Abortion Pill Access Threat Renewed by Red States, Federal Study

Conservative states are stepping up legal attacks on the abortion pill as the Trump administration launches safety reviews that could achieve the goals the states are seeking.

Texas, Florida, and Louisiana are urging US District Judge Matthew Kacsmaryk of the Northern District of Texas to let them join Missouri v. FDA, a lawsuit by three other red states seeking to force the Food and Drug Administration to drop telemedicine access to the abortion medication mifepristone and further restrict its use.

Used in 63% of US abortions in 2023, mifepristone was targeted in a report by the conservative think tank Ethics & Public Policy Center in April that claimed 1 in 10 users of the drug experienced an adverse event. The Trump administration is citing the report in justifying new safety reviews of the drug that could ultimately limit its availability.

The report, government review of the drug, and uptick in states heading to court mark a heightening interest in the long-used abortion pill, access to which has remained a hotly contested issue across both the Biden and Trump administrations.

In April, FDA Commissioner Marty Makary said he wasn’t planning to change mifepristone policy, although he would reconsider if new data emerged. Days later, the EPPC announced what it calls the “largest-known study of the abortion pill.” Department of Health and Human Services Secretary Robert F. Kennedy Jr. then called for the drug to be reviewed.

It’s “a concerning development anytime the government says, ‘Oh, we just need data.’ And then all of a sudden, conveniently, a few days later, a group that’s very vocally anti-abortion comes up with quote, unquote data,” said Liz McCaman Taylor, senior federal policy counsel at the Center for Reproductive Rights. The group is suing the Trump administration, alleging it’s withholding information on its mifepristone review.

“If the FDA announces new nationwide restrictions on mifepristone, such as a requirement that all patients pick up their medication in person and can no longer use telemedicine for care, that could have an effect on the course of the litigation,” said Julia Kaye, a senior staff attorney with the American Civil Liberties Union’s Reproductive Freedom Project.

The litigation stems back to 2022, when a physicians group sued the FDA over decisions such as allowing dispensing without in-person visits and use later in pregnancy. In 2024, the Supreme Court ruled the physicians couldn’t prove they were harmed and thus lacked standing to sue. Idaho, Kansas and Missouri convinced a lower court to let them take up the battle.

Move to Intervene

Now, Texas and Florida are awaiting word on whether they, too, can intervene, and expand the challenge to undo the FDA’s decades-old approval of the drug.

“Texas and Florida are not only asking the court to make it harder for people nationwide to get mifepristone—they have also asked Judge Kacsmaryk to take this essential medication off the market entirely in every state in the country,” Kaye said.

Texas and Florida say FDA telehealth provisions wrongfully circumvent their abortion restrictions, and that Kansas, Missouri and Idaho’s standing are threatened by local policy. In making their case, they point to the EPPC study, noting that the findings demonstrate that incidents of serious adverse events are 22 times higher than those listed on the FDA’s approved mifepristone label.

The HHS declined to comment, citing the litigation.

In September, Louisiana filed its motion to intervene, bringing its own challenge over the drug’s safety.

The three new states’ attorneys general offices didn’t respond to requests for comment.

Stripping Away

In some ways the litigation is now “more threatening,” said Katie Keith, who was deputy director of the Biden White House’s Gender Policy Council, as “a lot of this is now in the hands of the Trump administration to deal with any fallout.”

In May, before the new states tried intervening, the Trump administration asked Kacsmaryk to toss the lawsuit, sticking to procedural arguments.

And its “very likely” the administration will stick to technical defenses, Kaye said.

“The Trump administration does not need this lawsuit to strip away access to medication abortion nationwide when it’s already taking steps to do just that through the FDA itself,” Kaye said.

Shifting Policy

The EPPC’s study reportedly analyzes data from an insurance claim database that has over 800,000 prescribed mifepristone abortions. The EPPC has been criticized for its methodology, including not disclosing what database it analyzed.

Jamie Bryan Hall, EPPC’s director of data analysis and the study’s co-author, said his group is “contractually obligated” to withhold the data provider’s name, and that sharing it “opens that provider to attack.” Hall added that around 20 companies compile such information, and he suspects any researcher would get similar results with similar analysis.

Hall declined to comment on whether EPPC had been in touch with the Trump administration about the report.

‘Come to a Head’

Florida and Texas argue that mifepristone complicates their ability to enforce their own restrictions. But Keith said “the real threat is to states where abortion remains lawful.”

“This is about to come to a head,” she said.

Some attorneys are skeptical of Texas and Florida’s effort to take up the lawsuit, noting they don’t make a convincing argument for standing.

“States do not get to sue the federal government just because there is a difference between federal and state policy,” Kaye said.