LOS ANGELES — Lee had just been dumped when she found out she was pregnant.

With no car, no job and no support, the 23-year-old — who asked that her last name be withheld for medical privacy — ended up at the virtual clinic Hey Jane, where she was quickly assessed and prescribed abortion medication.

Four months later, thousands of Californians in a similar situation have been holding their breath as the U.S. Supreme Court weighed a case that could rewrite the rules of care in more than two-thirds of U.S. abortions, limiting access to a popular drug even in states where it remains legal.

The justices voiced clear doubts about a lower court's decision to overrule the Food and Drug Administration and restrict mifepristone — the first in a two-drug protocol that now accounts for 63% of all legal abortions in the United States — signaling they are unlikely to restore byzantine rules for prescribing the medication.

"Do we have to also entertain your argument that no one else ... in America should have this drug in order to protect your clients?" Justice Ketanji Brown Jackson said in a pointed exchange later echoed by her frequent rival Justice Neil M. Gorsuch.

But advocates in California say even if the current rules are left in place, the case represents a growing threat to reproductive rights in "sanctuary" states — particularly as legal challenges target telehealth, which has risen to account for 16% of U.S. abortions since 2021.

These numbers do not include the roughly 6,000 abortions estimated to take place outside the formal medical system each month, the overwhelming majority of them likewise induced by a combination of mifepristone and misoprostol procured through the mail, according to a study this week in the medical journal JAMA.

"I'm concerned that people don't realize how important telehealth is — it's a major pillar in the abortion care landscape," said professor Ushma Upadhyay of UC San Francisco, a reproductive healthcare expert. "People don't understand how important it could become in the future."

'Bewildering, surprising and unexpected'

The court's ruling on mifepristone is not expected until June. The reason the stakes are high is that unlike the decision in Dobbs vs. Jackson Women's Health Organization, which overturned Roe vs. Wade in 2022, a Supreme Court ruling to restrict the drug would roll back a series of important changes to the way it is prescribed and dispensed nationwide.

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