Rights, Health, and Democracy: The Urgent Case for Court Expansion

Rights, Health, and Democracy: The Urgent Case for Court Expansion


This June, the Supreme Court will issue a decision in Alliance for Hippocratic Medicine v. FDA, a case originally filed with the intent of severely restricting access to mifepristone, one of two drugs commonly used together for safe abortion care. The combination of mifepristone and another drug, misoprostol, is the most effective method of medication abortion. Extensive research shows that both mifepristone on its own and when combined with Misoprostol are extremely safe. Mifepristone was first approved by the U.S. Food and Drug Administration (FDA) in 2000, and again for generic distribution in 2019, and monitored via research over the years. It is recommended for early termination of pregnancy by the American College of Obstetricians and Gynecologists and has been approved for use in more than 90 countries

The mifepristone case is part of a decades-long effort by right-wing religious extremists to limit access to evidence-based reproductive and sexual healthcare by any means necessary. By asking judges to decide on the safety, efficacy, and availability of mifepristone, the right is doing two things: One, seeking judicial intervention to override decades of research and decision-making by established medical and public health experts thereby also weakening regulatory oversight writ large; and two, immediately reducing access to abortion care throughout the country by fiat. But they won’t stop there. 

The implications of this case are enormous. A Supreme Court decision to restrict access to mifepristone will further weaponize the judicial system to limit access to and criminalize any and all healthcare services, programs, and medications the right deems unacceptable, including gender-affirming care, contraception, infertility drugs, HIV prevention and AIDS drugs, treatments for sexually transmitted diseases, evidence-based addiction treatment, and treatment for depression and anxiety, among other critical interventions used to improve health and save lives. The dangerous repercussions for the nation’s public health and for individual health cannot be overstated. 


The current Supreme Court is a stolen court riven with secrecy and deep corruption. It was hand-picked by right-wing extremists like Donald Trump and Mitch McConnell to undermine our democracy and rubber stamp a hyper-partisan, conservative agenda with no checks and balances. No form of healthcare–whether access to abortion, contraception, gender-affirming care or other–should be determined by judges over regulatory agencies, nevermind by groups of ideologically-motivated justices often in the pockets of extreme right-wing billionaires. 

There is significant momentum for Court reform and expansion in the progressive movement. Organizations like Take Back the Court and others have been working for years to expand the Court, and garnered support from more than 60 members of Congress, a wide-ranging group of advocacy organizations, activists, legal experts, and other political leaders. Healthcare Across Borders strongly supports these efforts. Still, the Democratic party and many of the groups that support it are often highly conflict-averse, and efforts to expand the Court have suffered as a result of their stasis. 

Nonetheless, the only rational thing to do now to protect our health and, quite literally, ensure the survival of our democracy is to push harder to change the composition of the Court through reform and court expansion. In the mifepristone case, it is essential that the Court rule to respect medicine, science, and public health. There are no other just outcomes. But winning this case is only part of the struggle. Given the hunger among right-wing governors and state legislatures to eliminate all access to reproductive health care,  the only way to protect our freedoms–whether those be voting rights, abortion rights, trans rights, and access to evidence-based healthcare–is to change the Court.

We are running out of time and we need to expand the Court NOW.