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Republican presidential contenders and endangered incumbents this past week were once again forced to answer complicated questions on abortion rights, as a Texas case demonstrated why the issue that dominated the 2022 and 2023 elections is poised to play a central role next year.

The Texas Supreme Court on Monday denied Kate Cox, a 31-year-old mother of two, the right to end a pregnancy that she and her doctors said threatened her life and future fertility. The decision laid bare the political reality facing Republicans as they seek to navigate between their conservative anti-abortion base and a general electorate more supportive of abortion rights. As red states implement a patchwork of new restrictions on the procedure with untested exceptions, real-world events continue to muddle their efforts to stick to and sell to voters an effective message on the issue.

The US Supreme Court’s decision last year to reverse Roe v. Wade’s long-standing federal guarantee of abortion rights saw nearly every Republican-controlled statehouse launch debates over whether and when in a pregnancy to outlaw abortion and which exceptions to allow. That’s led to a cascade of legal challenges testing the constitutionality and boundaries of those bans and renewed attacks from Democrats eager to paint Republicans as having undercut women’s health care.

President Joe Biden’s campaign, citing the Texas case, said it plans to make abortion a key focus as it seeks to draw a contrast with the 2024 Republican front-runner.

“We will make sure that the American people know that Donald Trump is to blame,” Biden campaign spokesman Michael Tyler told CNN. “If Trump is reelected, we will face the reality of a nightmare scenario – and that’s a national abortion ban.”

Kentucky Gov. Andy Beshear provided a template for his fellow Democrats with his reelection win in a deep-red state last month. His campaign aired an ad featuring a young woman who discussed the trauma of being raped and impregnated by her stepfather at age 12.

“I’m speaking out because women and girls need to have options. Daniel Cameron would give us none,” 21-year-old Hadley Duvall said in the direct-to-camera ad, referring to Beshear’s Republican opponent.

Meanwhile, the US Supreme Court’s decision this past week to take up another abortion-related case could also have political consequences next year. The justices will consider whether to restrict access to a widely used abortion drug – even in states where the procedure is still allowed. The case concerns the drug mifepristone, which – when coupled with another drug – is one of the most common abortion methods in the United States.

That move sparked more concern from some Republicans, vulnerable New York Rep. Mike Lawler, who said the Supreme Court “needs to stand down.”

On the 2024 presidential campaign trail, Republicans vying to become the main GOP alternative to Trump have attempted to carefully navigate a middle ground between the party base and general election voters.

Asked about the Texas case at a CNN town hall Tuesday night, Florida Gov. Ron DeSantis, who signed a six-week state abortion ban in April, said Republicans must “approach these issues with compassion, because these are very difficult issues.”

Former South Carolina Gov. Nikki Haley has sought to sidestep questions about whether she would sign a federal abortion ban into law by pointing out the unlikelihood that such a prohibition could win passage in the Senate. She said Texas needs to revisit its approach to circumstances like what Cox faced.

“This is exactly why I said you have to show compassion and humanize the situation. We don’t want any women to sit there and deal with a rare situation and have to deliver a baby in that sort of circumstance, any more than we want women getting an abortion at 37, 38, 39 weeks,” Haley said Tuesday while campaigning in Manchester, New Hampshire.

Former New Jersey Gov. Chris Christie on Thursday in Bedford, New Hampshire, mocked the language Haley has used to answer such difficult questions.

“She wouldn’t have answered your question. But she would give me the feeling that she cares. She really cares,” he said at a town hall.

New Hampshire Gov. Chris Sununu, whose recent endorsement of Haley was a major boon for the former South Carolina governor’s campaign, said Friday that the Texas case was “terrible.”

“Lawmakers are going to have to go back in Texas and say we have to tweak this law because this is a problem, and I think we all agree that that shouldn’t happen,” Sununu told CNN

The New Hampshire governor dismissed the possibility of an abortion ban at the federal level, defending Haley’s position.

“Republicans might have 45 pro-life senators today. They will never have 60 pro-life senators ever,” he said, alluding to the votes needed to break a Senate filibuster. “It hasn’t happened in 100 years. So that’s beyond a hypothetical. So that’s not going to happen.”

Christie, meanwhile, sharply criticized Texas Attorney General Ken Paxton, a Trump-alilgned conservative who asked the state Supreme Court to reject Cox’s bid for an emergency abortion.

The former New Jersey governor told the Associated Press that the Texas case demonstrates “why so many people don’t trust certain members of my party with this issue, because either they are completely unmovable on it, no matter what the facts are, or they say nice words but are unwilling to take a position.”

Trump – whose appointment of three Supreme Court justices paved the way for Roe v. Wade’s repeal – has skipped the kind of engagement with voters and rivals that debates and town halls typically trigger. He has nonetheless in recent weeks portrayed many in the GOP as going too far on abortion.

Meanwhile, abortion rights advocates will seek to replicate in 2024 the success of recent ballot measures. In November, Ohio voters approved a constitutional amendment guaranteeing abortion rights. A year earlier, in the aftermath of Roe’s fall, the abortion rights side prevailed on ballot measures in states ranging from deep-blue California and Vermont to the swing state of Michigan to ruby-red Kansas, Kentucky and Montana.

People react after Issue 1 passes, which establishes a constitutional right to abortion in Ohio, during an election night watch party at Ohioans United for Reproductive Rights headquarters in Columbus, Ohio on Tuesday, Nov. 7, 2023. (Maddie McGarvey/The New York Times)

Now, abortion rights groups are pursuing similar efforts in a similar cross-section of states, including Arizona, Florida, Nevada, Colorado, Maryland, Missouri, South Dakota and Nebraska.

Those referenda could shape the 2024 electoral outcomes in those states after a series of elections – including the previous ballot measures, a state Supreme Court election in Wisconsin earlier this year, Beshear’s reelection in Kentucky and state legislative races in Virginia this fall – demonstrated that moderate voters are broadly supportive of abortion rights.

A coalition of Florida abortion rights supporters said Friday it is on track to gather enough signatures to place a constitutional amendment on next year’s ballot.

The Florida Division of Elections reports that the group, Floridians Protecting Freedom, has gathered 753,305 of the 891,523 signatures it needs to qualify for the ballot ahead of a February 1 deadline.

“We don’t want to be overconfident, but we’re feeling as positive as we can feel at this point in the campaign,” said Lauren Brenzel, the group’s campaign director. “We want to make sure that we get as many signatures in as we can.”

The ballot summary of the proposed amendment, which would require 60% of the vote to be approved, says: “No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider.”

However, Florida Attorney General Ashley Moody, a Republican, has asked the state Supreme Court – where five of the seven members were appointed by DeSantis – to kill the amendment. Moody argued that proponents did not define the word “viability” and are attempting to “hoodwink” voters.

In Florida, the state Supreme Court is separately set to rule on a 15-week abortion ban. If that law is upheld, then a six-week ban – which DeSantis signed into law in April to replace the previous 15-week prohibition – would take effect.

It’s the law DeSantis defended at his CNN town hall, noting the limited exceptions it allows for in cases of rape, incest, pregnancies that jeopardize the life of the mother and fatal fetal defects.

“I have signed legislation that included that. And I understand they’re very difficult. And these things get a lot of press attention, I understand,” he said. “But that’s a very small percentage that those exceptions cover. There’s a lot of other situations where we have an opportunity to realize really good human potential. And we’ve worked to protect as many lives as we could in Florida.”

Florida Gov. Ron DeSantis participates in a CNN town hall in Des Moines, Iowa, on December 12, 2023.

Brenzel argued that exceptions for situations such as cases of sexual assault and pregnancies that jeopardize the life of the mother “aren’t sensible. They aren’t based on any kind of best-care guidelines.”

Brenzel pointed to the Texas case in an interview, saying it “continues to highlight what a dangerous situation is being created.”

Florida, she said, has already seen similarly horrifying cases. She pointed to Deborah Dorbert, whose son Milo, who was born with no kidneys, died in her arms after she was unable to get an abortion.

She also pointed to Anya Cook, a Florida woman who was sent home from a hospital with a rare and potentially life-threatening complication. She then delivered her nearly 16-week fetus and, over the course of a day, lost nearly half the blood in her body, The Washington Post reported, citing medical records.

“When you let politicians intervene in private medical decisions,” Brenzel said, “this is what happens.”

CNN’s Arit John, Manu Raju, Alison Main and David Wright contributed to this report.

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