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Supreme Court rules to preserve access to abortion medication

Case is Alliance for Hippocratic Medicine v. FDA

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The abortifacent drug mifepristone is marketed under the brand name Mifeprex (Photo courtesy of Danco Laboratories)

The U.S. Supreme Court ruled Thursday in a much-anticipated decision against efforts by conservative doctors and medical groups challenging access to mifepristone, one of two pharmaceuticals used in medication abortions. As a result of the high court’s decision, access to the drug won’t change.

Associate Supreme Court Justice Brett Kavanaugh, writing for the court, reversed a lower court decision that would have made it more difficult to obtain the drug, which is used in about two-thirds of U.S. abortions. The ruling however was narrow in scope as it only addressed what is known as legal standing in a case.

SCOTUSblog senior court reporter Amy Howe noted that Kavanaugh acknowledged what he characterized as the challengers’ ā€œsincere legal, moral, ideological, and policy objectionsā€ to elective abortion ā€œby othersā€ and to FDA’s 2016 and 2021 changes to the conditions on the use of the drug.

But the challengers had not shown that they would be harmed by the FDA’s mifepristone policies, he explained, and under the Constitution, merely objecting to abortion and the FDA’s policies are not enough to bring a case in federal court. The proper place to voice those objections, he suggested, is in the political or regulatory arena.

ā€œUnder Article III of the Constitution, a plaintiff’s desire to make a drug less available for others does not establish standing to sue,ā€ Kavanaugh wrote.

ā€œWe are pleased with the Supreme Court’s decision in this incredibly important case. By rejecting the Fifth Circuit’s radical, unprecedented and unsupportable interpretation of who has standing to sue, the justices reaffirmed longstanding basic principles of administrative law,ā€ said Abigail Long, a spokesperson for Danco. ā€œThe decision also safeguards access to a drug that has decades of safe and effective use.ā€

The White House released a statement from President Joe Biden on Supreme Court Decision on FDA v. Alliance for Hippocratic Medicine:

“Today’s decision does not change the fact that the fight for reproductive freedom continues. It does not change the fact that the Supreme Court overturned Roe v. Wade two years ago, and women lost a fundamental freedom. It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states.
 
It does mean that mifepristone, or medication abortion, remains available and approved. Women can continue to access this medication – approved by the FDA as safe and effective more than 20 years ago. 
 
But let’s be clear: attacks on medication abortion are part of Republican elected officials’ extreme and dangerous agenda to ban abortion nationwide. Since the overturning of Roe v. Wade, Republican elected officials have imposed extreme abortion bans in 21 states, some of which include zero exceptions for rape or incest. Women are being turned away from emergency rooms, or forced to go to court to plead for care that their doctor recommended or to travel hundreds of miles for care. Doctors and nurses are being threatened with jail time, including life in prison, for providing the health care they have been trained to provide. And contraception and IVF are under attack.
 
The stakes could not be higher for women across America. Vice President Harris and I stand with the vast majority of Americans who support a woman’s right to make deeply personal health care decisions. We will continue to fight to ensure that women in every state get the health care they need and we will continue to call on Congress to restore the protections of Roe v. Wade in federal law — that is our commitment.”

U.S. District Court for the Northern District of Texas Judge Matthew Kacsmaryk in Amarillo, Texas, in a ruling a year ago, waved aside decades of scientific approval, ruled that the U.S. Food and Drug Administration improperly approved mifepristone more than 20 years ago in 2000.

Kacsmaryk, appointed to the federal bench by former President Donald Trump, in his 67 page opinion wrote that the FDA’s two-decade-old approval violated a federal rule that allows for accelerated approval for certain drugs and, along with subsequent actions by the agency, was unlawful.

The suit, Alliance for Hippocratic Medicine v. FDA, was originally filed in the U.S. District Court for the North District of Texas in mid-November by Alliance Defending Freedom, an anti-abortion, anti-LGBTQ+ legal organization.

Applauding Kacsmaryk’s ruling, Erik Baptist, speaking for the Alliance Defending Freedom said in a statement: ā€œBy illegally approving dangerous chemical abortion drugs, the FDA put women and girls in harm’s way, and it’s high time the agency is held accountable for its reckless actions.ā€

Erin Hawley, a senior attorney for the conservative group Alliance Defending Freedom who argued the case at the Supreme Court, said the opinion was ā€œdisappointing,ā€ but told reporters in a press gaggle after the ruling that the explicit mention of conscience protections was a victory.

ā€œThe Supreme Court was crystal clear that pro life doctors do have federal conscience protections, even in emergency situations,ā€ Hawley said. ā€œSo that’s a huge win for the pro-life cause. The Supreme Court clearly said that our doctors are entitled to those federal conscious protections that are based on their religious beliefs.ā€

The case now returns to the lower courts, and the dispute over access to the drug likely is not over.Ā 

SCOTUSblog also reported that Nancy Northrup, the president and CEO of the Center for Reproductive Rights, praised the decision but conceded that the dispute could continue even after Thursday’s ruling. She, too, noted that the three states ā€œcould still attempt to keep the case going, including taking it back up to the Supreme Court,ā€ and she warned that access to mifepristone ā€œis still at risk nationwide.ā€

The Hill notes that for instance, the same district court in Texas that originally ruled against the FDA said a group of three red states—Missouri, Idaho and Kansas— can intervene in the lawsuit.

ā€œI would expect the litigation to continue with those states raising different standing arguments than made by our doctors,ā€ ADF’s Hawley told reporters.

Equality California, the nation’s largest statewide LGBTQ+ civil rights organization, emailed the Blade the following statement from Executive Director Tony Hoang in response to a unanimous ruling by the United States Supreme Court:

ā€œWe appreciate today’s unanimous decision to uphold access to the abortion drug mifepristone, authored by a conservative Justice. This ruling reinforces the critical importance of maintaining accessible reproductive healthcare and highlights the necessity of safeguarding these rights from baseless legal attacks.

However, it is imperative to recognize that the Court should never have accepted this case. The so-called Alliance for Hippocratic Medicine lacked the standing to initiate this challenge. Moreover, federal conscience exemptions already exist for healthcare providers who object to offering abortion-related care. 

Medication abortions involving mifepristone constitute the majority of abortions in America, including those sought by LGBTQ+ people. Our community understands the necessity of bodily autonomy and the right to make decisions regarding our own medical care, including reproductive care. Patients deserve access to the medications they need, and providers should be able to deliver that care without unwarranted interference from extremist courts or politicians.   

Attacks on abortion do not end with this decision; millions of people nationwide are still unable to get abortion care and abortion opponents remain focused on their end goal of a nationwide abortion ban. 

Equality California will continue to work with our legislative partners in Sacramento and Washington, D.C., as well as organizational allies, like Planned Parenthood, to help protect and expand access to abortion and reproductive healthcare.ā€

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U.S. Supreme Court

Supreme Court hears oral arguments in LGBTQ education case

Mahmoud v. Taylor plaintiffs argue for right to opt-out of LGBTQ inclusive lessons

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U.S. Supreme Court (Washington Blade photo by Michael Key)

The U.S. Supreme Court on Tuesday heard oral arguments in Mahmoud v. Taylor, a case about whether Montgomery County, Md., public schools violated the First Amendment rights of parents by not providing them an opportunity to opt their children out of reading storybooks that were part of an LGBTQ-inclusive literacy curriculum.

The school district voted in early 2022 to allow books featuring LGBTQ characters in elementary school language arts classes. When the county announced that parents would not be able to excuse their kids from these lessons, they sued on the grounds that their freedom to exercise the teachings of their Muslim, Jewish, and Christian faiths had been infringed.

The lower federal courts declined to compel the district to temporarily provide advance notice and an opportunity to opt-out of the LGBTQ inclusive curricula, and the 4th U.S. Circuit Court of Appeals determined that the parents had not shown that exposure to the storybooks compelled them to violate their religion.

ā€œLGBTQ+ stories matter,” Human Rights Campaign President Kelley Robinson said in a statement Tuesday. ā€œThey matter so students can see themselves and their families in the books they read — so they can know they’re not alone. And they matter for all students who need to learn about the world around them and understand that while we may all be different, we all deserve to be valued and loved.”

She added, “All students lose when we limit what they can learn, what they can read, and what their teachers can say. The Supreme Court should reject this attempt to silence our educators and ban our stories.ā€

GLAD Law, NCLR, Family Equality, and COLAGE submitted a 40-page amicus brief on April 9, which argued the storybooks “fit squarely” within the district’s language arts curriculum, the petitioners challenging the materials incorrectly characterized them as “specialized curriculum,” and that their request for a “mandated notice-and-opt-out requirement” threatens “to sweep far more broadly.”

Lambda Legal, the Leadership Conference on Civil and Human Rights, PFLAG, and the National Women’s Law Center announced their submission of a 31-page amicus brief in a press release on April 11.

ā€œAll students benefit from a school climate that promotes acceptance and respect,ā€ said Karen Loewy, senior counsel and director of constitutional law practice at Lambda Legal.  ā€œEnsuring that students can see themselves in the curriculum and learn about students who are different is critical for creating a positive school environment. This is particularly crucial for LGBTQ+ students and students with LGBTQ+ family members who already face unique challenges.ā€

The organizations’ brief cited extensive social science research pointing to the benefits of LGBTQ-inclusive instruction like “age-appropriate storybooks featuring diverse families and identities” benefits all students regardless of their identities.

Also weighing in with amici briefs on behalf of Montgomery County Public Schools were the National Education Association, the ACLU, and the American Psychological Association.

Those writing in support of the parents challenging the district’s policy included the Center for American Liberty, the Manhattan Institute, Parents Defending Education, the Alliance Defending Freedom, the Trump-Vance administration’s U.S. Department of Justice, and a coalition of Republican members of Congress.

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U.S. Supreme Court

LGBTQ groups: SCOTUS case threatens coverage of preventative services beyond PrEP

Kennedy v. Braidwood oral arguments heard Monday

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HHS Secretary Robert F. Kennedy, Jr. (Washington Blade photo by Michael Key)

Following Monday’s oral arguments before the U.S. Supreme Court in Kennedy v. Braidwood Management, Inc., LGBTQ groups issued statements warning the case could imperil coverage for a broad swath of preventative services and medications beyond PrEP, which is used to reduce the risk of transmitting HIV through sex.

Plaintiffs brought the case to challenge a requirement that insurers and group health plans cover the drug regimen, arguing that the mandate “encourage[s] homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman.ā€

The case has been broadened, however, such that cancer screenings, heart disease medications, medications for infants, and several other preventive care services are in jeopardy, according to a press release that GLAAD, Lambda Legal, PrEP4All, Harvard Law’s Center for Health Law and Policy Innovation (CHLPI), and the Center for HIV Law and Policy (CHLP) released on Monday.

The Trump-Vance administration has argued the independent task force responsible for recommending which preventative services must be covered with no cost-sharing for patients is constitutional because the secretary of the U.S. Department of Health and Human Services can exercise veto power and fire members of the volunteer panel of national experts in disease prevention and evidence-based medicine.

While HHS secretaries have not exercised these powers since the Affordable Care Act was passed in 2010, Braidwood could mean Trump’s health secretary, Robert F. Kennedy Jr., takes a leading role in determining which services are included in the coverage mandate.

Roll Call notes the Supreme Court case comes as the administration has suspended grants to organizations that provide care for and research HIV while the ongoing restructuring of HHS has raised questions about whether the ā€œEnding the HIV Epidemicā€ begun under Trump’s first term will be continued.

ā€œToday’s Supreme Court hearing in the Braidwood case is a pivotal moment for the health and rights of all Americans,” said GLAAD President Sarah Kate Ellis. “This case, rooted in discriminatory objections to medical necessities like PrEP, can undermine efforts to end the HIV epidemic and also jeopardize access to essential services like cancer screenings and heart disease medications, disproportionately affecting LGBTQ people and communities of color.”

She added, “Religious exemptions should not be weaponized to erode healthcare protections and restrict medically necessary, life-saving preventative healthcare for every American.ā€

Lambda Legal HIV Project Director Jose Abrigo said, ā€œThe Braidwood case is about whether science or politics will guide our nation’s public health policy. Allowing ideological or religious objections to override scientific consensus would set a dangerous precedent. Although this case began with an attack on PrEP coverage, a critical HIV prevention tool, it would be a serious mistake to think this only affects LGBTQ people.”

“The real target is one of the pillars of the Affordable Care Act: The preventive services protections,” Abrigo said. “That includes cancer screenings, heart disease prevention, diabetes testing, and more. If the plaintiffs succeed, the consequences will be felt across every community in this country, by anyone who relies on preventive care to stay healthy.”

He continued, “What’s at stake is whether we will uphold the promise of affordable and accessible health care for all or allow a small group of ideologues to dismantle it for everyone. We as a country are only as healthy as our neighbors and an attack on one group’s rights is an attack on all.ā€

PrEP4All Executive Director Jeremiah Johnson said, “We are hopeful that the justices will maintain ACA protections for PrEP and other preventive services, however, advocates are poised to fight for access no matter the outcome.”

He continued, “Implementing cost-sharing  would have an enormous impact on all Americans, including LGBTQ+ individuals. Over 150 million people could suddenly find themselves having to dig deep into already strained household budgets to pay for care that they had previously received for free. Even small amounts of cost sharing lead to drops in access to preventive services.”

“For PrEP, just a $10 increase in the cost of medication doubled PrEP abandonment rates in a 2024 modeling study,” Johnson said. “Loss of PrEP access would be devastating with so much recent progress in reining in new HIV infections in the U.S. This would also be a particularly disappointing time to lose comprehensive coverage for PrEP with a once every six month injectable version set to be approved this summer.ā€

ā€œToday’s oral arguments in the Braidwood case underscore what is at stake for the health and well-being of millions of Americans,” said CHLPI Clinical Fellow Anu Dairkee. “This case is not just about legal technicalities — it is about whether people across the country will continue to have access to the preventive health services they need, without cost sharing, regardless of who they are or where they come from.”

She continued, “Since the Affordable Care Act’s preventive services provision took effect in 2010, Americans have benefited from a dramatic increase in the use of services that detect disease early, promote healthy living, and reduce long-term health costs. These benefits are rooted in the work of leading scientists and public health experts, including the U.S. Preventive Services Task Force, whose recommendations are based on rigorous, peer-reviewed evidence.”

“Any shift away from cost-free access to preventive care could have wide-ranging implications, potentially limiting access for those who are already navigating economic hardship and health disparities,” Dairkee said. “If Braidwood prevails, the consequences will be felt nationwide. We risk losing access to lifesaving screenings and preventive treatments that have become standard care over the past decade.”

“This case should serve as a wake-up call: Science, not politics, must guide our health care system,” she said. “The health of our nation depends on it.ā€

ā€œWe are grateful for the Justices who steadfastly centered constitutionality and didn’t allow a deadly political agenda to deter them from their job at hand,” said CHLP Staff Attorney Kae Greenberg. “While we won’t know the final decision until June, what we do know now is not having access to a full range of preventative healthcare is deadly for all of us, especially those who live at the intersections of racial, gender and economic injustice.”

“We are crystal clear how the efforts to undermine the ACA, of which this is a very clear attempt, fit part and parcel into an overall agenda to rollback so much of the ways our communities access dignity and justice,” he said. “Although the plaintiffs’ arguments today were cloaked in esoteric legal language, at it’s heart, this case revolves around the Christian Right’s objection to ‘supporting’ those who they do not agree with, and is simply going to result in people dying who would otherwise have lived long lives.”

“This is why CHLP is invested and continues in advocacy with our partners, many of whom are included here,” Greenberg said.

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U.S. Supreme Court

Supreme Court to hear Md. religious freedom case on Tuesday

Advocacy groups to rally outside during Mahmoud v. Taylor oral arguments

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U.S. Supreme Court (Washington Blade photo by Michael Key)

Activists on Tuesday will hold a rally in front of the U.S. Supreme Court as the justices hear oral arguments in a case that will determine whether schools are violating parents’ religious freedom by not letting them opt their children out of learning about LGBTQ-specific topics.

Mahmoud v. Taylor is a case out of Montgomery County about parents who wish to opt their children out of LGBTQ-themed lessons in public schools for religious reasons.Ā 

Montgomery County Public Schools, after initially allowing parents to opt their children out, changed the policy in March 2023.

The plaintiffs — Tamer Mahmoud, Enas Barakat, and other parents — argue ā€œthe storybooks were chosen to disrupt ā€˜cisnormativity’ and ā€˜either/or thinking’ among students.ā€ 

ā€œThe board’s own principals objected that the curriculum was ā€˜not appropriate for the intended age group,’ presented gender ideology as ā€˜fact,’ ā€˜sham[ed]’ students with contrary opinions, and was ā€˜dismissive of religious beliefs,ā€™ā€ according to the petition on the Supreme Court’s website. 

The petition goes further, saying the parents are ā€œnot challenging the curriculum, but arguing that compelling their elementary-age children to participate in instruction contrary to their parents’ religious convictions violated the Free Exercise Clause. Construing Wisconsin v. Yoder, the 4th Circuit found no free-exercise burden because no one was forced ā€˜to change their religious beliefs or conduct.ā€™ā€

The Coalition for Inclusive Schools and Communities, an organization that aims to bring together ā€œadvocates, educators, families, and organizations committed to inclusive, affirming, fact and science-based education,ā€ will participate in the ā€œRally for Inclusive Educationā€ rally outside the Supreme Court alongside Live In Your Truth and the Montgomery County Pride Family.

ā€œInclusive education isn’t just a value — it’s a necessity,ā€ said Phillip Alexander Downie, co-chair of the Coalition for Inclusive Schools and Communities and CEO of Montgomery County Pride Family. ā€œThe right of every child to learn in an environment where they see themselves reflected, affirmed, and respected is under attack. This rally is our moment to protect that right — and ensure future generations inherit classrooms rooted in truth, equity, equality, and justice.ā€

The Coalition for Inclusive Schools and Communities says the rally is a ā€œnonpartisan community gathering rooted in education, advocacy, and solidarity.ā€ 

ā€œThe focus of this event is to uplift the importance of inclusive learning environments, celebrate the power of diversity in our schools, and amplify the voices of those most impacted by exclusionary practices and rhetoric,ā€ it said.

The rally will feature speakers from across the country, including students, educators, civil rights leaders, and authors who will give their own testimonies as to why it is important to have inclusivity in primary education. Trans Maryland, the National Women’s Law Center, MoCoPride Center, and Authors Against Book Bans are among the LGBTQ groups sponsoring the event.

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