They don't have the votes to break a filibuster in the Senate (on nearly anything; Republican party discipline is really strong) or to break the filibuster itself (a handful of Democrats refuse). So almost all votes are just messaging at this point.

I also wouldn't assume a federal Act guaranteeing abortion access would survive the supreme court. There's a colourable claim that both healthcare and homicide regulation are the purview of the states, and I'd expect five votes for that with the current Court on this issue regardless of its legal merits.

Of course in order to reject that healthcare qualifies under interstate commerce, they would need to either reject Wickard v. Filburn and Gonzalez v. Raich, or jump through some crazy hoops to justify upholding those, while stricking this law down. (Although I'd not be shocked if this court tried).

Actions regulating healthcare within one state have at least as much impact on interstate commerce as growing pot or wheat for personal use. Healthcare is not strictly limited to state lines. My insurance does cover visiting doctors in a neighboring state for example.

Reopening Filburn would raise a crazy amount of questions. USDOT regulation of commercial trucking could falter if Filburn was struck down. Until some new clear line on what the limit was, there would be widespread uncertainly about the federal government's ability to regulate things like commercial trucking, flights, drugs, etc, at least for transactions that don't cross state lines.

I doubt they would actually go that far, as the republican party are not actually anti-federalists, despite often pretending to be that way.

My perspective is perhaps coloured by being a political scientist: we have always (unlike the law professors) seen the supreme court in particular as a deeply political institution.

The present incumbents have made clear that they're open to reopening settled questions, and to a results-focused jurisprudence. Given that New York State Rifle and Pistol Association has just undercut state power in favour of constitutional interpretation while Dobbs goes entirely the other way, my presumption is that there are no major strictly federalist principles at play and results will be case-by-case. And, as with Bush v. Gore, they can always publish an opinion saying "this decision is confined to its own facts" if they want to signal that they're not intending to displace post-Lochner understandings of the commerce clause.