Today, Explained

Abortion pills at the Supreme Court

26 min
May 12, 202618 days ago
Listen to Episode
Summary

The episode examines the Supreme Court's imminent decision on abortion pill access via telehealth, exploring Louisiana's push for a nationwide ban and the implications for reproductive healthcare. It also covers growing tensions between the Trump administration and anti-abortion advocacy groups over federal versus state-level abortion policy.

Insights
  • Medication abortion now accounts for two-thirds of all US abortions, with telehealth access critical for rural and underserved areas, making this Supreme Court decision potentially transformative for reproductive access nationwide
  • Anti-abortion groups are experiencing a strategic crisis: despite overturning Roe v. Wade and controlling the White House and Congress, abortion rates have increased post-Dobbs and the Trump administration refuses to pursue federal restrictions
  • The 'states' rights' argument is being weaponized by both sides—Louisiana claims state sovereignty to ban pills nationwide, while pro-choice states argue state sovereignty protects their citizens' access, creating an irresolvable constitutional tension
  • The Trump administration's silence on the Supreme Court case and approval of generic mifepristone signals political calculation over ideology, prioritizing electoral viability over core conservative principles
  • Susan B. Anthony Pro-Life America's $160M spending threat in 2028 primary signals the anti-abortion movement may force a reckoning on Republican identity and whether abortion remains a party-defining issue
Trends
Medication abortion dominance: Two-thirds of US abortions now use pills, with over 25% accessed via telehealth, fundamentally shifting abortion access patternsInterstate abortion arbitrage: Blue states implementing 'shield laws' to protect out-of-state patients, creating de facto national access despite state bansAnti-abortion movement fragmentation: Conservative base increasingly frustrated with Republican leadership's pragmatic approach over ideological purity on abortionTelehealth as healthcare equity issue: Rural and medically underserved regions depend on mail-based pill access, making this a healthcare access and equity question beyond abortion politicsPolitical realignment around abortion: Trump's transactional approach to abortion policy is forcing conservative movement to choose between electoral strategy and ideological consistencyFDA regulatory authority becoming political battleground: Generic drug approval and telehealth regulations now treated as proxy fights for abortion policyState-level policy divergence accelerating: Post-Dobbs patchwork creating 50 different regulatory regimes, with federal courts increasingly asked to referee interstate conflictsPro-life lobby's leverage declining: Despite decades of Republican loyalty, groups like SBA List finding reduced influence with Trump administration on abortion priorities
Topics
Mifepristone telehealth access and Supreme Court litigationLouisiana abortion pill ban and federal preemptionMedication abortion prevalence and clinical outcomesState versus federal abortion policy authorityInterstate shield laws protecting abortion accessTrump administration abortion policy and FDA approvalAnti-abortion movement strategy and political leverageSusan B. Anthony Pro-Life America political spendingRural healthcare access and medical desertsDobbs decision implementation and state patchworkRepublican Party abortion platform and 2028 primaryPublic opinion on abortion legality trendsTelehealth regulation and healthcare equityFDA regulatory authority over abortion medicationsConservative movement identity and ideological consistency
Companies
Food and Drug Administration (FDA)
Federal regulator overseeing mifepristone approval and telehealth access policies; approved generic version despite a...
Vanta
Compliance and security automation platform; episode sponsor offering SOC 2 and enterprise GRC solutions
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Term life insurance marketplace; episode sponsor helping Americans secure coverage
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Financial wellness and investment app; episode sponsor offering automated investing and financial planning
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People
Alice Miranda Olstein
Primary guest discussing Supreme Court abortion pill case, Louisiana's legal arguments, and telehealth access implica...
Philip Wegman
Guest discussing anti-abortion movement's frustration with Trump administration and 2028 primary strategy
Sean Ramos
Episode host conducting interviews and framing discussion
Marjorie Dannenfelser
Anti-abortion leader quoted on existential stakes for movement and $160M spending threat in 2028 primary
Donald Trump
Subject of discussion regarding silence on Supreme Court case and approval of generic mifepristone
Marty McCary
Approved generic mifepristone; target of anti-abortion group criticism and calls for dismissal
Skyler Diggins
Featured in podcast advertisement for 'and mom' community launching May 14th
Sue Bird
Featured in podcast advertisement discussing WNBA opening weekend and Maria Taylor interview
Quotes
"Every day that patients in our state can get abortion pills online and get them shipped in in violation of our state's ban is a day we are being injured as a state."
Louisiana (via Supreme Court brief)Mid-episode
"Why should a fetus's rights end at a state border? And of course, on the other side, you have folks saying, why should a pregnant woman's rights end at a state border?"
Alice Miranda OlsteinMid-episode
"If the Republican Party fully follows this administration's states only strategy and abandons its commitments to pro-life action at the national level, then the movement, as we know it, is finished."
Marjorie Dannenfelser, Susan B. Anthony Pro-Life AmericaLate-episode
"The president is the problem."
Marjorie Dannenfelser (to Wall Street Journal)Late-episode
"This issue is killing us. A majority of Americans do in fact believe abortion should be legal in most cases."
Trump administration (paraphrased via Philip Wegman)Late-episode
Full Transcript
Abortion pills have been on a bit of a journey in the United States over the past few weeks. The journey begins in Louisiana where the state sued the Food and Drug Administration to ban access to Mipha Pristone through telehealth pills in the mail. On May 1st, a district appeals court temporarily banned access to telehealth abortion and pills by mail nationwide. So for a few days a lot of people in the country were like, uh, but then the Supreme Court of the United States weighed in. But the Supreme Court wasn't finished. They said we'll have more for you on Monday, yesterday. But then yesterday they said, actually, Thursday. And we'll see if that happens. The Supreme Court said it would get out of the business of abortion after overturning Roe v. Wade and they were wrong. So while we wait for them to figure this out, again, we're going to talk about what's at stake on today's Explained from Box. What's up, y'all? I'm Skyler Diggins, seven time WNBA All Star, Olympic gold medalist and mom. And I'm Cassidy Hubbard, host and reporter for nearly 20 years, covering the biggest names and stories in sports and mom. And this is and mom, a community for athletes, game changers and moms of all kinds. Dropping May 14th. Tap in with us. Hey everybody, Sue Bird here. This week on a Touch More, I'm celebrating the start of the WNBA by breaking down what I saw on opening weekend. And we have NBC's one and only Maria Taylor to talk about her boundary breaking career in sports journalism, the NBA playoffs and her thoughts on which teams have the best chance of making the WNBA finals. Check out the latest episode of a Touch More wherever you get your podcasts and on YouTube. Oh, yay. Oh, yay. Today Explained. I am Alice Miranda Olstein and I am a senior health care reporter for Politico. By the end of the week, could the nature of access to abortion pills across the country change? Is that what's at stake here? Yes, absolutely. So what Louisiana is demanding is that the Supreme Court allow restrictions to go into effect right now, even before the case is finally resolved. Louisiana says, you know, every day that patients in our state can get abortion pills online and get them shipped in in violation of our state's ban is a day we are being injured as a state. They're claiming sovereign injury that they say the ability of patients around the country to access these pills by telehealth to have them prescribed by a doctor online and sent by mail is helping people in their state circumvent the law. And that's why they want the Supreme Court to step in and cut that off for everyone nationwide because it's a federal policy while the case is still in the works. And the drug makers are the ones fighting back against that. The two companies that make this abortion pill. And they say there's no sovereign injury. You can't just get rid of a policy for everyone because you don't like how people are using it. Louisiana thus suffers no sovereign injury because nothing undermines Louisiana's ability to legislate and enforce abortion restrictions as it sees fit. And they say that, you know, this policy has been in effect for several years already. There's no sudden emergency where you need it suddenly banned just now. And thus the Supreme Court should keep everything the way it currently is while the case works its way through. Do we have any idea where the Supreme Court stands on abortion pills at this point? So the reading of the tea leaves is always a, you know, tricky, tricky venture with the Supreme Court. You know, people try to guess based on, you know, the questions that were asked or all arguments. We haven't even gotten there yet in this case, but it's just very hard to know. It's very hard to know. Politico hasn't gotten like a leak this time about the decision. Not on this one. Not on this one. It's very possible that, you know, once again, they sort of duck the heart of the issue on abortion on federal power versus state power. And they just say, you don't have standing. You can't prove that you, the state are being injured by this policy. It seems a little contradictory, right? I mean, the Supreme Court said, let the states decide. Years later we have Louisiana saying, hey, ban abortion pills for the entire country. That's not letting the states decide at all, right? Just on its face. So what's interesting here is you really have both sides making a state's rights argument and saying my rights as a state are being infringed upon. So you have Louisiana saying, why should other blue states, liberal abortion policies where anybody can get pills? Why should that be allowed to invade our state when we're over here trying to ban abortion? New York and other states have also passed aggressive shield laws that, among other things, permit doctors and clinics to omit identifying information from pill bottles so that a 12-pill bottle with Mipha pristone can arrive in Louisiana without indicating who sent it. And so they're basically saying that allowing this anywhere, you know, infringes on their right as a state to prohibit it. Now of course, as you just articulated, you also have people saying, wait a minute, so that means it gets to be restricted for everybody, even people who, you know, have laws on the books in their states supporting access to abortion. States have no sovereign interest in having other sovereign's policies match theirs. And a divergence in abortion policy at the state level is a natural result of returning abortion policy to the states. And so, yeah, you really have all sides of this reaching for the states' rights banner. It's one of those sort of compromises that pleases nobody because, you know, the anti-abortion folks, they are not ever going to be satisfied. They say, you know, why should a fetus's rights end at a state border? And of course, on the other side, you have folks saying, why should a pregnant woman's rights end at a state border? And so this is always going to be a federal fight. How big a deal have abortion pills become since the Supreme Court overturned Roe v. Wade since Dobbs? Even before that, they were becoming more and more popular as a method of abortion. And especially since the COVID pandemic, they have become the predominant method that people are choosing in order to terminate their pregnancies. Most abortions today are obtained through medication, often accessed by mail and without an in-person visit to a doctor, something opponents have tried to stop. Medication is now used to bring about two-thirds of all abortions. And more than a quarter get them by telehealth. So, you know, even if the pills aren't banned entirely, but just telehealth is restricted, that's going to be a big blow. And it's not just a big blow to people living in states like Louisiana where there's a ban locally and they can't go to a doctor's office and get them even if they want to. But it'll impact people in states like California where there are these huge swaths of the state where it's very difficult to get to a clinic. You know, we have medical deserts all around the country. We have shortages of providers and telehealth has really broadened access, including in states where it was already legal and technically accessible on paper, but not in practice. OK, so give us an idea. Let's say by the end of this week, the Supreme Court weighs in Thursday afternoon, Thursday morning, who knows if they say no more abortion pills via telehealth. What does this look like in the United States? Yeah, so we actually got a sneak preview of what it would look like a couple of weeks ago. We had a few days between when the Fifth Circuit ruled for Louisiana and said, OK, we're going to restrict these pills, access to these pills nationwide. And it took the Supreme Court a few days after that to step in and say, whoa, let's hit pause. Let's go back to the way things were. Let's restore telehealth access while we figure this out. So in those few days, you saw these providers who prescribe and ship the pills to people living in states with bands make sort of a variety of decisions. Some of these groups immediately just paused and stopped. Other groups, including, you know, some doctors I talked to in Massachusetts, they have been preparing for this for years. And so they had a plan already in place to pivot to only providing the second pill of the two pill abortion regimen. So to have an abortion, you can't just take Mipha Prasad alone. You have to take it in combination with another pill, Mesa Prostyl. Now, you can take Mesa Prostyl alone, and that's actually pretty common in other countries. So these groups, including the ones I talked to, immediately pivoted to only sending Mesa Prostyl to patients who were who were ordering the pills. OK, so there's a lot at stake here for abortion access in the United States this week at the Supreme Court. I'm curious how the president of the United States feels about this, not that he has a say per se, but has he weighed in? He has not and neither has his Justice Department. So what was really striking is, you know, the Supreme Court was like, OK, we're going to we're going to, you know, step in here and at least decide this case on a temporary basis. And, you know, they heard from Louisiana. Out of state prescribers freed from the in person dispensing requirement are causing approximately one thousand illegal abortions in Louisiana each month. They heard from the drug makers. Louisiana's complaint should have been dismissed outright. They heard from all of these other people, members of Congress. Brief for two hundred and fifty nine members of Congress as amicic governors. Brief for states of New York, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, medical groups, leaving all medically sound options on the table, including dispensing Mithipristone via mail or at local pharmacies is critical. Activist groups on all sides, intimate partner violence often needs to coerce abortions of wanted children. Many religious traditions view abortion as morally acceptable. Former FDA officials, FDA was extremely cautious in approving Mithipristone. Everybody was sending briefs up to the Supreme Court. But, you know, who didn't? The Trump administration, the Trump administration, the guy who talks about everything, did not weigh in, did not either ask the Supreme Court to maintain the status quo or side with Louisiana. They were silent. The FDA has said it, you know, is reviewing the safety of the pills and will make its own decision. So the Trump administration had told lower courts, hey, back off, you know, let the FDA do its thing. But now that the case is before the Supreme Court, nothing to say, silent. Now, the anti-abortion folks took that as a sign that the Trump administration is cool with the Supreme Court imposing restrictions. They said, oh, even they won't defend the FDA's horrible telehealth policy, blah, blah, blah, blah, blah. Now, we don't know that that's the message that this lack of that the silence is sending, but it's it's definitely making people offer their interpretations. Why the silence? When today explained returns. Support for the show today comes from Vanta. If you're a business owner, you may have noticed a shift recently. Risk and regulation are increasing. But before they sign anything, customers now expect clear proof of security. Building that trust is essential to closing deals. 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Do not predict or represent the performance of any Acorns portfolio. Investment results will vary. Investment involves risk, guys. Acorns advisors LLC and SEC registered investment advisor view important disclosures at Acorns dot com slash explained. Mr. President, you have any reaction to today's play being named the best news show? Wow. I didn't know that. I just tell him enough for the first time. Philip Wegman reports on the White House for the Wall Street Journal and he recently helped write one called the anti-abortion movement is turning on Trump. We asked him to come talk to us about it. Right now, if you talk to folks in the anti-abortion movement, they're pretty disappointed because they thought that they would be doing much better right now. They have Republican allies in Congress. Senator Lindsey Graham is promising to hold a vote on a national abortion ban. That would say after 15 weeks, no abortion on demand, except in cases of rape and sex. The Supreme Court, of course, turned over Roe v. Wade several years ago. It was 191392, Dobbs versus Jackson Women's Health Organization. And the man that they helped return to the White House, Donald Trump, who brags about being the most pro-life president ever. Well, I'm pro-life. I am pro-life. He's back in power. And yet last month, you had the president of Susan B. Anthony Pro-Life America, a woman named Marjorie Dienen-Felzer, come out and say that the stakes were existential for their movement. If the Republican Party fully follows this administration's states only strategy and abandons its commitments to pro-life action at the national level, then the movement, as we know it, is finished. Basically, what, you know, it all boils down to, in their mind, is that there have been more abortions post-Rowe year after year. There are more abortions in the United States now than there were on the day that Roe v. Wade was overturned. And currently, the Trump administration has embraced a sort of state's rights patchwork framework for regulation. My view is now that we have abortion, where everybody wanted it from a legal standpoint. The states will determine by vote or legislation or perhaps both. And whatever they decide must be the law of the land. In this case, the law of the state. And so they were triumphant just a few years ago, but now they're very much on the back foot. It sounds like you're saying that these lobbying groups thought that the decision from the Supreme Court overturning Roe v. Wade, the Dodds decision, would mean fewer abortions in the United States. Was that kind of their bad for thinking that? There certainly was an expectation that one's Roe was reversed. There were going to be all sorts of other fights, that they were going to fight this out in all 50 different states. At the same time, though, these anti-abortion groups, they're of the opinion that the Dodds decision leaves room for federal action. And what they're frustrated by right now is that Trump, in their mind, has really held them at arm's length. Not only does he not want a federal abortion ban. Many states will be different. Many will have a different number of weeks or some will have more conservative than others, and that's what they will be. But his administration has moved forward with the approval of a generic version of Mipha Pristone. They have kept on the books, Biden-era regulations, that allow a woman to order these drugs through a telehealth service and not actually have to go see a doctor. They believe that Republicans are standing still at a moment when Democrats, and frankly this is backed up by the reporting, say that they want to codify Roe. So for these pro-lifers, it's existential. These groups you're talking about, can we get more specific? Who are we talking about here? So there's a lot of different groups here when it comes to the pro-life lobby. There's Americans United for Life, the March for Life, the Family Research Council, but the most politically connected is the Susan B. Anthony List. If a member of Congress gets a call from the March for Life, they're picking up the phone eager to talk. If they get a call from Susan B. Anthony List, they might be sweating. No. Marjorie Dennis Felser, president of SBA, pro-life America, is very much a political operator. The entire group, they are knife fighters through and through, and they really put the Republican Party on notice last month when they announced that they were planning to spend $160 million, not just in the coming midterms, but in the 2028 Republican presidential primary. Time is short, but our task can be accomplished, and over these next two cycles, we plan to spend $160 million to try to accomplish this great task. The pro-lifers at SBA, they have not hid their frustration. They were angry at FDA administrator Marty McCary because he approved a generic. Approving a new generic version of the drug myth of Pristone, these are medications used in about two-thirds of all abortions nationwide. With FDA approval, activists say it will be easier to get abortion pills through the mail, despite laws in some states that aim to make that illegal. The Susan B. Anthony group saying this reckless decision by the FDA is unconscionable. So last December, they called for McCary to be fired. SBA, they've been sort of rattling the saber, but in our interview with her, she told the Wall Street Journal, the president is the problem as a direct quote. She believes that Trump, who was as pro-life of an advocate as you could have in 2016, and again in 2020, has set aside the issue. And the president on Friday met with people from the Susan B. Anthony list, including their leader, Marjorie. Do we know how much Marjorie and the president see the midterms in the 2028 elections differently? The pro-life lobby thinks that there is a way for Republicans to run on abortion and not run away from it. And so they are going to spend a lot of money in these coming midterms, but they're also going to spend a ton of money in the coming presidential primary. And the expectation here is that any candidate that they're going to support has to agree to federal action on the abortion issue. Marjorie told the Wall Street Journal in our reporting that the president, who had been staunchly and openly pro-life, remember in 2016, there's that moment on the debate stage where he says that Hillary Clinton is okay with partial birth abortion and describes that in vivid terms. Based on where she's going and where she's been, you can take the baby and rip the baby out of the womb in the ninth month on the final day, and that's not acceptable. Well, that is not what happened. That got all of the social conservatives to stop thinking twice about this billionaire playboy from New York and see him instead as a social conservative champion. Well, in the 2024 election, Trump sort of says, hey, I delivered you three pro-life Supreme Court justices. My work here is done. I'm going to focus on other things. And when Marjorie went to Trump and said, hey, we need federal action, I need you to get on board, the answer that she got was, no, this issue is killing us. A majority of Americans do in fact believe abortion should be legal in most cases. Just about two-thirds of those polled 66% believe abortion should be legal in all or most cases. That is nearly 10 points higher than it was just over a decade ago. And there's a belief inside of the current administration that if they didn't have to deal with abortion, then maybe Republicans will be picking up dozens of additional seats. So the fact that this meeting was put on the schedule is incredibly significant because it shows that the White House knows, look, we have to service this part of our coalition. We have to get on board with them. Maybe it reflects that the administration believed that they let a court constituency outside of the fold. It seems pretty clear if you look at his, you know, decades of history of weighing in on every last issue that abortion didn't weigh heavily on the president's mind until it became politically expedient to do so. Do you really think if, say, JD Vance come 2027 or so starts advocating for a federal abortion ban, 20-week abortion ban, whatever it might be, that it's going to upset President Trump, who probably, you know, doesn't really have a dog in the fight to begin with? We don't know how much of a leash does the president actually give JD Vance to go pursue the nomination. And as he's doing it, is Donald Trump a stage mom giving helpful advice? Or is he one of the judges saying, hey, I thought you were the MAGA heir apparent, but some of these other guys have better stump speeches. And they are more deferential towards me. You know, Donald Trump, I think that everything is transactional. And so where you have these pro-lifers who are motivated by a single principle, and then you have a politician who is motivated just by getting the best deal that he can. Do they get it back on the same page? Or is this a break? And like, you know, the anti-abortion lobby has been one of the most loyal constituencies for Republicans for decades. Sean, this is the story of the Trump era. He shows up and he tears the curtain on what Republican orthodoxy is, remaking the party in his own image. There are some things he absolutely cares about. Trade, immigration, foreign policy. On all of the other areas, though, now there's no gatekeeper to say what is and isn't conservative. And all have sort of freely entered in to have this argument. Some folks, like the pro-lifers, are saying this has been a party platform issue for decades. It cannot change. It shouldn't change. They are looking not just to change the direction of the current administration. They're looking for the future of the party and saying, what will Republicans believe in 2028? And their argument is that any definition of conservatism has to include robust limitations on abortion. And previously, a lot of Republicans were very successful in saying, hey, you know, we want to overturn Roe v. Wade. And that was sort of the consensus. And so this is going to be a fascinating, fascinating fight that is going to tell us a lot about the identity of the new American right. And Philip at The Journal, wsj.com, read Alice from earlier at Politico.com. Listen to today explained because Peter Ballin on Rose and produces Jolie Meyers edits Gabriel Dunnetov, fact checks David Tadda shore and Bridger Dunnegan mix. I'm Sean Ramos for him. Goodbye. 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