How changes to an abortion pill could lead to an impact 'bigger than Dobbs'

A surge in telemedicine helped to lessen at least some of the impacts of the Supreme Court's 2022 decision to overturn Roe v. Wade and remove a constitutional right to abortion.

But the effects could be more widely felt, some economists and healthcare experts say, if an upcoming high court debate about a mail-order abortion pill results in greater restrictions in the years ahead.

The issue will be front and center for many Americans in the coming days as the Supreme Court hears a case that could change access to Danco Laboratories’ mifepristone — the commonly used medication that can be ordered in some places without an in-person clinic visit.

The pill allows a person to end a pregnancy in its early stages.

"I am not sure that the general public really understands that the mifepristone case could be bigger than Dobbs," Middlebury College economist Caitlin Myers says, referring to the landmark 2022 decision in Dobbs v. Jackson Women's Health Organization.

"There are potential future worlds in which this case reduces abortion access far more," she added in a recent interview.

Oral arguments are set for Tuesday, with a decision possible by this summer.

To make things even more complex, a parallel debate in the US around in vitro fertilization (IVF) could have yet another set of economic effects — with a different universe of Americans potentially being impacted — if policy changes are considered on that front either in Washington or at the state level.

Mifepristone is part of a decades-long trend toward telemedicine that was spurred in recent years by the COVID-19 pandemic but then turbocharged in the reproductive health space by the Dobbs decision.

The Supreme Court's ruling has led to abortion bans in more than a dozen states. Thousands of residents in those states responded by traveling for these services while also relying more directly on telemedicine.

Medication abortion accounted for 63% of all abortions in the US healthcare system in 2023, up from 53% in 2020, according to new data from the Guttmacher Institute released last week. Tellingly, the sharpest increases were in states that bordered areas where abortion is now banned.

"Telehealth was increasing and then exploded," said Sean Tipton, the chief advocacy and policy officer at the American Society for Reproductive Medicine, adding, "That's true for reproductive care as it is with anything else."

The links between abortion access and economics

Abortion access and economics have been linked for years. One recent study at UC San Francisco found that those with the ability to access abortion "were more financially stable" and able to live more ambitious and productive lives as a result.

Republicans, for their part, have been skeptical of looking at abortion through an economic lens, preferring instead to keep the focus on moral issues.

Professor Myers and others nevertheless say economic issues are inextricably intertwined.

Myers spearheaded a Supreme Court amicus brief with over 150 of her academic colleagues in 2021 on the economic effects of abortion. She also testified to Congress earlier this year on how Dobbs has proven to be "an inequality story, not a macro-level shock story" — with the impact of abortion bans being most strongly felt by poorer people of color.

Tens of thousands of poorer residents of the 14 states where abortion is banned don't have the means to travel elsewhere to access an abortion. A recent Institute of Labor Economics study pegged the number at about 30,000 births that wouldn't have happened in recent years if abortion had been available everywhere.

On the other hand, the total number of abortions in the United States has risen since the Dobbs decision, according to Guttmacher Institute data. It may have risen more if the ruling had never come down, but that was far from the decline many were predicting. Telemedicine may help explain that development.

"I was really thinking about the decreased access in banned states and not about the fact that access would actually improve in so much of the country almost as a result of the ruling," says Myers, adding, "That's one thing that took me by surprise."

The convergence of these trends raises the stakes for the coming mifepristone decision. The case was brought by a conservative group called Alliance for Hippocratic Medicine and challenges current policies allowing widespread access.

At specific issue are moves in 2016 and 2021 from the Food and Drug Administration to allow the medication to be prescribed online without an in-person doctor's visit. The group argues that the moves to change that policy "were arbitrary and capricious."

The court could also look at current rules that allow the medication to be used up to around 10 weeks of pregnancy. The court declined to take up a separate case around the question of whether mifepristone should be banned entirely.

Limiting mail-order medication could cause "even larger economic damage than Dobbs," Sen. Sheldon Whitehouse, a Rhode Island Democrat, said in a recent congressional hearing on the issue.

Why IVF changes would impact a 'very different' group

Whitehouse, at that hearing, also surfaced concerns about in vitro fertilization.

"Even in vitro fertilization is under the gun, at the hands of right-wing extremists," he added.

IVF is a hot-button issue after the Alabama Supreme Court ruled in February that frozen embryos can be considered children under state law, sparking off an immediate backlash and a move within the state to protect IVF providers from legal liability.

Republicans dispute Whitehouse's characterization and often express their support for IVF but it's already a key campaign trail issue.

Some GOP leaders, including House Speaker Mike Johnson, have also discussed IVF as "a states issue," which could open the door to different access levels depending on where one lives.

Economically speaking, the effects of any potential IVF restrictions are only beginning to be studied.

One study of access in Israel centered on a 1994 move to make in vitro fertilization free. It found that increased access "contributed to better labor market outcomes, reducing the gender gap in career achievement."

It's unclear if inverse effects would be felt if IVF access is rolled back, but Myers says it's likely that limitations would be an issue more felt by people higher up on the income spectrum.

IVF changes are "particularly likely to impact women with more education who've invested more in their careers, who've delayed motherhood," she says.

How the IVF issue plays out politically remains to be seen but advocates like Tipton are in the midst of a push to pass national legislation that could enshrine access to IVF.

"There has been such a bipartisan outpouring of support for IVF, and we are really hoping to help policymakers make that support more manifest," he says, adding a mantra many on his side of the debate would apply to the array of reproductive health issues at play in 2024.

"A patient's ability to access needed medical care should not depend upon their ZIP code."

Ben Werschkul is Washington correspondent for Yahoo Finance.

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