No, it was never about being ‘ left to the states’. The right-wing wants to impose its will on the entire country.

So Much for Leaving Abortion Up to the States
Louisiana’s case against the FDA is not just about one drug.
By Adam Serwer
June 14, 2026, 7:31 AM ET

The 2022 Dobbs decision, which overturned Roe v. Wade, supposedly gave states the authority to decide for themselves whether to permit abortion. What should have been apparent then, and is obvious now, is that anti-abortion activists and their allies on the high court were never going to be satisfied with that.

Since October, the state of Louisiana has been seeking to block the distribution of mifepristone, a drug used to induce abortion, through the mail—not just in Louisiana, but anywhere in the United States. The state’s lawsuit against the FDA asserts that the Comstock Act—an anti-obscenity law championed by the 19th-century book burner Anthony Comstock—bans the mailing of abortion medication, and that the federal government wrongly repealed the in-person requirement for prescribing it.

“Louisiana is complaining about reported harms in Louisiana, but they would be imposing a nationwide requirement that patients pick up the pill in person from their health-care provider, even in states that protect abortion access, even in states that explicitly, in their laws, allow for telemedicine provision of mifepristone,” Andrew Beck, an attorney with the ACLU, told me. “Louisiana is really trying to impose its own policy choices on the entire country.”

Medication abortion accounts for about two-thirds of all abortions in the United States, which have actually increased since Dobbs v. Jackson Women’s Health Organization made it possible to send mifepristone through the mail. Providers were first able to mail the drug during the pandemic, a temporary measure that was made permanent by the FDA in 2023. Even in Louisiana, which has a strict anti-abortion law with few exceptions, the number of abortions has risen, according to the state’s lawsuit. This was in part because Louisianans were able to access abortion drugs through providers based in states where the procedure is legal. Indeed—abortion medication has made it possible for women who live far from any clinic to end unwanted pregnancies. Many of those pro-abortion-rights states had passed “shield laws” that protected providers in their jurisdictions from being sued or prosecuted by authorities in anti-abortion states.

Although Louisiana v. FDA is ostensibly about a federal regulatory decision and the safety of an abortion drug, it is really about access to abortion. Louisiana even began its complaint with the declaration that “the fight for life is far from over.” The FDA has asked the court to hold off on a ruling for now, as the Trump administration has said it is conducting its own review of the drug (all medical evidence indicates that mifepristone is safe). In the meantime, two drug companies are asking the courts to allow the continued distribution of mifepristone. The Supreme Court responded to this question on May 14, overturning a lower order that halted distribution and sending the case back for review. The late Justice Antonin Scalia once predicted that overturning Roe would get the Court out of the “abortion-umpiring business.” That prediction has not aged well.

…………………………

Whatever happens next, the legal battle reveals that the paradise of abortion federalism is a fraud. Either anti-abortion states will get to impose their policies on pro-abortion-rights states, or they will have to live with their residents being able to access abortion care from providers elsewhere.

“Those who oppose abortion are not satisfied with the Supreme Court’s ruling that it should be up to the states to decide abortion policy,” Nancy Northup, the president of the Center for Reproductive Rights, told me. “They want a national ban. They’ve always wanted a national ban. And this case, Louisiana v. FDA, is a type of effort to get at least a national ban on medication abortion.”

Lawmakers in anti-abortion states have sought to ban or criminalize the sharing of information about abortion, such as through a Texas proposal that would outlaw providing “information on the method for obtaining an abortion-inducing drug.” Anti-abortion states have tried to sue Planned Parenthood for providing accurate information about the safety of abortion drugs; Florida accused the organization of violating its racketeering law. Early efforts at restricting pregnant women’s travel have been stymied in the courts, but Texas’s bounty law, which allows a private individual to sue anyone who helps someone else get an abortion, is still in effect.

There’s no need to travel, however, if you can get what you need through the mail. Since 2023, the anti-abortion movement’s biggest priority has been trying to block the distribution of abortion medication nationally, either by reversing the FDA’s approval of mailing mifepristone or by getting the Supreme Court to rule that Comstock retains the authority to “enforce evangelical Protestant doctrine regarding sexuality,” as the historian Amy Werbel described the law in Lust on Trial: Censorship and the Rise of American Obscenity in the Age of Anthony Comstock.

………………………

If Louisiana succeeded in halting the mailing of mifepristone, people could still access an alternative drug, such as misoprostol, but anti-abortion advocates aren’t simply trying to make one particular drug harder to get, and they surely wouldn’t stop with this case. Access to abortion through telehealth is an “existential threat” to the anti-abortion movement, Rachel Rebouché, a law professor at the University of Texas at Austin who has helped pro-abortion-rights states draft shield laws, told me. “The average number of abortions has gone up, and people in banned states are getting pills. It’s a threat because you can try to police it, but doing so would be very expensive, very intrusive, and it’s probably going to create a massive backlash.” Louisianans probably don’t want cops ransacking their mail any more than New Yorkers do.

Before Dobbs was even issued, abortion-rights advocates knew that red states would try to impose civil liabilities on out-of-state medical professionals. This is because Republicans announced their intentions publicly: In March 2022, two months before the Dobbs opinion was leaked, Missouri Republicans were considering a proposal to impose civil liabilities on anyone who helped a woman get an abortion out of state. Texas’s bounty law, which also applies to out-of-state abortions, was passed in 2021.

Given that anti-abortion advocates see themselves as fighting for life (although not the lives of women dying in anti-abortion states—those don’t seem to count), they were never likely to let state borders confine their efforts. So abortion-rights advocates began pushing for the shield laws; in March 2022, Rebouché and two fellow law professors, David S. Cohen and Greer Donley, made the case for them in The New York Times. Shield laws have been passed in 22 states and Washington, D.C.

“We started to think, Let’s map out all the ways interstate conflict is gonna manifest—all the things that we think that states are gonna do to try to extend their abortion bans across their borders to patients, to providers, and the like,” Rebouché told me. “It can’t be that the end goal is just to ban abortion in a state. The end goal has to be to ban abortion everywhere.”

The point is that Alito’s timeline is wrong. Shield laws were not a response to Dobbs itself; they were a response to Republicans’ threats to extend their bans on abortion beyond their own borders once Roe was overturned.

“Many of the same anti-abortion politicians who were telling the Court, Hey, we should leave this to each individual state to decide its own policies—they immediately set about trying to impose their own restrictions on abortion care that was taking place legally elsewhere,” Beck said.