Five things to know about the Texas abortion fight

A Texas judge, the state Supreme Court and its attorney general are at odds with each other over the future of Texas’ abortion laws, calling into question some of the country’s most strict regulations.

Here’s what you need to know:

One woman at the center of it all

This image provided by Kate Cox shows Kate Cox. A Texas judge has given the pregnant woman whose fetus had a fatal diagnosis permission to get an abortion in an unprecedented challenge to the state’s ban that took effect after Roe v. Wade was overturned last year. It was unclear Thursday, Dec. 7, 2023 how quickly or whether Kate Cox, a 31-year-old mother of two from the Dallas area, will be able to obtain an abortion. State District Judge Maya Guerra Gamble says she will grant a temporary restraining order that will allow Cox to have an abortion. (Kate Cox via AP)

Kate Cox, a 31-year-old woman from Dallas, petitioned a state court this month for an exemption from the state’s strict laws to receive an abortion. 

She had just learned that her 20-week-old fetus was diagnosed with full trisomy 18, a fatal condition for the fetus that could also lead to severe pain and an increased risk of pregnancy and birth complications.

Her doctors argued that carrying the fetus to term and giving birth via Caesarion section could be dangerous, possibly resulting in her losing the ability to have children in the future.

Texas District Judge Maya Guerra Gamble gave Cox a temporary restraining order on Thursday, giving Cox, her husband and her doctor immunity from prosecution to perform an abortion procedure.

“The idea that Ms. Cox wants desperately to be a parent and this might cause her to lose that ability is shocking, and would be a genuine miscarriage of justice,” Gamble wrote.

It’s an unprecedented ruling from a state judge, completely throwing out the state’s laws in the interest of Cox’s health. Gamble argued that Cox’s case falls under one of Texas’ few legal exceptions which allows women to receive abortion care because her pregnancy threatened her life.

Ken Paxton leads the state’s fight

Texas state Attorney General Ken Paxton, center, sits with his attorneys Dan Cogdell, right, and Tony Buzbee, left, during his impeachment trial in the Senate Chamber at the Texas Capitol, Tuesday, Sept. 5, 2023, in Austin, Texas. (Juan Figueroa/The Dallas Morning News via AP, Pool)

The state argued that she didn’t fall under that exemption and that any potential complications were not truly life-threatening. 

Jonathan Stone, a lawyer for the Texas Office of the Attorney General, said Cox did not “meet all the elements” to qualify for an exemption, and that the state would need to change the medical exemption and then say “that the plaintiffs meet this changed newly rewritten standard.” 

Texas Attorney General Ken Paxton blasted the ruling in a letter late Thursday, threatening Cox, her doctor and area hospitals, saying they could be prosecuted if she receives abortion care.

He wrote that the ruling “will not insulate hospitals, doctors, or anyone else, from civil and criminal liability for violating Texas’ abortion laws.”

“The TRO [temporary restraining order] will expire long before the statute of limitations for violating Texas’ abortion laws expires,” he continued.

Paxton also penned a separate letter to the three hospitals where Cox’s doctor has admitting privileges.

“Your hospital may be liable for negligently credentialing the physician and failing to exercise appropriate professional judgment, among other potential regulatory and civil violations, if you permit Dr. Karsan to perform an unlawful abortion,” Paxton wrote.

Those statements have made Paxton, a politically divisive figure in Texas, the face of the issue. The attorney general narrowly survived a removal effort after being impeached in September over corruption allegations.

Texas Supreme Court draws case into question

People march through downtown Amarillo to protest a lawsuit in federal court to ban abortion pills on Saturday, Feb. 11, 2023, in Amarillo, Texas. (AP Photo/Justin Rex)

A federal judge in Texas last week issued a ruling that said the FDA rushed their approval of an abortion drug over two decades ago. Protestors gathered outside of the Supreme Court to show support for safeguarding access to the drug mifepristone. (Christina van Waasbergen/The Hill)

Following the state’s challenge, the Texas Supreme Court paused Gamble’s ruling on Friday, meaning Cox can not longer legally receive abortion care until a final decision is made over the legality of granting an exception.

Paxton’s office applauded that decision, which it argued directly saves the life of the terminally-ill fetus.

“Future criminal and civil proceedings cannot restore the life that is lost if Plaintiffs or their agents proceed to perform and procure an abortion in violation of Texas law,” Texas Attorney General Paxton’s office said to the court, per The AP.

But for Cox, that pause means she will continue to carry the pregnancy despite risks of complications. She described the stresses as “overwhelming.”

“She'll either die in my belly, or I'll carry her to term and have to deliver her stillborn. Or, if she arrives into this world, her life will be measured in minutes or hours or days and plagued with medical devices,” Cox said in a PBS interview. “She would need to be placed directly onto hospice. Imagine receiving that news and pairing that with the risks and complications of continuing the pregnancy and the childbirth. It's overwhelming.”

Abortion in the spotlight politically

Utah Sen. Mitt Romney speaks to reporters in his Capitol Hill office in Washington, Wednesday, Sept. 13, 2023. (AP Photo/J. Scott Applewhite)

The Texas fight draws another wave of national attention to the issue of abortion rights, considered key by Democratic strategists in efforts to regain the House and keep the White House in 2024.

Abortion rights issues have mobilized voters to the polls in recent years, including victories for abortion-rights activists in red states like Kansas and Kentucky in 2022 and Ohio this year. 

Activist groups are gathering signatures for 2024 ballot efforts in South Dakota, Florida, Arizona and Missouri.

While GOP presidential candidates have dared each other to embrace strict anti-abortion rights legislative promises, the Biden campaign has held up the president’s record as a rallying issue.

Some Republicans have openly worried that the issue will hurt GOP odds at the ballot box.

“The more we talk about abortion, the worse we’re doing,” retiring Sen. Mitt Romney (R-Utah) said last month.

Notable Democrats have already taken advantage of the issue to gain ground politically.

“A woman in Texas is fighting in court for an abortion while corrupt extremist Ken Paxton threatens to throw her doctors in jail. It’s cruel and horrific,” Sen. Elizabeth Warren (D-Mass.) said on X, formerly Twitter. “This case is a direct consequence of the Trump-stacked Supreme Court’s reversal of Roe v. Wade.”

Could have big 2024 implications for Texas

Sen. Ted Cruz (R-Texas) questions from FBI Director Christopher Wray over the Hunter Biden investigation during a Senate Judiciary Committee oversight hearing on Tuesday, December 5, 2023.

Those 2024 impacts could also filter down to Texas, which hosts an important Senate race and may be in play for Democrats after years of thinning GOP presidential election margins.

Sen. Ted Cruz (R-Texas) faces a challenge from likely primary winner Rep. Colin Allred (D-Texas) for his seat in November.

The Democratic Party’s Senate fundraising arm announced that it will expand its financial support for Cruz’s challenger in October, also targeting Sen. Rick Scott (R-Fla.).

“Senators Cruz and Scott’s deep unpopularity is driven by their unique vulnerabilities, their self-serving politics and their toxic policy agendas — all of which make Texas and Florida prime offensive opportunities for Senate Democrats,” said DSCC Executive Director Christie Roberts.

Allred criticized the Supreme Court's ruling and Texas abortion law in a statement to The Hill.

“To force someone to carry out a nonviable pregnancy — at risk to her own life — is unthinkably cruel and barbaric. These extreme abortion bans are life-threatening. Texas women deserve freedom, not subjugation," he said. “Extreme politicians like Ted Cruz have failed Texas women, and that’s why Texas voters will reject his dangerous extremism next November.”

Cruz hasn’t publicly commented on the issue as of Saturday. The Hill has reached out to his campaign for comment.

Former Rep. Beto O’Rourke (D-Texas), who ran against Cruz in 2018, also blasted Paxton’s letter and the GOP stance on abortion in Texas.

“This is Texas AG Ken Paxton saying he’ll throw a woman’s doctors in prison for life if they perform a *court-granted* abortion on a *nonviable* pregnancy that risks causing her permanent infertility and death,” he said.

“Still think the GOP is pro-life?” O’Rourke added.

Updated at 4:29pm.