With six months to go until the 2026 midterms, abortion has not been a major issue in the campaign. But on Friday, the conservative 5th Circuit Court of Appeals temporarily blocked telehealth access to mifepristone, one of the drugs used in the standard protocol for medication abortion.
The three-judge panel sided with Louisiana’s request to halt telehealth access to the drug nationwide while its suit against the Food and Drug Administration is underway. Louisiana argues that the agency erred when, under the Biden administration, it allowed mifepristone to be obtained by mail. The order was temporarily stayed Monday by Supreme Court Justice Samuel Alito, but the high court’s final decision is still to come. However the justices rule, the case already has significant consequences both for patients seeking abortions and for national politics.
The total number of abortions didn’t significantly decline after the end of Roe, even in states that have criminalized abortion.
Almost four years after the Supreme Court overturned Roe v. Wade, the reality of a post-Roe America hasn’t set in for most Americans. Many live in states where abortion is legal. In other states, people who want abortions can still often get them. Those unable to travel can take advantage of telehealth providers in states with “shield laws,” which seek to protect doctors and other residents from out-of-state criminal and civil consequences for aiding in abortion.
The result has been a sort of uneasy equilibrium: Americans can still often access abortion early in pregnancy, and the total number of abortions didn’t significantly decline after the end of Roe, even in states that have criminalized abortion. The Society of Family Planning estimated that more than 1 in 4 abortions nationwide involved telehealth, and it makes up a growing share of abortion care for residents in states with total bans. The Trump administration largely looked the other way, while letting social conservatives believe that the president would deliver on their priorities after the election.
In the 2024 presidential election, Donald Trump largely neutralized the abortion issue by simultaneously claiming credit for the end of Roe and suggesting that if he was returned to the presidency, each state could continue to set its own abortion policy. After he was elected, anti-abortion groups rolled out a “Make America Pro-Life Again” wish list, much of it focused on eliminating access to mifepristone. The Trump White House mostly ignored these demands, acutely aware of polls showing that most Americans opposed sweeping criminal laws and favored access to mifepristone.
Instead, the Trump FDA promised a study of mifepristone’s safety. That pledge was next to worthless: Mifepristone is already one of the nation’s most studied drugs and was widely used in other nations well before the FDA approved it in 2000. But the study bought the White House time and even helped persuade a lower court judge to delay proceedings in the Louisiana case so the FDA could complete its review.
Meanwhile, abortion-rights supporters have strengthened a legal and medical framework for ensuring abortion access, even in states with bans. Twenty-two states and the District of Columbia now have shield laws, and doctors began mailing abortion medication into states where abortion was a crime.
What is clear is that abortion, once considered a minor issue in 2026, will now be on the front burner again.
In political terms, this equilibrium has worked for the president and the GOP, but changes to the broader landscape made it increasingly untenable in the long term. While Trump has continued picking judges with strong anti-abortion credentials, social conservatives have grown tired of waiting for the president.
In addition to Louisiana, Republican attorneys general in Texas, Florida, Missouri, Idaho and Kansas have all filed suit against the FDA. These lawsuits argue that the agency improperly reviewed evidence about the safety of mifepristone, insisting that despite the drug’s track record, it is dangerous for girls and women. Some, including Louisiana, also argued that the Comstock Act, a 19th century obscenity law, operates as a de facto ban on mailing any drug or device designed, intended or adapted for abortion. (The 5th Circuit ruling did not address the Comstock Act.)
The Trump Justice Department has asked courts to delay or even dismiss these lawsuits, much to the ire of social conservatives. “Trump is the problem. The president is the problem,” Marjorie Dannenfelser, the president of Susan B. Anthony Pro-Life America, told the Wall Street Journal.
The 5th Circuit ruling could bring Republicans’ high-wire act crashing down. The administrative stay granted Monday came after an appeal by the manufacturers of mifepristone, Danco and GenBioPro. The Supreme Court could try to hear the case before the current term ends in June or schedule the case for argument sometime in the fall.
It isn’t clear how the court will rule. A similar challenge to mifepristone was turned away in 2024 on the grounds that the plaintiffs, a group of anti-abortion doctors, lacked standing. Danco and GenBioPro argue that the same is true of Louisiana, but the court has a conservative majority and Louisiana has focused a great deal of its case on demonstrating standing.
There’s medical uncertainty too. Providers mailing pills into ban states may pivot to new telehealth protocols, like those involving only misoprostol. Patients with the option to travel may have to decide between going to a clinic to receive mifepristone and misoprostol and relying on a misoprostol-only alternative. That choice will look different for people in rural areas, minors and others who were especially likely to rely on telehealth.
What is clear is that abortion, once considered a minor issue in 2026, will now be on the front burner again. And the Trump administration will be forced to take a position on mifepristone before the Supreme Court.
In the past, Trump has been able to pass the buck on the end of Roe: claiming credit for its demise while suggesting that judges are the ones ultimately making the decisions. But he is trapped between increasingly angry social conservatives and an electorate broadly approving of abortion rights and access. The 5th Circuit’s ruling could harm an already wounded Republican Party and, if it stands, bring home for the first time the reality of Roe’s end.
Mary Ziegler is a law professor at the University of California, Davis, School of Law and the author of "Roe: The History of a National Obsession."