The Texas judge who previously halted approval of the country’s most common abortion method ruled Thursday that three states can move forward with another attempt to roll back federal rules and make it harder for people across the United States to access the abortion drug mifepristone.
Idaho, Kansas and Missouri filed late last year to bring the case to federal court in Amarillo, Texas, after the U.S. Supreme Court issued a narrow ruling determining that abortion opponents who first brought the case They lacked the legal right to sue.
The only federal judge based in Amarillo is Matthew Kacsmaryk, former President Donald Trump’s nominee who in recent years ruled against the Biden administration on several issues, including immigration and LGBTQ protections.
The states want the federal Food and Drug Administration to ban telehealth prescriptions for mifepristone and require it to be used only in the first seven weeks of pregnancy instead of the current 10-week limit. They also want to require three in-person doctor’s office visits instead of none to get the medication.
That’s because, the states argue, efforts to provide access to the pills “undermine state abortion laws and frustrate state law enforcement,” according to court documents.
Meanwhile, Kacsmaryk said they should not automatically be ruled out of suing in Texas just because they are out of state.
The American Civil Liberties Union said Thursday that the case should have been resolved when the U.S. Supreme Court unanimously preserved access to mifepristone last year, when the justices issued a narrow ruling in determining that abortion opponents who were the first to file the case lacked the legal right to sue.
Kacsmaryk’s decision “has left the door open for extremist politicians to continue attacking medical abortion in their courtroom,” the ACLU said.
The ruling comes days before Trump begins his second term as president, so his administration will likely represent the FDA in the case. Trump has repeatedly said that abortion is a problem for the states, not the federal government, although he also highlighted during the election campaign that he appointed Supreme Court justices who were in the majority when they overturned the national right to abortion in 2022.
In the years since, abortion opponents have increasingly attacked abortion pills, largely because most abortions in the United States are performed using drugs rather than surgical procedures. So far, at least four states (Indiana, Missouri, New Hampshire and Tennessee) have seen Republicans introduce bills aimed at banning the pills. None take the same approach as Louisiana, which last year classified drugs as controlled dangerous substances.
Previously, Kacsmaryk sided with a group of anti-abortion doctors and organizations who wanted the FDA to be forced to completely rescind its approval of mifepristone in 2000.
However, states are pursuing a more limited challenge. Instead of focusing entirely on approval, they attempted to undo a series of FDA updates that had made access easier.
But while state leaders are pushing to severely limit access to drugs, Missouri voters sent a different message in November when they approved a ballot measure to undo one of the nation’s strictest bans. In Idaho, abortion is prohibited at all stages of pregnancy. In Kansas, abortion is generally legal until the 22nd week of pregnancy.
Across the United States, 13 states under Republican legislative control ban abortion at all stages of pregnancy, with some exceptions, and four more ban it after the first six weeks, before women know they are pregnant.
Some Democratic-controlled states have adopted laws seeking to protect from investigations and prosecutions doctors who prescribe the pills through telehealth appointments and mail them to patients in states with bans. Those prescriptions are one of the main reasons why one study found that residents of states with bans are having abortions at about the same rate as before the bans went into effect.
Mifepristone is commonly used in combination with a second drug for medical abortion, which has accounted for more than three-fifths of all abortions in the United States since the Supreme Court ruling overturning Roe v. Wade.
The medications are different from Plan B and other emergency contraceptives that are typically taken within three days of possible conception, weeks before a woman knows she is pregnant. Studies have found that they are generally safe and result in complete abortions more than 97% of the time, which is less effective than procedural abortions.
