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, as the Trump administration navigates mounting pressure from anti-abortion advocates frustrated with federal inaction on the issue. Supreme Court Justice Samuel Alito issued an order Monday temporarily pausing an appeals court decision that would have imposed nationwide restrictions on the medication.
Louisiana Case Challenges FDA Authority
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. The appeals court decision would add limits to access nationwide by requiring in-person doctor's visits, fundamentally altering how the medication can be distributed.
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. 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 would not happen until much later this year.
Administrative Hold Creates Brief Window
Justice Alito's order stayed the ruling for a week, until next Monday, and parties in the case have just a couple of days to deliver arguments to the justices. The Supreme Court has put the 5th Circuit ruling on a brief administrative hold, allowing telehealth abortions to continue, until May 11. Louisiana has been asked to file briefs on Thursday. The court could keep the status quo, allow the appeals court ruling to take effect or do something else entirely.
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. The original approval goes back more than a quarter of a century to when Bill Clinton was president. The earlier case was dismissed because the doctors group that brought it lacked standing to sue. The Louisiana case is less likely to face that problem.
Political Pressure Intensifies
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. Kelsey Pritchard of Susan B. Anthony Pro-Life America said, "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."
Anti-abortion state officials and advocates sued the Trump administration to force it to tighten the rules for mifepristone. Pritchard said, "If 1-2% of pro-lifers had stayed home in 2024, Trump wouldn't be president." 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. A Wall Street Journal report indicated Marty Makary had expressed indifference to regulations for mifepristone.
Court briefs from Louisiana noted how a Justice Department lawyer could promise only that parts of the review "might" be done by 2027. White House spokesperson Kush Desai said, "Makary continues to deliver for the American people, from modernizing the drug approvals process to cracking down on artificial ingredients in our food supply."
Sam Bagenstos, who was general counsel for US Department of Health and Human Services during the Biden administration, said, "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."
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."
Telehealth has allowed women to get around most state bans in the 20 states that now have them. 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. 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.
Medication abortion now makes up some two-thirds of all U.S. abortions. 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.
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." 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.
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."
Why This Matters:
The mifepristone case represents a critical test of federal regulatory authority and the limits of administrative discretion in implementing policies that affect millions of Americans. The FDA's ongoing safety review, with completion potentially delayed until 2027, raises questions about the proper pace and scope of regulatory oversight for medications approved more than a quarter of a century ago. For the Trump administration, the case creates tension between its stated preference for state-level decision-making on abortion and pressure from core supporters demanding federal action to restrict access. The Supreme Court's handling of the case will determine whether states can effectively regulate medication that crosses state lines through telehealth and mail delivery, affecting the practical implementation of abortion restrictions in the 20 states with bans. The political ramifications extend directly into the midterm elections, with abortion rights supporters and opponents both mobilizing around the issue. The case also tests the boundaries of standing requirements for legal challenges and the extent to which federal courts will intervene in FDA regulatory decisions, with implications for administrative law beyond abortion policy.