How Abortion Politics Could Derail Trump’s 2024 Agenda

Last week, a federal appeals court in New Orleans delivered a major blow to the Biden administration’s abortion policies, ruling that the FDA’s authorization of telehealth prescriptions and mail delivery for mifepristone—a key abortion drug—violated states’ rights to regulate abortion within their borders.

The decision, issued by the Fifth Circuit Court of Appeals in a case brought by Louisiana, upended a long-standing status quo that had allowed women in restrictive states to access abortion pills discreetly via mail-order pharmacies. The Supreme Court intervened the next day, temporarily halting the ruling to allow time for appeals.

Mifepristone, often used in combination with misoprostol, is a cornerstone of medication abortion in the U.S. Its FDA approval in 2000 and subsequent expansions under the Biden administration have made it a critical tool for circumventing state-level abortion bans. But the Fifth Circuit’s unanimous decision last week declared that the FDA’s policy overstepped federal authority, siding with Louisiana’s argument that it effectively enabled abortions that are illegal under state law.

Danco Laboratories and GenBioPro, the two manufacturers of mifepristone, warned in a joint statement that the ruling would create “immediate chaos,” rendering an agency action that has been in effect for years inoperable. Reproductive-rights advocates echoed these concerns, framing the decision as a potential disaster for abortion access nationwide.

Trump’s Political Tightrope on Abortion

For Donald Trump, the timing of this legal battle could not be worse. The former president, who has historically downplayed abortion as a personal priority, has spent much of his 2024 campaign distancing himself from the issue—even after the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health decision overturned Roe v. Wade. Yet abortion politics may be poised to re-enter the national conversation with a vengeance.

Trump’s administration has actively worked to avoid taking a firm stance on mifepristone. Last September, amid pressure from Republican state attorneys general, then-Health and Human Services Secretary Robert F. Kennedy Jr. announced that the FDA would conduct a “review” of mifepristone’s authorization. Nearly a year later, that review remains incomplete, and the Trump administration has consistently urged courts to delay rulings on the drug until the process concludes.

This strategy reflects Trump’s broader approach to abortion since his re-election: avoid the issue while quietly maintaining the status quo. But the Fifth Circuit’s decision has exposed the fragility of that approach. If the Supreme Court ultimately sides with Louisiana, it could force Trump to confront a dilemma he has long sought to sidestep—alienating either anti-abortion activists, who form a core part of his base, or reproductive-rights advocates and independents who view the mail-order abortion pill as essential to maintaining access.

What’s Next for Mifepristone and the 2024 Election

The Supreme Court’s temporary hold on the Fifth Circuit’s ruling buys time, but the clock is ticking. The justices must now decide whether to take up the case or allow lower-court rulings to stand. If they decline to intervene, the FDA’s mail-order policy could be struck down, leaving millions of women in restrictive states with fewer options for abortion care.

For Trump, the stakes are high. The abortion issue played a pivotal role in the 2022 midterms, when Democrats leveraged backlash to the overturning of Roe v. Wade to win key races. With the 2024 election looming, a renewed focus on abortion could once again galvanize Democratic voters and sway independents—particularly women—who have grown increasingly concerned about reproductive rights.

Meanwhile, anti-abortion groups are pressing their advantage. Last week’s ruling was celebrated by organizations like the Susan B. Anthony Pro-Life America, which has long argued that the FDA overstepped its authority by allowing mifepristone to be distributed without in-person medical supervision. The group’s president, Marjorie Dannenfelser, praised the Fifth Circuit’s decision as a “victory for life and the rule of law.”

As the legal and political battles intensify, one thing is clear: abortion is far from dead as a campaign issue. For Trump, the question is no longer whether he can avoid it—but how he will navigate the fallout when the Supreme Court finally weighs in.