Roe v. Wade was overturned in June 2022, when the Supreme Court decided Dobbs v. Jackson Women’s Health Organization and ruled that the Constitution does not protect a right to abortion. That decision handed the question to state legislatures. As of early 2026, thirteen states enforce total or near-total bans, more than ten states have written reproductive rights into their own constitutions, and a patchwork of federal statutes, state shield laws, and unresolved cross-border questions fills the space in between.
What Dobbs Actually Changed
Roe, decided in 1973, held that the Fourteenth Amendment’s protection of personal liberty covered a person’s decision about whether to continue a pregnancy. Planned Parenthood v. Casey reaffirmed that core in 1992 while giving states more room to regulate before fetal viability. Dobbs threw out both. Justice Samuel Alito’s majority opinion concluded that abortion is not “deeply rooted in this Nation’s history and tradition” and therefore does not qualify as a protected liberty under the Due Process Clause.1Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization
The practical effect is narrow and enormous at the same time. Narrow, because Dobbs did not ban anything on its own; it removed a federal floor. Enormous, because that floor was what stopped states from banning the procedure outright. With it gone, whatever your state legislature has decided, or whatever your state constitution says, is the law that governs you.
Where You Live Decides Almost Everything
Thirteen states enforce total or near-total bans: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. Most took effect through trigger laws, statutes drafted specifically to activate the moment Roe fell. Other states set gestational limits at six weeks, fifteen weeks, eighteen weeks, or later, and some impose no limit at all.
Voters have pushed in the opposite direction in more than ten states. California, Michigan, Ohio, and Vermont approved constitutional amendments protecting reproductive autonomy in 2022. Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York followed in 2024. The language differs from state to state, but each amendment raises the bar a legislature would have to clear to restrict the procedure.
Penalties for Providers
In states with bans, the consequences for providers are severe. Civil fines can reach $100,000 or more. Criminal sentences in the strictest states range from five years in prison to life imprisonment. Several states have moved to revoke medical licenses for prohibited procedures. At least one state uses a private enforcement mechanism that lets any individual sue a provider or anyone who assists with a prohibited procedure and collect a minimum of $10,000 in statutory damages. Because there is no single government official to sue, that model is unusually hard to challenge in court.
The Emergency Exception Problem
Most bans include an exception for medical emergencies, but the wording is often vague. Doctors in several states have described waiting until patients deteriorate to life-threatening conditions before intervening, because the legal risk of acting earlier is unclear. State courts are now the main venue for fights over how narrow or broad these exceptions really are.
Federal Law Still in the Picture
Dobbs eliminated federal constitutional protection, not federal law generally. Several statutes continue to shape what happens on the ground.
Emergency Room Care Under EMTALA
The Emergency Medical Treatment and Labor Act requires Medicare-participating hospitals with emergency departments to screen anyone who comes in and provide stabilizing treatment for emergency medical conditions.2Office of the Law Revision Counsel. 42 U.S. Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor The federal government has argued that this obligation includes abortion care when a patient’s health is in serious jeopardy, even in states with bans. States with strict bans say their laws control.3Office of Inspector General. The Emergency Medical Treatment and Labor Act
The Supreme Court took up that conflict in Moyle v. United States, involving Idaho’s ban, but dismissed the case in June 2024 without deciding the underlying question. A lower court injunction went back into effect, so Idaho cannot enforce its ban when termination is needed to prevent serious health consequences. The core federal-state question is still open, and another case could put it back before the Court.4Supreme Court of the United States. Moyle v. United States
Medication Abortion and the FDA
Mifepristone, the primary drug used in medication abortions, is regulated by the FDA under the Federal Food, Drug, and Cosmetic Act. The agency has loosened its distribution rules to allow telehealth prescribing and pharmacy dispensing by mail.5Congressional Research Service. Medication Abortion: A Changing Legal Landscape Anti-abortion groups challenged those changes, but the Supreme Court unanimously rejected the challenge in FDA v. Alliance for Hippocratic Medicine in June 2024, finding the plaintiffs lacked standing. The FDA’s current rules stay in place, though the ruling did not address the merits and does not foreclose new lawsuits.6Supreme Court of the United States. FDA v. Alliance for Hippocratic Medicine
Whether federal drug approval overrides a state criminal ban on a specific use of an approved medication is a question no court has definitively answered.
Workplace Accommodations
The Pregnant Workers Fairness Act took effect in 2023 and requires employers with fifteen or more employees to provide reasonable accommodations for conditions related to pregnancy, childbirth, or related medical conditions. That includes modified schedules, additional breaks, temporary reassignment, and leave for healthcare appointments. Employers cannot push a worker into unpaid leave when another accommodation would let them keep working, and they cannot retaliate against employees who ask.7U.S. Equal Employment Opportunity Commission. What You Should Know About the Pregnant Workers Fairness Act
Traveling Out of State
The right to travel between states is well established. The Supreme Court has recognized it under the Privileges and Immunities Clause and the Fourteenth Amendment and has applied strict scrutiny to state laws that penalize people for using it.8Legal Information Institute. Interstate Travel No state has successfully enforced a law that directly prohibits a resident from traveling elsewhere for care.
The realistic risks are indirect. Some states have “aiding and abetting” liability that reaches people who help someone obtain a prohibited procedure. Whether those laws can extend across state lines remains largely untested. A friend who drives a patient, a family member who pays for a ticket, or a physician who prescribes medication via telehealth to a patient in a restrictive state all sit in uncertain territory. At least one state has tried to enforce a civil judgment against an out-of-state provider by asking courts in the provider’s home state to recognize it. Whether those attempts succeed depends heavily on the receiving state’s own laws.
Shield Laws
Twenty-two states and the District of Columbia have passed shield laws to blunt that risk. They typically do several things at once:
- Prohibit state agencies from sharing information or cooperating with out-of-state investigations into protected reproductive healthcare.
- Refuse to extradite people charged in another state for care that was legal where it happened.
- Shield providers from professional discipline or licensing consequences for legally provided care.
- Refuse to enforce civil judgments imported from another state’s abortion ban.
- Give targeted individuals the right to sue anyone who tries to use another state’s ban against them.
The Dormant Commerce Clause, which limits state laws that burden interstate commerce, may offer another line of defense against cross-border enforcement, but the Supreme Court has not weighed in and lower-court cases are still developing.
What HIPAA Does and Doesn’t Cover
The federal HIPAA Privacy Rule was amended in 2024 to add specific protections for reproductive health records, including a requirement that covered entities obtain an attestation before releasing that information for legal proceedings. A federal district court in Texas struck down the key provisions in June 2025, and the Department of Health and Human Services suspended enforcement. The pre-2024 HIPAA rules apply again, so reproductive health information gets the same protection as other medical records but no additional safeguards tied to the post-Dobbs environment.
What the Dissent Warned Could Come Next
Justices Breyer, Sotomayor, and Kagan filed a joint dissent in Dobbs arguing that the majority’s historical test threatens more than reproductive rights. Their reasoning: if a liberty counts as fundamental only when it was recognized in the mid-nineteenth century, then contraception (Griswold v. Connecticut), same-sex intimacy (Lawrence v. Texas), same-sex marriage (Obergefell v. Hodges), and interracial marriage (Loving v. Virginia) all rest on the same shaky ground. “So if the majority is right in its legal analysis,” the dissent wrote, “all those decisions were wrong, and all those matters properly belong to the States too.”1Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization
The majority said abortion is different because it involves potential life. Justice Clarence Thomas, in a concurring opinion, was explicit that the Court should reconsider Griswold, Lawrence, and Obergefell. Whether it does is a matter for future cases.
The Short Version
Your state’s law is now the controlling authority on whether you can obtain an abortion, on what timeline, and under what conditions. Federal statutes still govern emergency room stabilization, FDA-approved medications, and workplace accommodations, but the conflicts between those statutes and state bans are unresolved. Shield laws in protective states offer real but untested protection for cross-border care. If you are trying to figure out what applies to you, start with the law of the state where the care would happen, then the state where you live, and then the federal statutes above. The answers can differ, and the differences matter.