5th Circuit restricts distribution of mifepristone by fiat

Trump has enough political instincts not to push Congress to try for a national abortion ban, but legislation isn’t how Republicans prefer to proceed in any case:

On Friday, the conservative U.S. Court of Appeals for the Fifth Circuit blocked a Food and Drug Administration rule that allows doctors to prescribe the abortion pill mifepristone via telemedicine. The decision sends a clear message: No woman in America, no matter where she lives, has total control over whether to continue or end a pregnancy.

For women in red states, where abortion clinics have been forced to close, this ruling is an attempt to sever one of their final tethers to safe abortion procedures. For blue-state women who may have believed they were protected by dint of their ZIP code, it could come as a shock: A judicial panel of three men, two appointed by President Trump (one of whom was the lead counsel for a conservative group in the Supreme Court case that kneecapped the Affordable Care Act’s contraception mandate), can curtail your right to abortion, too.

Since the Supreme Court overturned Roe v. Wade in June 2022, the number of in-person abortions has declined. Instead of visiting a clinic for a surgical abortion or to collect pills that prompt an abortion, an increasing number of women are turning to telemedicine, where a doctor can prescribe the same pills, which can be sent in the mail.

In states where abortion is banned, in-person procedures are near zero, while the number of telehealth abortion prescriptions was about 9,000 a month by June 2025, according to data gathered by the Society of Family Planning. Most of these prescriptions come from doctors in blue states, which have passed shield laws to ensure that clinicians cannot be criminally charged for prescribing abortion pills to women in need, wherever in the United States those women live.

But it’s not just women in states with abortion bans who will be affected. Telehealth abortions have increased threefold in states that permit abortion, from about 4,500 in June 2022 to 14,000 in June 2025.

Many women opt for telehealth prescriptions over going to a clinic because it is simpler and more private. Others do so because, even in states that permit abortion, it can be difficult to get access to one. The impact of the Fifth’s Circuit judges’ decision will be especially acute in rural areas. Instead of phoning a trained physician and getting pills by mail as she could do as of Thursday, a woman in rural Montana may now have to drive close to 250 miles for a safe in-person abortion at an overburdened clinic, despite the procedure being legal in her state.

One would like to think that the Court’s aggressive use of the shadow docket will mean this order is stayed very quickly given that the balance of harms overwhelmingly falls on the women who will be denied access to critical medication, but needless to say it would be foolish to count on that.

By the way, how is the post-Dobbs Republican pivot to healthcare going?

Millions of Americans appear to be dropping Obamacare coverage in the months since Congress failed to extend the generous subsidies that had become a defining feature of the Affordable Care Act.

Initial sign-ups had already fallen by about 1.2 million people. But insurance companies, state officials and industry analysts are reporting that many more have lost Obamacare coverage now that people are facing long-term higher costs. The federal government has yet to report current enrollment data.

Many insurers and analysts are estimating overall declines of about 20 percent, dropping to around 19 million from the 24 million who were covered under the A.C.A. last year. Other indications suggest there could be even larger potential losses by the end of the year, a deep retrenchment for Obamacare coverage and a reversal of significant gains in the last several years.

Over to you, Mr. Douthat:

At the same time the pro-life movement’s many critics regard it as not merely conservative but as an embodiment of reaction at its worst — punitive and cruel and patriarchal, piling burdens on poor women and doing nothing to relieve them, putting unborn life ahead of the lives and health of women while pretending to hold them equal.