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How the Supreme Court’s abortion pill ruling affects Missouri and Illinois

An illustration of life after Dobbs was repealed
Tracy Lee
Special to NPR
A decision Thursday by the U.S. Supreme Court to reject a challenge to the federal Food and Drug Administration's approval of mifepristone doesn’t change the availability of the abortion-inducing medication for patients in Missouri and Illinois. But many say they expect other challenges to come soon.

A ruling released Thursday by the U.S. Supreme Court maintains access to the pill mifepristone, a federally approved medication that in the United States is commonly used with another pill, misoprostol, to terminate pregnancies.

The court ruled that the challengers to the pill’s Food and Drug Administration approval did not have standing to bring their suit. For patients in Missouri and Illinois, that means nothing has changed with regard to access to abortion. However, advocates for and against abortion rights said that Thursday’s decision will not be the end of attempts to outlaw abortion procedures.

Here’s how the decision affects people in the St. Louis region and what may come next:

What did the Supreme Court decide?

The high court dismissed a suit brought by the Alliance for Hippocratic Medicine, an organization that was incorporated in Texas in 2022, saying the group did not have the right to bring the case.

The organization takes the position that abortion “violates the basic tenets of medical ethics.” The group sued the FDA for relaxing some restrictions regarding mifepristone, which is sometimes called “the abortion pill” and is commonly used in a two-drug regimen to induce abortions.

The alliance called for the regulatory agency to rescind its approval of the drug or to take back the actions that made it more accessible to patients. The court’s ruling said the Alliance for Hippocratic Medicine didn’t have the standing to sue, since it wasn't directly affected by the FDA’s actions.

“The FDA is not requiring them to do or refrain from doing anything,” wrote Justice Brett Kavanaugh in the court’s decision. “Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain… a plaintiff’s desire to make a drug less available for others does not establish standing to sue.”

What does the decision mean?

For now, mifepristone is still available in the United States. However, after the Supreme Court overturned Roe v. Wade in 2022, many states passed laws outlawing abortion. This decision doesn’t overturn that ruling, and state-level laws that limit or ban abortions are still in effect.

How does the ruling affect patients in Missouri and Illinois?

People in Missouri who want to use mifepristone to induce an abortion will still need to go out of state to legally access the procedure. The Supreme Court in 2022 overturned Roe v. Wade, which long protected access to abortion. Since then, clinics in the Metro East and other parts of Illinois, where abortion is still legal to the point of viability, have seen an influx of patients coming from Missouri and other states with abortion restrictions.

Patients in Missouri have also been accessing mifepristone through websites and seeing doctors using telemedicine, though not all of those practices are legal in the state, said Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region, which operates a clinic in Fairview Heights, Illinois.

To legally get mifepristone or other abortion-inducing drug from that clinic through telemedicine, patients need to be within Illinois state boundaries for the appointment and need to have the drugs delivered to an Illinois address. However, more patients have been using websites that aren’t affiliated with medical clinics to buy the drug, McNicholas said.

The decision means nothing has changed for Illinois patients, who can still access mifepristone and other abortion procedures until a fetus is viable outside the womb. Usually that’s until around 24 to 28 weeks of pregnancy.

How is Missouri involved in the case?

Missouri joined the lawsuit late last year, along with Kansas and Idaho. Missouri Attorney General Andrew Bailey said the state will continue moving forward with its own suit in a lower court in northern Texas.

“Today’s ruling only applies to standing; the Court did not reach the merits,” Bailey wrote in a post on X, formerly Twitter. “My case is still alive at the district court. We are moving forward undeterred with our litigation to protect both women and their unborn children."

There’s another connection to Missouri: One of the lawyers arguing on behalf of the Alliance for Hippocratic Medicine is Erin Morrow Hawley, who is married to Republican U.S. Sen. Josh Hawley.

What happens next?

Because the decision was based not on the argument’s content but on who brought the case, it’s likely new plaintiffs could file a similar challenge to the FDA’s approval of mifepristone, McNicholas said.

Groups that oppose abortion rights have been challenging federal and state laws that protect access for years, she said. “I fully expect a loss in this case isn’t going to stop them here either.”

The Supreme Court also is considering a case originating in Idaho that would affect abortion providers’ ability to provide care for people in medical emergencies.

The decision will affect whether the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat patients who come to emergency departments, overrules state-specific laws outlawing abortion.

Correction: This story has been updated to state patients in the Metro East must be within Illinois boundaries for telemedicine appointments that dispense abortion medications.

Sarah Fentem is the health reporter at St. Louis Public Radio.