The Trump campaign and allied Republicans spent roughly $215 million on anti-trans advertising in the 2024 election and the impact on the results will be debated for years to come. But for trans rights activist Mara Keisling, the effect was profoundly personal.Keisling, a transgender woman, was the interviewer who asked Vice President Kamala Harris the question that led to her explaining how she supported surgery for prisoners in the past as California attorney general. Related Donald Trump is hammering Kamala Harris on trans issues. But voters say they dont care. Even a plurality of Republicans agreed that the anti-trans rhetoric has been sad and shameful. Kamala is for they/them, the 30-second ad concluded. President Trump is for you. Your LGBTQ+ guide to Election 2024 Stay ahead of the 2024 Election with our newsletter that covers candidates, issues, and perspectives that matter. Subscribe to our Newsletter today I think it had devastating impact; not on the election itself, but on trans people, Kiesling told LGBTQ Nation in a rare interview on the subject following Donald Trumps victory.She called the idea that the ads were determinative of the election outcome absurd.Much more important, Keisling said, was their effect on trans people.It was atmospheric, she said, describing the ads ubiquitous appearance on screens tens of thousands of times in the last months of the campaign on social media, cable television, and live broadcasts like NFL games popular with men. It was out there, and people heard it.The history of the clip at the center of those ads began with a call from the National Center for Transgender Equality (NCTE), which Keisling headed up in 2019, to the candidates running for president in 2020 including Harris, Joe Biden, Pete Buttigieg, Bernie Sanders, and the rest of the Democratic field to participate in an interview with Keisling about their stances on transgender rights. They were scheduled in different cities convenient to the candidates. Harris was interviewed in Los Angeles. A look at the full interview reveals the candidate defining herself as a longtime champion of the transgender community, hitting a series of talking points portraying her as proactive in her support of trans rights.I cant remember a time that theyve not been important to me, Harris responded to one of only three questions Keisling asked in the six-and-a-half-minute interview posted to YouTube by NTCE in October 2019. The query that elicited Harris answer about trans prisoners was in answer to what Keisling termed a very broad question: Why should transgender people vote for you?I have a long-standing awareness based on my experience in the community of knowing the lives that people are living every day, that are burdened with fear, that are burdened with unequal access to everything from employment to a response from law enforcement to access to health care to access to housing. I mean, it covers the gamut, Harris said. The ironic thing in all of this is that Kamala Harris was among the candidates who trans people were most suspicious of, Keisling said.Those doubts are a clue to why Harris brought up healthcare for trans prisoners in the first place: she took the broader question as an opportunity to defend herself to a trans audience.As Californias attorney general a position she was elected to in 2010 and held until she won a Senate seat in 2016 Harris represented the state Department of Corrections and Rehabilitation in its refusal to provide gender-affirming surgery to a trans woman inmate convicted of murder. The case infuriated trans rights activists and their anger followed Harris into her presidential run. Unprompted by Keisling, Harris reframed the episode.When I was attorney general, I learned that the California Department of Corrections, which was a client of mine I didnt get to choose my clients, Harris told Keisling that they were standing in the way of surgery for prisoners. When I learned about the case, I worked behind the scenes to not only make sure that that transgender woman got the services she was deserving. I made sure that they changed the policy in the state of California so that every transgender inmate in the prison system would have access to the medical care that they desired and needed.And in fact, the settlement that Harris reached in 2015 did help clear the path for the first taxpayer-funded gender-affirmation surgery for a trans inmate in U.S. history. While the explanation may have satisfied some trans voters in the 2020 election, it would be a gift to Republican campaign strategists five years later.Trumps attack ad boiled the explanation down. Surgery for prisoners every transgender inmate in the prison system would have access, Harris said in the pulled-up clip used to such devastating effect.Republicans use of the interview didnt come as a total surprise to Keisling, who saw Trump first bring up Harris stand on healthcare for trans prisoners in his one and only debate with her in September.There was a lot of Yep, this is just another insane thing that Donald Trump says,' Keisling recalled. I think it was pretty close to when he made up that nonsense about kids going to school and coming home having had an operation' to change their sex. It was Elon Musk, Keisling pointed out, who first brought the receipts about Trumps claim, posting the clip of Keislings interview with Harris to X. It earned tens of millions of views and retweets.A cut of the first campaign ad using Harris words and the infamous tagline broke through in testing to an extent that stunned some of Trumps aides, according to The New York Times. The first ad aired a week after the debate.Another ad in the series using Harris answer which featured Harris supporter Charlamagne Tha God and his exasperated reaction to the then-senators remark shifted the race 2.7 percentage points in Trumps favor after viewers watched it, according to an analysis by Future Forward, Harris own leading super PAC. Keisling said a friend forwarded a link to the first they/them ad.She called it absolutely shameful.Do I think it cost Kamala Harris the election? No. Did it solidify Trumps attacks that she was a quote San Francisco liberal? Probably some. But the really scary part about it is how much it terrified children and parents of children, Keisling said. I dont think were going to know for years how much $200 million plus in anti-trans ads has hurt trans people. We know its hurt us individually, but we dont know how much its set back the movement for our rights. Asked if Harris might regret the defensive explanation, Keisling replied, Youd have to ask her if she regrets it. You know, I assume there was a time in October that she really regretted it. But I dont know. I dont regret it.I didnt say things like, Hey, there was this case in California where you represented I didnt do any of that. I sort of let them talk, Keisling said of Harris and the candidate forums. But I knew that trans people wanted them to say something very trans. And I think we have to think really hard about that.I think everybody needs to reconsider whether forcing people to the right or the left during primaries is worthwhile, she added. Particularly galling to Keisling was Trumps use of the clip after his own Justice Department was subject to the same constitutional requirements Harris cited to get her trans prisoner settlement.Its about the Eighth Amendment to the Constitution, which bars cruel and unusual punishment. And the Supreme Court, lots of times over the 250 years weve been a country, has said that withholding health care is cruel and unusual punishment, Keisling explained. And we understand if an inmate breaks their leg, the prison has to set their leg and give them appropriate medical care. If an inmate has cancer, they have to deal with that.I think one of the things that Americans dont understand is that trans healthcare is just healthcare for trans people. It is the medically recognized, medically necessary treatment in many, many cases. Not everybody needs medical intervention, but folks whose doctors say they need medical intervention, the jails and prisons, whether theyre local, state or federal, have a have a constitutional mandate which is what the Trump Justice Department understood to provide health care. They had to enforce it, too.What did Keisling think about some Democrats, including Rep. Seth Moulton (D-MA) and Rep. Tom Suozzi (D-NY), laying the blame for Harris loss on her trans prisoner explanation?It was absurd to say that it was the deciding factor in the election. I think it is worth repeating that anybody who talks days after an election is just wrong. Or if theyre right, theyre right by luck, Keisling said. So I dont put any stock in those two members of Congress talking immediately after the election. I think they were ill-advised to do it.I dont know whether it had 2.7 percentage point impact or 0.1% impact, but even if it wasnt the most important thing, it was a thing, Keisling said. If it hasnt put us back on our heels, were not thinking strategically.I think all of us need to digest our new reality and think about how we move forward in a smart way, she added.Subscribe to theLGBTQ Nation newsletterand be the first to know about the latest headlines shaping LGBTQ+ communities worldwide.