Abortion Access In The High Court, Again | Katie Keith

This episode of Health Affairs This Week examines the ongoing legal battle over access to mifepristone, the primary medication used in medication abortion, as it reaches the Supreme Court for the second time in recent years. Katie Keith, a former Biden administration official and expert on reproductive health policy, explains how the FDA’s 2023 rule changes—allowing telehealth and pharmacy access to mifepristone—have been challenged by Louisiana’s Republican Attorney General and a private plaintiff. The Fifth Circuit Court of Appeals quickly granted emergency relief, effectively halting nationwide access to telehealth and pharmacy-based mifepristone, sparking widespread disruption. The Supreme Court is now deciding whether to extend an administrative stay that temporarily preserves current access while litigation continues. Keith emphasizes that the drug has been safely used for over 25 years and that the FDA’s decisions were science-driven, not politicized. She warns that allowing one state to use litigation to impose nationwide restrictions on a widely used drug could destabilize the entire prescription drug development ecosystem. The episode also traces the long history of legal challenges to mifepristone, including prior cases dismissed for lack of standing and new lawsuits from multiple Republican-led states. Keith highlights the broader implications: if states can block access to a safe, effective medication based on ideological objections, it sets a dangerous precedent for all pharmaceutical innovation. The Trump administration’s quiet stance—neither defending nor challenging the FDA’s rules—suggests political calculation, possibly to avoid controversy ahead of the 2026 election. Despite the chaos, the drug manufacturers have intervened to defend access, signaling confidence in the drug’s safety and the importance of maintaining patient access. The outcome of the Supreme Court’s decision will determine whether millions of women face renewed barriers to a foundational reproductive health tool.