The Supreme Court on Monday restored broad access to the abortion pill mifepristone, blocking a lower-court ruling that had threatened to upend one of the main ways abortions are provided across the nation. The order signed by Justice Samuel Alito temporarily allows women seeking abortions to obtain the pill at pharmacies or through the mail, without an in-person visit to a doctor. That access had been permitted for several years until a federal appeals court imposed new restrictions last week, another reminder that people’s health care can be yanked around by judges and legal machinery far above their heads.
Who Controls the Gate
The latest order will remain in effect for another week while both sides respond and the high court considers the issue more fully. For now, the court has paused the immediate damage, but only on a temporary basis, with access to medication abortion still hanging on the next move from the same institutions that keep deciding who gets care and how. The majority of abortions in the U.S. are obtained through medications, which makes the fight over mifepristone a fight over one of the main routes people use to end pregnancies.
Some Democratic-led states have laws that seek to give legal protection to those who prescribe the drugs via telehealth to patients in states with bans. That is the reform lane: patchwork legal shields inside a system where access still depends on state lines, court orders, and whatever the next ruling says. Meanwhile, Louisiana sued to roll back the Food and Drug Administration’s rules on how mifepristone can be prescribed, asserting that the policy undermines the ban there. The lawsuit is the furthest along of several efforts by abortion opponents to curtail access to mifepristone.
The People Keeping Care Alive
While the legal apparatus churned, several groups that prescribe abortion pills by telehealth made the switch over the weekend to misoprostol only, a regimen that can cause longer-lasting side effects. Dr. Angel Foster, founder of The Massachusetts Abortion Access Project, said her organization was prepared to send misoprostol only on Monday afternoon but was able to switch back to the two-drug combination. She said, “Regardless of what happens with this regulatory issue, we and other groups will continue to provide high-quality abortion care to patients in all 50 states.”
Foster also said her organization spent the weekend guiding different groups of patients: those who were sent mifepristone but had not received it yet; those who had been approved for the drugs but had not paid or been sent them; and those who reached out with initial requests. That is the actual labor of care here: not grand speeches from the bench, but people and organizations trying to keep medication moving while the courts and politicians play tug-of-war with access.
Julie Burkhart, the founder of Wellspring Health Access, a Wyoming abortion clinic that provides roughly 100 abortions a year through pills prescribed by telehealth, said, “We have a little bit more time to navigate this new landscape with the stay.” Elizabeth Ling, associate director of legal services at If/When/How, said, “The outcome is not going to make it a crime for people to access care.”
What the Powerful Are Fighting Over
The case also questioned the safety of the drug, which was approved 25 years ago and has repeatedly been deemed safe and effective by FDA scientists. Mifepristone is usually taken with misoprostol for abortions, and according to the FDA label on mifepristone, the combination completes medical abortion 97.4% of the time. Misoprostol can also be used alone for terminating pregnancies, with some studies putting its effectiveness at around 80% or higher. In countries where mifepristone is banned or unavailable, misoprostol is frequently used alone. Unlike mifepristone, misoprostol has never been formally approved by the FDA for abortion. The drug is most commonly used to treat stomach ulcers, but it has been adapted by doctors for use in medication abortions.
Anti-abortion groups vowed to continue the legal battle. Carol Tobias, president of National Right to Life, said Monday’s ruling “is a temporary procedural step that leaves unresolved the very real concerns about the safety of these drugs and the decision under the Biden administration’s FDA to recklessly remove longstanding safeguards.” Louisiana Attorney General Liz Murrill, who filed the lawsuit against the FDA along with a woman who says her boyfriend coerced her into taking abortion pills to end a pregnancy, criticized drug companies for their role in the case. She said, “Big abortion pharma claims they need an emergency stay because they will lose massive amounts of money if they can’t kill more babies quickly and efficiently by mail without medical oversight.” She added, “The administrative stay is temporary, and I am confident life and the law will win in the end.”
Politico also reported that the GOP health care vision would encourage Obamacare enrollees to shift into high-deductible insurance plans and that President Donald Trump and GOP senators want to shift remaining Obamacare subsidies into tax-advantaged health savings accounts. The newsletter said the plan would cut off telemedicine prescriptions of mifepristone for non-abortion purposes, such as easing miscarriages. The same political class that keeps rearranging insurance schemes and subsidies is also narrowing the channels through which people can get care, with telemedicine itself treated as another lever to be tightened or cut off depending on the agenda in power.