Republicans are once again embracing anti-trans rhetoric in a series of advertisements across the country, hoping to capitalize on voter fears about transgender people as the clock ticks down to the November election.

Over the weekend, former President Donald Trump’s campaign Instagram account unveiled a new ad with the slogan “Kamala is for They/Them,” targeting Vice President Kamala Harris’ support of gender-affirming care for all people, including incarcerated people and immigrants.

“Even the liberal media was shocked Kamala supports taxpayer-funded sex changes for prisoners and illegal aliens,” the narrator in the ad warns.

The new ad hinges on a now-viral moment during the Sept. 10 presidential debate when Trump warned that Harris supports “transgender operations on illegal aliens that are in prison.” That perplexing word salad of a claim was Trump’s own spin on Harris’ response to a 2019 ACLU candidate questionnaire.

Days before the debate, CNN published a story about the questionnaire, in which Harris wrote about slashing funding for the construction of new immigrant detention centers and decreasing ICE’s budget. The story also notes Harris’ support of “taxpayer funding of gender transition surgeries for detained immigrants and federal prisoners.”

The ACLU survey asked if candidates supported gender-affirming surgery for trans people who rely on state insurance — including those who are incarcerated or in immigrant detention.

Harris responded that it was important for all trans people to receive that care.

“I support policies ensuring that federal prisoners and detainees are able to obtain medically necessary care for gender transition, including surgical care, while incarcerated or detained,” she wrote at the time. “Transition treatment is medically necessary, and I will direct all federal agencies responsible for providing essential medical care to deliver transition treatment.”

The survey resurfaced during the week of the presidential debate and attracted a deluge of coverage from right-wing media. Trump’s team leaped at the chance to use Harris’ response as an attack.

Trump has been highly critical of Harris’ and her running mate Tim Walz’s support of LGBTQ+ rights, and has vowed to roll back Title IX protections for transgender students, criminalize doctors who provide care to trans youth, and make it much harder for trans adults on Medicare and Medicaid to receive gender-affirming care.

Over the last few weeks, Trump has also spent much of his time on the campaign trail repeating false claims that children are undergoing gender-affirming surgeries at school and without parental consent — although there is no evidence of this happening anywhere.

But Trump isn’t the only Republican candidate pushing anti-trans rhetoric as a strategy to cozy up to conservative voters.

In Texas, various conservative organizations have pushed forward ad campaigns to target Democrats who support gender-affirming care for trans youth and allowing trans girls to participate in school sports on girls’ teams.

Republicans in Texas are eager to keep their majority in the state Senate and have unleashed a number of ads targeting Democrats who have been vocal proponents of LGBTQ+ equality.

Sen. Ted Cruz (R-Texas) released two ads attacking his Democratic challenger, Rep. Colin Allred, for being “wrong for our girls” because of Allred’s support for the Equality Act and his opposition to legislation that Cruz introduced that would bar trans girls from participating on competitive sports teams that align with their gender identity.

Cruz’s campaign told The Texas Tribune that the new advertisements are part of a $6.7 million ad buy in collaboration with the Republican Party of Texas.

Similarly, the National Republican Congressional Committee released an ad about Vicente Gonzalez, a Democratic U.S. House candidate for South Texas, saying that he is pushing for “sex changes for kids.” The NRCC has been busy bolstering Republican congressional candidate Mayra Flores.

In Missouri, incumbent GOP Sen. Josh Hawley ran an ad featuring Riley Gaines, a former collegiate swimmer who has become an advocate against trans women’s participation in sports, and has testified in support of anti-trans legislation across the country. Hawley’s ad slams his Democratic opponent, Lucas Kunce, a lawyer and Marine veteran running for Hawley’s seat, for supporting the “radical trans agenda.”

Kunce, on the other hand, has criticized Hawley’s opposition to abortion and trans rights. During his 2022 campaign for Senate, Kunce’s trans brother, Warren Kunce, shared how the two of them had spoken about the importance of supporting trans rights and said that his brother has “never thrown me under the bus.”

Republican attacks on Democrats are just heating up 50 days from the general election, but the strategy of amplifying harmful rhetoric about trans people in the eleventh hour of the election cycle is nothing new.

Today’s playbook is the same one Republicans used during the midterm elections — though the results showed that these efforts largely did not resonate with voters.

During the 2022 midterms, conservative organizations like the American Principles Project, America First Legal and Citizens For Sanity spent at least $50 million to air ads featuring anti-trans rhetoric across 25 states.

America First Legal, spearheaded by former Donald Trump aide Stephen Miller, spent $4 million to push ads to specifically target Black and Spanish-speaking voters accusing President Joe Biden of pushing “radical gender experiments” on children and accusing the White House of “anti-white bigotry” and putting white people at the end of the line on COVID-19 relief funds.

But at the end of the day, these efforts to push anti-LGBTQ+ rhetoric and mischaracterize the nature of care for trans youth largely backfired.

Voters overwhelmingly rejected candidates endorsed by Moms for Liberty, the right-wing extremist group trying to enshrine conservative values in public education, in Pennsylvania, Virginia, Ohio and Iowa school districts in 2022.

That same year, five states put abortion rights on the ballot — and voters elected to protect reproductive rights in California, Kentucky, Michigan, Montana and Vermont.