U.S. Supreme Court rulings on medication abortion, emergency medical care cases will impact essential health care across the country

(Portland, MAINE) – The U.S. Supreme Court may rule on two cases this month that could have significant implications on reproductive health care and patient rights in Maine and across the country.  

Those cases are Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration et al and Moyle v. United States.  

Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration et al 

This case challenges the Food and Drug Administration’s approval of mifepristone, one of two safe, effective, legal medicines commonly used for medication abortion (also known as the “abortion pill”). The outcome of this case could profoundly impact access to mifepristone and, consequently, early abortion care nationwide.  

The importance and safety of mifepristone for early pregnancy termination 
Mifepristone stands as a cornerstone of early abortion care and is used up to 11 weeks, or 77 days, after a last menstrual period. Mifepristone, the first of two drugs used in medication abortion, has been used by more than five million people in the U.S. to safely end their pregnancies, and is used in over half of all abortions in the United States. That number is even higher at Planned Parenthood of Northern New England (PPNNE), where about 70% of abortion patients choose medication abortion. Mifepristone is also commonly used in miscarriage management. 

For more than 20 years, medication abortion has been an essential option for patients, enabled access to abortion care when a health center visit wasn’t an option, and empowered patients to make private medical decisions. 

Everyone should have the freedom and power to control their bodies and their lives without government interference. Keeping mifepristone available is critical to protecting access to abortion for people across the country. But if the Supreme Court rules to uphold the extreme decision of the lower courts, it would make it much harder to get medication abortion—and undermine the authority of the FDA. 

Status of medication abortion at Planned Parenthood of Northern New England 
While we await the Supreme Court’s decision, mifepristone continues to be available to patients seeking abortion care at PPNNE health centers in Maine, New Hampshire and Vermont, and through the telehealth program. Should access to mifepristone become curtailed, PPNNE will adjust its medication abortion protocol to ensure that it can continue to offer medication abortion with or without mifepristone. 
 
An Overview of the Supreme Court Case on Mifepristone 
A group of anti-abortion activists and organizations sued the FDA over its approval of mifepristone, one of two medications most commonly used in medication abortion in the United States. In the case that originated in Texas, Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration et al, the plaintiffs asked the court to order the FDA to rescind its approval of mifepristone from more than 20 years ago, in order to remove it from the market.  

On April 21, 2023, the Supreme Court of the United States granted the stay requested by the Department of Justice (DOJ) and Danco in Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration et al allowing mifepristone’s FDA approval to remain unchanged as the case proceeds through the Fifth Circuit Court of Appeals and the Supreme Court. 

U.S. Supreme Court heard oral arguments on the case March 26, 2024. Notably, two studies that plaintiffs cited as key evidence in their case that medication abortion should be pulled from the market or heavily restricted have been retracted from the medical journals that first published the studies due to flaws and conflicts of interest. 

About Maine’s position on this case
In January 2024, both Governor Janet Mills and Attorney General Aaron Frey have joined their counterparts in other states in submitting amicus briefs urging the U.S. Supreme Court to reject a lower court panel’s August 2023 ruling to severely restrict access to mifepristone.

What’s at stake for Maine? 
If the U.S. Supreme Court decides to curtail access to mifepristone, PPNNE health centers may be forced to adjust its medication abortion protocol as needed to ensure medication abortion—with or without the use of mifepristone—remains an option for its patients. PPNNE is committed to ensuring medication abortion remains available to its patients throughout Maine, New Hampshire and Vermont and to providing care to anyone who needs it, no matter what.  

Any restrictions on mifepristone could reduce already tenuous access to care in states throughout the country. While Maine remains a safe harbor in the midst of the national storm, this court case and others highlight the importance of state-level protections for reproductive rights and sexual and reproductive health care. Laws like LD 1619, passed in 2023, that expanded access to abortion care throughout pregnancy, and LD 227, passed in 2024, which protects providers of reproductive care and care for transgender people from attacks, are critical to ensuring Mainers continue to have access to essential medical care they need right here at home.  

In addition to repercussions for reproductive health care, a ruling in favor of the plaintiffs in this case could extend far beyond abortion care—it could stifle medical innovation, upend the country’s drug approval process and put every approved medication at risk of political interference. 

Moyle v. United States 

In this case, the U.S. Supreme Court will decide whether the federal Emergency Medical Treatment and Labor Act (EMTALA), which mandates hospitals offer emergency care and has been in place for nearly 40 years, preempts the state of Idaho’s near-total abortion ban. 

In short, the Supreme Court will decide whether hospitals can deny patients abortion care even when a patient is experiencing a serious medical emergency, like their water breaking dangerously early, uncontrollable hemorrhage, sepsis, or pre-eclampsia which could cause seizures or brain injury. 

EMTALA requires hospitals accepting Medicare and offering emergency services to check whether a patient is experiencing a medical emergency and either stabilize the patient or make an appropriate transfer to another facility. Under EMTALA, if a patient needs an abortion to make them stable, the doctor—with the patient’s permission—must provide it. 
 
Everyone must be able to get the emergency care they need—including pregnant people who need abortions. Anti-abortion lawmakers and their allies are willing to endanger pregnant people even when they are experiencing medical emergencies. 

How We Got Here
Moyle v. United States arose following the Supreme Court's Dobbs decision in 2022, which overturned Roe v. Wade and erased the federal constitutional right to abortion. This case, which centers around Idaho’s near-total abortion ban, highlights the clash between states’ extreme abortion bans and federal obligations like those under EMTALA, and shows how states can, post-Dobbs, jeopardize access to critical medical care for patients across the country. 

With its decision to overturn Roe nearly two years ago, the Supreme Court unleashed a national reproductive health crisis. This was never about sending the issue of abortion back to the states. It is about controlling people’s lives, bodies and futures and making abortion inaccessible at every turn. 

What’s at stake for Mainers 
At this point, without the details of the decision in hand, it’s impossible to know exactly how a Supreme Court decision siding with the state of Idaho would impact care in Maine. What we do know is that the decision threatens essential healthcare for pregnant people throughout the country, and it is essential to protect and expand access to safe and legal abortion care in Maine. 

Maine’s laws protecting essential health care, including LD 1619, which passed in 2023 and decriminalized abortion care in our state, are critical in ensuring providers can offer the right care for their patients without fear of criminal prosecution. One of Idaho’s largest hospitals reported an increase in air transports of patients out of state for pregnancy complications because of the state’s near-total abortion ban that conflicts with EMTALA. Amicus briefs in the case detail horrendous patient experiences due to clinicians fearing criminal penalties for providing essential medical care. 

This Supreme Court’s decision could have far-reaching impacts on patient rights and health care delivery and could have fatal consequences across the country.  

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Planned Parenthood Maine Action Fund is an independent, nonpartisan, not-for-profit membership organization formed as the advocacy and political arm of Planned Parenthood of Northern New England in Maine. PPNNE has four health centers in Maine and sees more than 12,000 patients a year.