Why the fight over abortion pills isn’t over yet

You're reading Route Fifty's State and Local Roundup. To get the week’s news to use from around the country, you can subscribe here to get this update in your inbox every Saturday. In the meantime, be sure to read to the end as we've rounded up headlines from the week.

This week the U.S. Supreme Court tossed out a lawsuit brought by anti-abortion advocates that sought to put more restrictions on the abortion drug mifepristone. The court’s ruling is a significant win for abortion rights advocates, but conservative state officials are still trying to limit access to the medicine in other ways.

ICYMI: In a unanimous decision, the high court on Thursday ruled that the abortion opponents did not have standing to bring a challenge to the Food and Drug Administration’s rules for mifepristone. “The plaintiffs have failed to demonstrate that FDA’s relaxed regulatory requirements likely would cause them to suffer an injury in fact. For that reason, the federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions,” Justice Brett Kavanaugh wrote for the court.

What’s at stake: Last year, 63% of all abortions in the country were performed with medication, a jump from 53% in 2020, according to the Guttmacher Institute, a research group that supports abortion rights. That number has steadily grown since mifepristone was first approved for use in 2000. The two-drug combination of mifepristone and misoprostol is the most common medication abortion regimen offered by U.S. providers, Guttmacher reported.

The medicines have become a focal point in the fight over abortion rights, after the high court overturned the federal right to an abortion in 2022. As a result, 14 states have banned the procedure, and seven others have restricted it to at or before the 18th week of pregnancy. But doctors in states where abortion is legal can prescribe mifepristone and have it mailed to patients, even if they are in another state.

Easier to get: In 2021, during the height of the COVID-19 pandemic, the FDA removed restrictions on mifepristone that required patients to have an in-person visit with their doctor or nurse practitioner to get the medicine. The rule change—which was finalized last year—came after the FDA eased restrictions on the medicine in 2016. Those FDA actions were at the heart of the Supreme Court case.

Can states intervene? The Supreme Court’s decision prevents advocacy groups from challenging the federal regulations for mifepristone, but three states—Idaho, Kansas and Missouri—have also tried to intervene in the case. The justices did not address whether states have standing. Erin Hawley, a lawyer for the Alliance Defending Freedom, which represented the abortion opponents, told reporters she hoped the lawsuit could continue with the states bringing the challenge instead.

State restrictions: Last month, Louisiana Gov. Jeff Landry, a Republican, signed a law that classifies mifepristone and misoprostol as controlled substances, making possession of them without a valid prescription punishable by up to five years in prison. The state already banned abortion and made it a crime to use the medicines to perform an abortion. But adding the drugs to the list of controlled substances makes it harder for doctors to prescribe mifepristone, which is also used to treat miscarriages.

Preemption questions: Nineteen states have laws specifying how, when and where physicians can prescribe abortion drugs. But those face legal challenges, too. For example, a federal judge’s ruling in May invalidated several North Carolina restrictions on how abortion pills can be dispensed.

U.S. District Judge Catherine Eagles found that the state could not impose restrictions that the FDA had previously lifted, such as requiring that doctors prescribe the medicine and give it to patients in person. Those rules “stand as obstacles to Congress’ clear and manifest purpose of providing a comprehensive regulatory framework for safe use and distribution of higher-risk drugs run by the FDA,” she wrote.

Eagles allowed other North Carolina restrictions to stand, though. She held that those rules, such as requiring an ultrasound and a three-day waiting period, were not preempted because the FDA didn’t expressly reject those ideas.

More Supreme Court questions: The high court is expected to rule by the end of the month in a case challenging Idaho’s near-total abortion ban, on the grounds that the law runs afoul of federal rules governing standards for emergency rooms.

Traveling for care: Severe restrictions on abortion, particularly in the South, have forced patients to travel long distances to get the procedure. More than 171,000 people traveled across state lines for an abortion last year, reports The New York Times. That includes 16,000 people who traveled from Southern states to Illinois and another 12,000 from South Carolina and Georgia who went to North Carolina (where a federal judge blocked a 12-week ban last September).

Did someone forward this email to you? Sign up here.

Keep reading as there’s more news to use below, and if you don’t already and would prefer to get this roundup in your inbox, you can subscribe to this newsletter here. We’ll see you next week.

News to Use

Trends, Common Challenges, Cool Ideas, FYIs and Notable Events

OPIOIDS: Baltimore City wins $45M settlement with Allergan, seeks billions in suits vs. other opioid distributors. Rather than joining other states and local governments in suing opioid manufacturers, Baltimore took its own path and has won the first leg of a potentially billion-dollar lawsuit against opioid distributors. Pharmaceutical company Allergan will pay the city a $45 million settlement within 30 days for its role in pumping pharmacies with drugs, according to a news release from the mayor’s office Monday morning. If the city had been part of the joint settlement, the payoff would have only been $7 million over seven years. The city’s share is also larger than the settlements Allergan reached with Maryland—$38 million over seven years. Baltimore, one of the hardest-hit cities in the country for overdoses, is also in the process of suing Johnson & Johnson, McKesson, Cardinal Health, AmerisourceBergen, Walgreens, CVS, Teva, former Insys CEO John Kapoor, members of the Sackler family among others.

Medicaid, SNAP processing delays could cost Texas millions in federal funding. In letters to the Texas Health and Human Services Commission, two federal agencies are warning that they may withhold funding to the state’s Medicaid, Children’s Health Insurance Program and the Supplemental Nutrition Assistance Program. The Centers for Medicare & Medicaid Services and the U.S. Department of Agriculture both found the longstanding application processing delays and backlogs exceeded federal requirements. They are requiring HHSC to provide a plan to remedy the errors or lose funding associated with administering the programs. The delays started before the federal government required all Medicaid participants to be recertified as eligible at the end of the pandemic-era Medicaid expansion.. 

FINANCE: State general fund conditions continue ‘back-to-normal’ trend. State finances are returning to a more familiar budget environment after a few years of “robust expenditure growth, according to a new report from the National Association of State Budget Officers, New funding is expected to be limited, revenues will come in as expected and rainy day funds are on track for modest growth. 

TRANS CARE: Judge strikes down Florida gender-affirming care restrictions for minors and adults. Florida can no longer enforce its ban against transgender youth receiving gender-affirming care or its restrictions against adults accessing gender-affirming care. A federal district court on Tuesday found those rules to be unconstitutional and fueled by animus against trans people. The ruling is effective immediately.

KEY BRIDGE: Debris finally cleared, shipping channel into Baltimore fully reopened.The full 700-foot-wide, 50-foot-deep Fort McHenry shipping channel into the Port of Baltimore has reopened to ship traffic, more than two months after the crash that destroyed the Francis Scott Key Bridge and closed the Patapsco River channel. But replacing the bridge is expected to take years and could cost billions of dollars. The Biden administration remains committed to having the federal government pay 100% of the cost to replace the Key Bridge, U.S. Transportation Secretary Pete Buttigieg said in a call with reporters Tuesday.

VOTING: Ranked-choice voting suffers red state backlash. Five states—Alabama, Kentucky, Louisiana, Mississippi and Oklahoma—have recently enacted laws banning ranked-choice voting, which allows voters to rank candidates in order of preference. Only Alaska and Maine currently use the process for federal and statewide elections, but more than 50 cities have approved it and are moving toward using it. Republicans lost U.S. House races in 2018 and 2022 in Maine and Alaska under ranked-choice systems and have turned against it, according to Pluribus News.

INSURANCE: Could New York force insurance companies to drop fossil fuels? Homeowner insurance companies are paring back coverage and hiking rates to cover losses from climate change-based extreme weather events, but many of them have also been investing customer premiums in fossil fuel projects, according to New York Focus. A new long-shot proposal would ban insurers from backing new fossil fuel projects, force them to phase out support for existing ones and prohibit them from dropping customers after a storm or denying coverage in areas based on their environmental risk. Most major insurers do business in New York and would be subject to the law, so action in Albany could have substantial implications for fossil fuel projects across the globe.

CAMPAIGNS: Montana governor’s race pits known Republican against aggressive Democrat. The race between Republican Gov. Greg Gianforte and Democratic challenger Ryan Busse is shaping up as one to watch. In the staunchly red state, the race is Gianforte’s to lose, but Busse is running an aggressive campaign against the incumbent. In a phone interview with The Daily Montanan, Busse said he’d speak out on issues like “wildlife being commercialized” and threats to the state’s rivers. Referring to Gianforte’s opposition to abortion, Busse said the governor “wants to be in the doctor’s office with women,” and the ways he is changing the state are “wrong and dangerous.”

AGE LIMIT: North Dakota voters approve age limit for Congress. Sixty-one percent of voters in North Dakota approved a ballot measure Tuesday that would keep candidates from being elected or appointed to Congress if they turn 81 before the end of their term. While the vote is likely to be challenged in court, it shows how voters in one state think about older elected officials. “Most people think it’s common sense that politicians should retire at some point,” Jared Hendrix, a Republican politician in Fargo who gathered signatures to put the question on the ballot, told The New York Times. “I think it’s very possible that if we pull this off here, other states will follow.”

COURTS: Abbott appoints first judges to new appeals court for cases involving state government, businesses. On Tuesday, Texas Gov. Greg Abbott appointed three conservative justices to two-year terms on a new 15th Court of Appeals. The court was created to oversee appeals involving the state, the constitutionality of state laws and cases from business courts—a move proponents say will improve judicial efficiency and put cases with statewide implications statewide before judges elected statewide. Critics say Republicans created the new court so that businesses and the state could avoid having their cases heard in urban counties where Democrats dominate local judicial races.The Legislature last created a new appeals court in 1967 to help manage caseloads in the Houston area.

REPARATIONS: Oklahoma Supreme Court dismisses Tulsa Massacre lawsuit. The Oklahoma Supreme Court dismissed a lawsuit for reparations brought by the last two survivors of the 1921 attack by a white mob on a neighborhood of Tulsa. The decision affirms a lower court’s dismissal of the suit. The plaintiffs, Lessie Benningfield Randle, 109, and Viola Ford Fletcher, 110, were young children when a mob of white residents murdered as many as 300 African Americans and destroyed homes and businesses in the wealthy black neighborhood of Greenwood. The two women said that the attack amounted to an ongoing public nuisance that still has social and economic impact in the neighborhood more than a century later. The justices ruled that the plaintiffs’ grievances, though legitimate, “do not fall within the scope of our state’s public nuisance statute.”

HOUSING: San Jose makes it legal to sell your ADU separately from your home. Starting July 18, homeowners in San Jose, California, will be allowed to buy and sell their accessory dwelling units, sometimes called granny flats, separately from their primary residences. Last year, nearly 23,000 ADUs were built in the state. It’s unclear whether anyone would choose to sell an ADU on their property, but Mayor Matt Mahan said any new option for homeownership is a boon for the city.

CLASS TIME: Kids receive up to two years more school depending on where they live. In a new study, researchers found that even minute differences in the length of a school day or year, whether stemming from state laws or local rules governing school districts, eventually grow into colossal gaps in learning opportunities. Colorado, for example, requires 160 days in a school year and Kansas mandates 186 days. Among the 37 states that set a minimum number of yearly instructional hours, Arizona is at the bottom with 720, while Texas is at the top with 1,260. Adding in students’ absences, teacher absences, tardies, suspensions and a score of outside interruptions, the  average high schooler misses as much as 25% of their intended instructional time.

Picture of the Week

To celebrate Pride Month, the Chicago Transit Authority unveiled the Pride Train, an eight-car train wrapped in rainbow colors to celebrate the LGBTQ community locally and nationally.  This is the seventh year the CTA Pride Train, and this year’s train features a new design, which uses bands of color like the transit map lines, but with a curved and inverting rainbow pattern forming shapes. The design continues to embrace not only the classic Pride Flag colors, CTA officials said, but also includes colors to represent LGBTQ people of color with the black and brown stripes and trans color trio.
 

What They’re Saying

“Let’s disconnect from our devices, and start connecting with the people around us!”

Utah Gov. Spencer Cox has declared June 14 to Aug. 15  as “Utah’s phone-free Friday summer,” encouraging all Utahns to have a phone-free Friday, or spend at least one day a week away from their phones. “As we continue to recognize the harmful effects of social media and constant phone use, we encourage parents, educators and community members to focus on cell phone-free environments and support regular time away from devices,” the declaration states. To ease into the phone-free lifestyle, Cox suggests Utahns start with a phone-free date night, phone-free dinner or phone-free family time. The governor has signed some of the most restrictive laws to curb social media use among Utah teens by requiring parental consent to users under 18 years old. 

ICYMI: The Top 5 Stories from This Week

Midwest states launch new rail service, 12 years in the making
The new Borealis Amtrak service between Chicago and St. Paul has given rail advocates something to cheer about. But they hope other new projects can come online quicker.
BY DANIEL C. VOCK

What makes a city ideal for office-to-housing conversions?
It’s the state and local leaders who can work creatively with restrictive building codes and tax incentives, one expert says.
BY KAITLYN LEVINSON

Mayoral candidate pledges ‘digital by default’ city services
In his bid to become the next mayor of San Francisco, Mark Farrell promised to digitize government services within two years.
BY CHRIS TEALE

More cities are seeing budget gaps: Here’s what not to do
A growing number of cities are having to make tough decisions this spring in order to balance next year’s budgets.
BY KATHERINE BARRETT & RICHARD GREENE

AI in law enforcement is risky, but holds promise
Leaders should not be reluctant to use AI in controversial applications, even if they risk blowback, one city’s CIO advises.
BY CHRIS TEALE