Introduction

Since Dobbs, federal litigation impacting abortion access has continued, with the Supreme Court already deciding three cases and multiple cases involving medication abortion working their way through the court system. The Supreme Court has heard three abortion-related cases since Dobbs that have deepened the legal chaos around reproductive health care in the absence of a federal right to abortion, in a landscape where 20 states are enforcing total bans or severe restrictions, while 25 states have at least some constitutional or state-law protections for abortion.¹ Federal courts will continue grappling with efforts to impose nationwide restrictions on abortion access for the foreseeable future.

SCOTUS decisions

SCOTUS decisions

Post-Dobbs, the Supreme Court has issued decisions in cases that involved access to medication abortion,² emergency abortion care,³ and a range of comprehensive reproductive healthcare services for individuals insured through Medicaid.⁴ The Court decided these cases on procedural or quasi-procedural grounds that invited renewed attacks by anti-abortion actors. The Center has submitted amicus briefs in each case that lift up the high-quality evidence supporting abortion safety and the real-world harms from restrictions that the Supreme Court has largely failed to address.

FDA v. Alliance for Hippocratic Medicine ⁵

In 2022, anti-abortion doctors and medical groups filed a lawsuit aiming to block the U.S. Food and Drug Administration (FDA)’s long-standing approval of mifepristone, a safe and effective medication used in nearly two-thirds of U.S. abortions as well as for miscarriage care.⁶ Ending access to mifepristone nationwide has been a central goal of the anti-abortion movement since Dobbs. The case reached the Supreme Court in 2024 after a federal district judge in Texas rescinded the FDA’s 2000 approval of mifepristone and the Fifth Circuit reinstated burdensome prior restrictions, including a requirement that patients travel to a health center just to pick up the medication, rather than receive it by mail.⁷ The Center and its movement partners filed an amicus brief detailing how the lower courts disregarded decades’ worth of high-quality evidence on mifepristone’s safety and effectiveness and instead relied on flawed research and testimony from anti-abortion witnesses who have been discredited by courts across the country.⁸ Instead of ruling on and affirming mifepristone’s safety and shutting down this line of attack, however, the Court resolved the case on procedural grounds, holding that the plaintiffs lacked standing to challenge the FDA’s actions because they do not have an actual connection to the FDA’s regulation of the drug.⁹

The Court’s 2024 ruling left the door open for other plaintiffs to assert standing and attempt to block access to mifepristone, and several anti-abortion states quickly joined the fray.¹⁰ As discussed below, three separate cases are pending in the federal courts seeking to severely limit mifepristone nationwide, including in states where abortion is legal. These cases will likely require the Supreme Court to grapple with its prior assertion in Dobbs that it was returning the question of abortion to the states.

Moyle v. United States¹¹

Weeks after the Alliance opinion came down, the Supreme Court issued a decision in Moyle v. United States.¹² Like in Alliance, the Court avoided weighing in on abortion and instead dismissed the case, inviting continuing challenges.

The central issue in Moyle was a conflict between federal and state law—specifically, whether Idaho could enforce its abortion ban with no health exception in situations where the federal Emergency Medical Treatment & Labor Act (EMTALA) requires hospitals that receive Medicare funds to provide stabilizing treatment to all patients with emergency medical conditions.¹³ At oral argument the Court heard searing accounts of pregnant people in Idaho being airlifted to other states so that they could get the abortion care they needed. Briefing by the Center and other medical and legal organizations highlighted that people across the country are being delayed or denied lifesaving and health-preserving abortion care under abortion bans, making EMTALA more critical than ever.¹⁴ The Court, however, did not resolve any of the legal questions. Instead, it dismissed Moyle as “improvidently granted”—meaning a majority of the court said it didn’t want to decide the case.¹⁵ The Court’s refusal to address whether people in dire emergencies who need abortion care are entitled to the same EMTALA protections as people seeking any other type of care leaves the door open to future litigation, as states double down on bans with few or no exceptions. And due to conflicting federal appellate court rulings, the federal government cannot enforce EMTALA to require emergency abortion care in Texas.¹⁶

Planned Parenthood v. Medina¹⁷

The Court decided its third abortion-related case since Dobbs on narrow, quasi-procedural grounds that obscure its significant implications for personal healthcare decisions. Even though federal law prohibits Medicaid funding for abortion except in rare circumstances, states hostile to abortion have barred Planned Parenthood from receiving Medicaid reimbursements for non-abortion services such as cancer screenings, STI treatment, and contraception, because it also provides abortion care.¹⁸ Planned Parenthood and a patient sued South Carolina, arguing that the exclusion violated the federal Medicaid law’s free-choice-of-provider provision.¹⁹ The Court held that Medicaid patients do not have a right to sue when a state prevents them from going to a qualified provider of their choice.²⁰ The upshot of the decision is that states like South Carolina can exclude qualified healthcare providers from Medicaid reimbursement for any reason, greenlighting hostile states to defund Planned Parenthood and other health centers based on their opposition to abortion. As an amicus brief filed by the Center and partners explained, because there is a limited pool of trusted providers who accept Medicaid patients, and because Medicaid beneficiaries often experience discrimination in healthcare settings, eliminating Medicaid funding for Planned Parenthood harms the most vulnerable, and it exacerbates reproductive health inequities.²¹

The Supreme Court’s three abortion-related cases since Dobbs have deepened the legal chaos around reproductive rights and access in the absence of a federal right to abortion. They show the Court’s reluctance to enforce remaining federal protections, paving the way for states to enact policies that further limit sexual and reproductive healthcare, sometimes with nationwide consequences.

Medication abortion challenges

Medication abortion challenges

Enabled in part by the Supreme Court’s standing-based decision in Alliance, multiple cases challenging the FDA’s regulatory actions around medication abortion are making their way through the federal courts.

Since its approval in 2000, over 7.5 million people in the U.S. have safely used mifepristone for medication abortion and miscarriage care.²² Mifepristone is closely regulated by the FDA, more extensively than other drugs with comparable safety profiles.²³ After Alliance stayed silent on mifepristone’s safety, anti-abortion litigants have renewed their efforts to either remove mifepristone from the market or reinstate burdensome, outdated requirements that would make it more difficult to access nationwide—even in states where abortion is legal and constitutionally protected.²⁴ These cases claim that the FDA’s scientific review process was flawed and ask courts to reimpose restrictions based on junk science, broadly upending FDA regulatory authority far beyond the issue at hand.

Meanwhile, a second category of cases—brought by the Center, partner organizations, and a collection of states—have sought to eliminate the FDA’s remaining outdated and medically unnecessary restrictions on mifepristone, arguing that the FDA cannot justify them through its own review processes.²⁵ The Center and others have asked courts to require that the FDA apply evidence-based criteria and rigorous methods to guide its regulation of a drug that has been used safely and effectively for over 25 years.

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