The Supreme Court has delayed restrictions on the abortion pill mifepristone from going into effect by a week, allowing the drug to be prescribed online and sent through the mail until at least early next week. Supreme Court Justice Samuel Alito issued an order Monday temporarily pausing an appeals court decision, keeping telehealth abortions alive for now while the legal machinery keeps grinding over who gets to control reproductive care.
Who Gets to Decide
Louisiana brought the case against the Food and Drug Administration, arguing that access to medication abortion should be restricted. The ruling on hold is from the 5th Circuit, based in New Orleans, which said mifepristone could not be mailed anywhere in the country. That is the hierarchy in action: state officials, federal agencies, appellate judges, and Supreme Court justices all fighting over access to a drug that affects ordinary people’s bodies and lives.
CNN said the Supreme Court has put the 5th Circuit ruling on a brief administrative hold, allowing telehealth abortions to continue, until May 11, and that Louisiana has been asked to file briefs on Thursday. The court’s pause is temporary, not a resolution, and the people who need the medication are left waiting on deadlines set by institutions that treat their access like a procedural inconvenience.
Julie Rovner said there was mass confusion after the ruling because medication abortion accounts for more than 60% of all abortions in the U.S. and mifepristone is also used to treat miscarriage. That confusion is not accidental; it is what happens when a small circle of judges and officials can threaten access for millions and then call the fallout a legal dispute.
The Paperwork War
Rovner said the Trump administration itself had asked the lower court to put the case on hold until the FDA finishes an ongoing review of mifepristone’s safety, which she said would not happen until much later this year. She said Justice Alito’s order stayed the ruling for a week, until next Monday, and that parties in the case have just a couple of days to deliver arguments to the justices. The court could keep the status quo, allow the appeals court ruling to take effect or do something else entirely.
That is the whole game in miniature: a drug used in medication abortion and miscarriage care becomes a hostage to administrative review, court deadlines, and the strategic patience of power. The people at the bottom are expected to wait while the institutions above them decide whether access continues, narrows, or disappears.
Rovner also said a 2023 case out of Texas asked not only to roll back availability to what it was prior to 2021, when patients physically had to get the pill handed to them by a doctor, but also to cancel the pill’s FDA approval altogether. She said the original approval goes back more than a quarter of a century to when Bill Clinton was president. Rovner said the earlier case was dismissed because the doctors group that brought it lacked standing to sue. She said the Louisiana case is less likely to face that problem.
Elections, Courts, and the Usual Theater
Rovner said the issue affects the political landscape ahead of the midterms and that anti-abortion groups have been increasingly vocal about their frustration that the president has not done more to limit, if not outlaw, the abortion pill. She said telehealth has allowed women to get around most state bans in the 20 states that now have them. That detail matters because the bans already on the books have not ended access; they have just forced people to navigate around the state’s barriers however they can.
She said President Trump has said several times he does not want to impose more restrictions on abortion because most voters support abortion rights, even in many red states, and that abortion is likely to be front and center in this year’s elections. CNN said the return of abortion to the Supreme Court is testing President Donald Trump’s strategy of avoiding the issue, that the 5th Circuit ruling would add limits to access nationwide by requiring in-person doctor’s visits, and that anti-abortion state officials and advocates sued the Trump administration to force it to tighten the rules for mifepristone.
CNN also quoted Kelsey Pritchard of Susan B. Anthony Pro-Life America as saying, “What is shocking is that the Trump administration’s inaction has stopped pro-life laws from taking effect, and that they forced several Republican attorneys general to take their battle to the federal courts.” Pritchard also said, “It’s just really hard for us to understand how the Trump administration has been so negligent as to leave this policy in place.”
CNN quoted Sam Bagenstos, who was general counsel for US Department of Health and Human Services during the Biden administration, as saying, “It’s clear that they do not want to have a ruling taking access to mifepristone away from women across the country before the midterms,” and, “However, they are doing everything they can to preserve their ability to take access to mifepristone away from women across the country as soon as they’re out of the woods.”
CNN said the Democratic National Committee accused Trump in a statement Monday of making “it even harder to get lifesaving reproductive healthcare by banning medication that has been safely used for decades.” CNN also quoted White House spokesperson Kush Desai as saying, “Makary continues to deliver for the American people, from modernizing the drug approvals process to cracking down on artificial ingredients in our food supply.”
CNN said anti-abortion advocates have grown to suspect the FDA review is a way to slow-walk the issue, a claim the FDA has previously denied, and that a Wall Street Journal report indicated Marty Makary had expressed indifference to regulations for mifepristone. CNN said court briefs from Louisiana noted how a Justice Department lawyer could promise only that parts of the review “might” be done by 2027.
Mary Ziegler, a law professor at University of California, Davis, said, “As this case moves along, the current game plan about making this only about procedural issues is going to become more and more untenable,” and, “The 5th Circuit blew up that strategy.” CNN said Trump has embraced the way the 2022 Roe reversal was framed in the majority opinion by Justice Samuel Alito as returning the issue to the states to decide for themselves.
CNN said medication abortion now makes up some two-thirds of all U.S. abortions and that the Supreme Court in 2024 rejected a challenge to the pill’s access brought by anti-abortion doctors because the physicians had not shown they were being harmed by the current regulations in a way that would warrant court intervention. CNN said the Trump administration has enacted some policies sought by abortion opponents since his reelection, but his appointees to lead federal health agencies have not shown interest in implementing regulatory changes that would limit access to medication abortion.
Pritchard said, “If 1-2% of pro-lifers had stayed home in 2024, Trump wouldn’t be president.” Bagenstos, now a University of Michigan Law School professor, said the Trump administration is eventually “going to have to put up or shut up about their position regarding whether mifepristone was appropriately approved for termination of pregnancy and whether the in-person dispensing requirement should have been eliminated,” and added, “Are they going to have to do that soon? You know, it all depends on what the Supreme Court does.”