The Supreme Court decided Thursday to allow emergency rooms in Idaho to carry out abortion procedures despite the state’s ban.
The decision in Moyle v. United States comes just one day after the opinion in the case was inadvertently posted and marks a blow to the six states that have enacted near-total abortion bans with narrow exceptions for life-threatening circumstances for the mother.
In a 6-3 decision, the justices decided to stay the lower court’s order striking down the Idaho statute, dismissing the state’s petition for redress.
“Federal law and Idaho law are in conflict about the treatment of pregnant women facing health emergencies,” Justice Elena Kagan wrote in her concurrence with the dismissal of the case.
While the justices did not reach the merits of the case, their decision marks a temporary victory for the Biden administration, which has championed access to abortion since the high court overturned Roe v. Wade two years ago. It also comes on the heels of the Supreme Court providing abortion access advocates an effective win by rejecting a separate challenge to federal rules that allow patients to obtain the abortion pill by mail.
“The Court’s order today means women in Idaho should once again have access to the emergency care that they need while the case proceeds in the lower courts,” Secretary of Health and Human Services Xavier Becerra said in a press statement. “However, it does not change the fact that reproductive freedom is under attack.”
Becerra also said HHS will be simplifying the process of filing civil rights complaints for patients denied procedures under the Emergency Medical Treatment and Active Labor Act.
The Biden administration sued Idaho shortly after the Supreme Court overturned federal protections for abortion in June 2022 in the Dobbs v. Jackson Women’s Health Organization case.
The Biden Department of Health and Human Services officials have argued that abortion procedures in certain extreme circumstances constitute medically stabilizing treatment under EMTALA. The agency has argued that Idaho law prevents doctors from providing such necessary care.
EMTALA was enacted in 1986 following several prominent cases of pregnant women being denied emergency care and delivery due to lack of health insurance. The law requires healthcare providers to facilitate necessary emergency care to a woman and her child in utero.
The administration contended during oral arguments in April that Idaho’s abortion restrictions violated EMTALA because it only permits an abortion in a medical emergency if it poses a threat to the mother’s life.
Solicitor General Elizabeth Prelogar, on behalf of HHS, argued that certain medical emergencies may develop into life-threatening conditions if left untreated, but the law is unclear as to when the physician is legally allowed to induce an abortion in that case.
One condition discussed extensively during oral arguments was premature rupture of membranes, which occurs when the amniotic sac ruptures before labor begins. If left untreated, PROM can cause significant damage to a woman’s reproductive system and may develop into sepsis, a critical emergency.
“EMTALA unambiguously requires that a Medicare-funded hospital provide whatever medical treatment is necessary to stabilize a health emergency–and an abortion in rare situations is such a treatment,” Kagan wrote, agreeing with the Biden administration’s interpretation of the law.
Josh Turner, Idaho’s chief of constitutional litigation, said during oral arguments that no part of the state’s statute required that the medical condition either immediately or certainly threaten the mother for an abortion to be provided. Rather, according to Turner, the law intended that medical professionals could use their “good faith medical judgment” for when to perform an abortion procedure.
Justice Sonia Sotomayor, along with Kagan, pushed back against Turner’s argument in April, saying the law is too ambiguous in severe cases.
“Idaho law says the doctor has to determine not that there’s really a serious medical condition but that the person will die,” Sotomayor said during arguments in April. “That’s a huge difference.”
Justices Amy Coney Barrett, Brett Kavanaugh, and Chief Justice John Roberts voted in favor of dismissing the case, in large part because both sides narrowed their initial positions during oral arguments.
While Idaho acknowledged that its law allows for abortions during extreme emergencies, even if to preserve the health of the mother rather than solely to prevent her death, the Biden administration also conceded that the mental health of the mother does not constitute a condition that requires an abortion under emergency circumstances.
“The dramatic narrowing of the dispute … has undercut the conclusion that Idaho would suffer irreparable harm under the preliminary injunction,” Barrett wrote. “Even with the preliminary injunction in place, Idaho’s ability to enforce its law remains almost entirely intact.”
Critics of the Biden administration’s argument highlight that EMTALA explicitly references the “unborn child” as a patient worthy of medical care four times, implying that an abortion-rights access piece of legislation would not have acknowledged a fetus with personhood status.
Prelogar argued before the court that Congress used the phrase “unborn child” in the legislation “to expand the protection for pregnant women so that they could get the same duties to screen and stabilize when they have a condition that’s threatening the health and wellbeing of the unborn child,” but that it “did nothing to displace the woman herself as an individual with an emergency medical condition.”
The Alliance Defending Freedom, a group involved in the efforts to overturn Roe v. Wade two years ago, backed Idaho and state Attorney General Raul Labrador’s efforts to fight the Biden administration’s suit.
Kristen Waggoner, ADF’s CEO and general counsel, argued in a statement that the “Biden administration lacks the authority to override Idaho’s law and force emergency room doctors to perform abortions.”
“I remain committed to protect unborn life and ensure women in Idaho receive necessary medical care, and I will continue my outreach to doctors and hospitals across Idaho to ensure that they understand what our law requires,” Labrador said. “We look forward to ending this administration’s relentless overreach into Idahoans’ right to protect and defend life.”
Idaho is not the only state facing friction between the Biden administration and EMTALA guidance.
Texas has a separate but similar legal fight against the Biden administration surrounding EMTALA, which began after the Democratic administration issued guidance to hospitals, reminding them that if a doctor believes an abortion is necessary to save a patient’s life, “the physician must provide the treatment.”
The Idaho abortion ban has remained in effect while the Supreme Court deliberated on its decision, and the Biden administration’s guidance saying EMTALA preempts state abortion bans is suspended.
Kavanaugh, who was part of the majority in Dobbs, stressed in his 2022 concurrence that the high court would no longer meddle in the contentious abortion debate.
“Instead, those difficult moral and policy questions will be decided, as the Constitution dictates, by the people and their elected representatives through the constitutional processes of democratic self-government,” Kavanaugh wrote.
Justices Samuel Alito, Clarence Thomas, and Neil Gorsuch, who dissented from the decision not to rule on the case’s merits, chided their colleagues for dodging the central matter.
“Apparently, the Court has simply lost the will to decide the easy but emotional and highly politicized question that the case presents,” Alito wrote in his dissent. “That is regrettable.”
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Abortion rights advocates also rebuked the court for not taking a firmer stance on the merits of the case.
“It is now clear that the Supreme Court had the opportunity to hold once and for all that every pregnant person in this country is entitled to the emergency care they need to protect their health and lives, and it failed to do so,” said Alexa Kolbi-Molinas, deputy director of the ACLU Reproductive Freedom Project.
