This was originally published on the Alliance for Citizen Engagement (Center bias). It was written by Shailee Sinha.
Background and Legal Landscape
In June of 2022, the Supreme Court overturned Roe v. Wade in Dobbs v. Jackson’s Health, which eliminated the constitutional right to abortion and returned the right to regulate abortion to the states. This landmark decision created a fragmented legal landscape, with some states moving to enact bans and others choosing to expand access. On June 12, 2025, the Supreme Court declined to hear a lawsuit that sought to reduce access to mifepristone, a drug that is used to induce abortion. The Court’s unanimous decision to not hear the case FDA v. Alliance for Hippocratic Medicine, in which anti-abortion groups challenged the FDA’s loosening of restrictions for mifepristone, was based on the argument that the plaintiffs lacked legal standing because they could not demonstrate direct harm from the FDA’s policies. While this ruling preserved access to the medication, it also left unresolved key questions about the scope of the FDA’s regulatory authority and the legal future of abortion pills.
A Patchwork of State Laws
As of June 2025, 19 states have implemented a near total ban on abortion medication, including Texas, Indiana, and Louisiana. The other 31 states allow some form of legal access to abortion medication. Based on data from June 2024, Mifepristone is openly available in 22 states, where it can be prescribed by a non-physician practitioner, like a nurse practitioner or physician’s assistant. In 14 other states, as of June 2024, it is more regulated and only able to be prescribed by a doctor or after compulsory counseling and ultrasounds.
Despite bans and heavy restrictions in many states, abortion medication remains accessible to thousands of patients through different workarounds. Telehealth providers based in states with protective laws like California and New York can prescribe and mail abortion medication to patients in states with restrictive laws. WeCount noted that in the month before the Dobbs ruling, about 1 in 20 abortions occurred through telehealth, but in the last three months of 2024, it became 1 in 4. To support abortion access nationwide, multiple states have passed shield laws that protect in-state providers from legal action initiated by officials in abortion-restrictive states. These laws block the enforcement of out-of-state subpoenas, civil judgements, and investigations, creating legal safe zones for telehealth providers who serve patients across borders.
However, abortion-restrictive states such as Texas are pushing back. Texas Attorney General Ken Paxton recently filed a lawsuit against a New York doctor for mailing abortion pills to a Texas resident, citing violations of state law. These efforts represent a growing strategy by conservative states to enforce abortion restrictions beyond their borders, raising questions about interstate commerce and how abortion laws can be enforced.
FDA Authority Under Pressure
While the Supreme Court’s decision to not hear FDA v. Alliance for Hippocratic Medicine preserved access to mifepristone for now, it left unresolved deeper legal tensions over the authority of the FDA. At the heart of this debate is a fundamental question: Can states override or ignore federal drug approvals based on moral or political disagreement? The FDA has maintained for over two decades that mifepristone is safe to use in a medical abortion. Its regulatory decisions, including allowing the drug to be prescribed through telehealth and mailed to patients, are based on scientific evidence and public health standards. Under the principle of federal supremacy, as the FDA is a federal agency, these policies must be applied uniformly across the whole country.
However, post-Dobbs, several states have taken the unprecedented step of banning or severely restricting the use of mifepristone, even though it remains FDA approved. In September of 2024,Louisiana moved to classify mifepristone as a controlled substance, while other states have implemented criminal penalties for its distribution. These actions directly contradict federal guidelines and effectively challenge the FDA’s authority to regulate drug access. Legal scholars argue that if the courts allow state or local actors to overturn FDA-approved drugs, it sets a precedent dramatically expanding judicial intervention in drug policy. Drug and biotech companies have also expressed concern that legal challenges to FDA-approved drugs could discourage new drug development, opening the door to challenges against other politically controversial medicines like vaccines, HIV treatments, and hormone therapies.
Conclusion
The post-Dobbs era has turned access to abortion pills into a broader legal and political struggle, one that raises fundamental questions about state power, federal authority, and patient rights. There now remains conflict over whether or not states can defy FDA decisions. As some states ban abortion pills entirely and others protect access through shield laws, patients and providers face a fragmented and inconsistent system.
