| Hi rulers! Happy last Friday of Women's History Month! Today we're talking about FDA v. Alliance for Hippocratic Medicine. Let's get into it: On Tuesday, the Supreme Court heard oral arguments in what could be the most influential case on abortion since the Dobbs decision. The case could upend the way that the majority of women in the U.S. receive abortions — by medication — by restricting how mifepristone, one of two drugs used in the process, can be prescribed and mailed. And, as a result, it could also further overwhelm the country’s busiest abortion clinics — in states like Illinois, Kansas and New Mexico — islands in a sea of states with strict abortion bans. “It really is likely to create a lot of chaos, a lot of confusion, and likely send more patients back to traveling across state lines,” says Middlebury economist Caitlyn Myers, who studies abortion. “And we still haven't ramped up capacity and some of the key destinations — I think it could create waits for appointments.” If the court rules in favor of the plaintiffs — doctors, associations and organizations that oppose abortion — it could require that patients attend in-person appointments to access the drug. Currently, patients can be prescribed the drug via telehealth and receive it through the mail. The in-person requirement would disrupt the way that many women in banned states access abortions. Shield laws offer legal protection to providers in states where abortion is legal who prescribe the pills via telehealth and ship them into states where abortion is illegal. Without that option, it could send more women traveling across state lines — to clinics that are already experiencing sky-high rates of out-of-state patients. Andrea Gallego is the executive administrator of Alamo Women’s Clinic, which has a location in New Mexico and one in Illinois. She tells Women Rule that 90-95 percent of patients at both clinics are “traveling from a banned state.” She’s been watching the case closely, and is gearing up for a rush of out-of-state patients. “This is just the daily world of abortion care,” Gallego said. “We have to have [a possible influx of patients] in our minds and have plans in the back of our head to accommodate that.” Jessica Wannemacher, director of clinic operations at Trust Women in Wichita, Kansas, where out-of-state-patients constitute a majority of their clients, says her clinic may have to lean on other independent clinics and Planned Parenthood to make ends meet if they do see a large increase. “That’s where the patient navigation component really comes in and the relationship that we have with outside providers comes in,” she tells Women Rule. “You can’t see 1,000 patients if you have four staff members.” As part of the same case, the Supreme Court is also considering whether the FDA should have extended the period in which mifepristone can be used from seven gestational weeks to 10. If the court rules against the FDA, clinics will see more out-of-state patients — and those patients will also need to stay longer, says Jennifer Welch, president and CEO of Planned Parenthood of Illinois. Many clinics — including hers — also offer medication abortion, in addition to procedural abortion. If the Supreme Court decides to roll back that approval, Planned Parenthood of Illinois is preparing to switch to misoprostol-only abortions for some patients, which Welch stressed is “still safe and effective.” But that type of medication abortion typically takes longer than mifepristone, says Welch, which could mean more time off work and more money spent on lodging. “Extending their stay in the state where they're forced to travel to is one of the biggest challenges,” Welch says. Tuesday’s arguments were somewhat reassuring for abortion rights supporters, as the court seemed skeptical that the plaintiffs —- who don’t prescribe mifepristone themselves — had standing to bring the case in the first place. But Rachel Rebouché, dean of Temple University's Beasley School of Law, warns that even if this specific case gets dismissed based on standing, there could still be more challenges to mifepristone to come. “I don't think that this stops — I don't think that [Alliance for Hippocratic Medicine] or other groups that want to see an end to medication abortion will say ‘Oh well, we lost,’” Rebouché tells Women Rule. She suggests that, if the case is dismissed, anti-abortion groups may look for other plaintiffs to bring a similar case. Says Skye Perryman, president and CEO of Democracy Forward, a national legal organization which submitted an amicus brief in the case on behalf of GenBioPro, the manufacturer of generic mifepristone: “I don't believe that this is any type of time to breathe a sigh of relief.”
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