nonbinary youth have seriously considered attempting suicide over the last year. Read More Inside the ‘mentally exhausting’ protest shutting down Nebraska’s anti-trans legislation Inside Montana’s ‘disturbing’ attack on trans kids and the campaign to silence lawmaker Zooey Zephyr Exclusive: Zooey Zephyr responds to her political silencing and Montana’s attacks on trans children: ‘I show up with my head held high’ Anti-abortion laws harm patients facing dangerous and life-threatening complications, report finds