State supreme court elections in 2026 will decide whether trans teenagers can access gender-affirming care and whether abortion protections hold. Thirty-one states are holding these races, filling more than 60 seats. After the US Supreme Court handed these questions back to the states, the judges elected this November become the last word on rights that affect millions of people.

The courts most people cannot name are the ones that matter now

There is something quietly alarming about the way this works. A teenager needs puberty blockers. A family needs to know whether their state will fund treatment through insurance. A trans adult needs an accurate ID. And the people who will decide all of that are not the nine justices whose names everyone knows. They are state supreme court judges whose names appear on ballots most voters barely glance at.

The Conversation's analysis of the 2026 midterms makes this plain, and it deserves more attention than it is getting. Thirty-one states are holding supreme court elections this year. More than 60 seats are open. In states like Ohio, North Carolina, Michigan and Montana, whoever wins in November will be deciding some of the most consequential cases on trans rights and reproductive healthcare for years to come.

What Skrmetti actually did

In June 2025, the US Supreme Court ruled 6-3 in United States v. Skrmetti that Tennessee's ban on puberty blockers and hormone therapy for trans minors does not constitute sex discrimination under the federal constitution. The practical consequence is significant: bans like Tennessee's only need to survive the lowest level of judicial scrutiny. Lower federal courts can, essentially, approve them without serious examination.

That cleared the path for roughly two dozen states with similar bans to keep enforcing them. It did not, however, require any state to pass such a law. And it left open questions about adults, insurance coverage, and other aspects of gender-affirming care. Those gaps are now live legal questions, and they will be answered in state courts.

Skrmetti narrowed what federal courts will do, but it did not close every door. State constitutions can and do offer protections that the federal constitution does not. Whether those protections survive depends entirely on who is reading them.

Ohio: what a single seat could cost

Ohio is the clearest example of what is at stake. Republicans hold a 6-1 majority on the state's highest court. The one Democrat, Justice Jennifer Brunner, is defending her seat this year. If she loses, Ohio could have a unanimous conservative bench.

Ohio voters approved a constitutional amendment in 2023 that protects reproductive rights. Lower courts are now working through what that amendment actually permits, including whether the state's 24-hour waiting period and telehealth ban can survive it. The Ohio Supreme Court will likely have the final word. A more conservative court may choose to read that voter-approved amendment as narrowly as possible, which would effectively hollow it out while leaving it technically in place.

On trans rights, the same court is positioned to decide whether Ohio's ban on gender-affirming care for trans minors stands. An appellate court struck the law down in 2025, after it had been passed over the governor's own veto. The state supreme court could reverse that. One seat, elected in November, may be the difference.

North Carolina, Michigan, Montana

The pattern repeats across the country, in different directions. North Carolina's court already leans heavily conservative. Democrat Anita Earls is up for reelection, and if she loses, Republicans would hold a near-total supermajority. Michigan is closer to the mirror image: Democrat-backed justices hold a 6-1 majority, and two of them, Chief Justice Megan Cavanagh and Justice Noah Hood, are on the ballot this year. Democrats want to hold that edge, partly because Michigan voters enshrined abortion rights directly into their constitution in 2022, and the court has already used that to dismiss restrictions.

Montana's races are technically nonpartisan, but Republicans see a real opportunity to shift the court's ideological balance. The current Democrat-endorsed majority ruled in 2023 that the state constitution protects abortion rights. That ruling, and others like it, hangs on who wins judicial races most national coverage ignores entirely.

The quiet power of judicial elections

I find myself thinking about the trans teenager in Ohio who has been waiting for treatment, whose family has been watching court rulings come and go, who understands that their access to care is genuinely contingent on which judge wins a seat on a court they have probably never heard of. That is the reality these elections create. The law is not abstract. It lands on specific people, in specific bodies, with specific and irreversible consequences.

Puberty does not pause while litigation proceeds. Every month of the wrong puberty is a physical change that cannot be undone. When courts delay, restrict, or reverse access to care, that cost falls on young trans people, not on the judges, not on the politicians, not on the advocates. On them.

The article from The Conversation is careful and precise in laying out what is at stake, and the author is right that whoever wins these races will not merely be interpreting law. They will be writing the next chapter of it. In a very practical sense, the map of where trans people can access care, where they can get accurate documents, where they can participate fully in public life, will be drawn by judges elected this November in races drawing relatively little national attention.

Pay attention to them. Talk to people about them. These races affect real lives, and the people whose lives depend on the outcome deserve to have that said plainly.