The law of unintended consequences aptly arrived in black robes. On January 6, Wyoming’s Supreme Court struck down both a near-total abortion ban and the country’s first explicit ban on abortion pills, citing a 2012 state constitutional amendment that promises “each competent adult shall have the right to make his or her own health care decisions.”

“This ruling is a victory for the fundamental right of people across Wyoming to make decisions about their own lives and health,” said Julie Burkhart, who runs Wellspring Health Access, the state’s lone abortion clinic. The catch is that the sentence doing the work she welcomed was drafted years ago to fight the Obamacare wars, not the abortion wars. It’s a boomerang that has swung round on Republicans.

Wyoming is not alone. During the Tea Party wave, several red states wrote nearly identical “health care freedom” provisions into their constitutions, aimed at blocking the Affordable Care Act’s mandates. Arizona’s constitution now says no law may “compel… any person, employer or health care provider to participate in any health care system.” Oklahoma’s does, too. Ohio added a “Preservation of the freedom to choose health care” clause. All three sit on the books today. If “abortion is health care,” as Wyoming’s High Court held, those anti-ACA boomerangs could yet spin back across state lines.

Common Knowledge

Progressives say the legal logic is straightforward. If a state constitution explicitly protects “health care decisions,” then abortion, whatever else it is, fits the category. Vox spoke for many by calling it the moment Republicans “accidentally protected abortion while trying to kill Obamacare,” a “symbolic effort” that “sabotaged” a core conservative goal.

Conservatives counter that the voters who passed those Obamacare-era amendments were not voting on abortion at all, and that the legislature (or the voters) can rewrite the constitution to make that clear. Wyoming’s attorney had argued as much at earlier stages and Governor Mark Gordon is now pressing the case. He described the opinion as “profoundly unfortunate.”

After President Donald Trump urged Republicans on Tuesday to be “a little flexible” on the decades-old Hyde Amendment to cut a new health-care deal, Susan B. Anthony Pro-Life America’s Marjorie Dannenfelser warned that such flexibility would be “a massive betrayal” that could doom the party in November.

Uncommon Knowledge

Wyoming’s Article I, Section 38—adopted in 2012 amid anti–Affordable Care Act fervor—reads, in part, “Each competent adult shall have the right to make his or her own health care decisions.” The amendment passed with overwhelming support, a testament to how Obamacare was the proxy fight of the time.

Many similar versions exist. Arizona added Article XXVII, §2 in 2010: “A law or rule shall not compel… any person, employer or health care provider to participate in any health care system.” Oklahoma’s Article II, §37 says the same. Ohio’s Article I, §21 declares the “preservation of the freedom to choose health care and health care coverage,” barring government from compelling participation in a “health care system.” These weren’t drafted with abortion in mind; they were written to defy the ACA’s individual mandate. But it might not matter.

Medication abortion already accounts for 63 percent of clinician-provided abortions, up from 53 percent in 2020—a structural shift since Dobbs. If “health care freedom” clauses protect adult decision-making about lawful medical care, bans on prescribing mifepristone are the square peg for a suddenly round hole. Wyoming’s decision didn’t create that paradox, it merely revealed it.

There are caveats. Wyoming’s opinion emphasized that the constitution—not the court’s own policy preferences—drives the result, and it left open whether a future law that survives “strict scrutiny” could pass muster. The court also noted that if legislators want a different policy, they can ask voters to change the constitution; Governor Gordon has now invited them to do just that. And the ruling binds only Wyoming. But the context beyond state lines is shifting: two abortion-rights amendments are already certified for 2026 ballots (Missouri and Nevada), and organizers in other states are pushing their own measures.

The day before Wyoming ruled, Reuters tallied multiple Republican-led state lawsuits aiming to curtail mifepristone access notwithstanding FDA approvals. And then there is Trump, who told House Republicans to be “flexible” on the Hyde Amendment—a ban on most federal abortion funding that has shaped health-care politics since 1976—in order to cut a new health-insurance subsidy deal after enhanced ACA premium aid lapsed at the end of 2025. The last time conservative politics went all-in on health care, states embedded “health care freedom” in their constitutions. A decade later, those words are the sharpest tool for keeping abortion pills legal.

Ohio litigants have already cited their “Health Care Freedom Amendment” in abortion cases, even before voters adopted an explicit reproductive-rights amendment in 2023. And Arizonans and Oklahomans didn’t just pass statutes, they constitutionalized the language, making it far harder to repeal than an ordinary bill.

The broader lesson is about American politics’ habit of unintended consequences. The boomerang, and others, may not have finished swinging.

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