Idaho hospitals that receive federal funds must allow emergency abortion care to stabilize patients even though the state strictly bans the procedure, the Supreme Court ruled on a day Thursday after the advice was prematurely placed on the website.
The court’s unsigned 6-3 decision does not address the merits of the case. Instead, while litigation in the case continues, the justices temporarily reinstated a lower court ruling that had allowed hospitals to perform emergency abortions without being subject to prosecution under Idaho’s abortion ban.
Three conservatives — Justices Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch — dissented.
Please note: The majority opinion was unsigned. Jackson
agreed with the majority and also submitted a partial dissenting opinion.
Note: the majority opinion was not signed. Jackson agreed with the
majority and also filed a partial dissent.
Note: The majority opinion was unsigned. Jackson concurred with the majority and also filed a
partial dissent.
Note: The majority opinion was unsigned. Jackson agreed with the majority and also filed a partial dissent.
At issue is the nearly 40-year-old Emergency Medical Treatment and Labor Act, known as EMTALA, which requires certain hospitals to stabilize or transfer patients in need of emergency care.
The Biden administration sued Idaho in 2022, saying the state’s strict abortion ban violates federal law, which the Justice Department says has mandates emergency abortions when necessary to address threatening health problems that do not result in death, such as organ failure or loss of fertility.
Abortion rights groups and medical experts cast the ruling as a temporary victory that guarantees emergency aid in Idaho for now but does not resolve the question of whether federal law overrides strict state bans, including in other states. The Biden administration has separately asked the Supreme Court to address the same issue in a case from Texas, where another lower court said doctors must comply with state restrictions — and are not required to perform emergency abortions.
“We don’t have time to wait for this to go through the legal process,” Idaho Medical Association CEO Susie Keller said in an interview Thursday. Keller said gynecologists/obstetricians are “fleeing” Idaho after the abortion ban. Citing data that shows about one in five obstetricians/gynecologists has left the state, She called on the Idaho Legislature to change the law to explicitly allow abortions when a pregnant woman’s health is at risk, even if her life is not in danger.
The June 27 ruling allows emergency abortions in Idaho to stabilize patients while lawsuits continue. Health reporter Dan Diamond explains. (Video: Drea Cornejo/The Washington Post)
Idaho Attorney General Raúl R. Labrador (R) also claimed a partial victory, noting that some conservative justices embraced his state’s arguments that EMTALA did not trump the state ban in these circumstances. He also pointed out that Justice Amy Coney Barrett, who joined the majority, wrote in a dissenting opinion that the Biden administration had made concessions that limited the potential reach of the federal law.
“We feel very strongly that we are ultimately going to win this case,” Labrador said in a call with reporters. “My office has obtained significant concessions from the United States that Judge Barrett described as ‘significant’ and ‘critical.’”
The Idaho case was one of two cases before the Supreme Court this term addressing abortion access nationwide, two years after the justices overturned the high court’s decision. Roe v. Wadethat guaranteed a constitutional right to abortion. The justices unanimously rejected a challenge to the widely used abortion drug mifepristone in early June, saying the anti-abortion doctors who brought the lawsuit lacked the authority to do so.
The Supreme Court agreed in January to intervene in the Idaho case. in response to the state’s emergency request, but allowed the abortion ban to remain in effect while the arguments in the case were heard and deliberated.
The Biden administration first turned to EMTALA in late 2021 to try to ensure abortion access in limited situations. That effort was ramped up after the Supreme Court Roe the following summer.
In July 2022, the government told hospitals receiving Medicare funds that emergency physicians must terminate pregnancies in certain circumstances, even if a state’s law prohibits the procedure. Hospitals that fail to comply face fines of up to $120,000 per violation.
The White House and abortion rights advocates say the administration is implementing the emergency room law as originally intended, pointing to cases that date back years and show a consistent pattern of enforcement, they say.
Idaho bans all abortions except those necessary “to prevent death of the pregnant woman” and imposes penalties of up to five years in prison for doctors who perform the procedure. There have been chilling reports of hospitals turning away women with high-risk pregnancy complications. Health care providers have reported uncertainty and confusion about when state bans on abortions apply, leading to delays in some procedures.
Conservatives and abortion opponents say the administration is distorting EMTALA’s intent to ensure access to abortion.Roe.
The text of the federal law requires hospitals to provide “to any individual” with a medical emergency “the treatment necessary to stabilize the medical condition.” The law does not refer to abortion or any other type of care, and GOP officials say the Biden administration cannot use EMTALA to force hospitals that receive federal funds to violate a state law.
Lower courts have issued conflicting decisions on the application of the federal law. A district judge sided with the Biden administration in August 2022 and temporarily blocked the challenged provision of Idaho’s law. The judge left in place the state’s ban on most abortions but said that because hospitals have a duty under conflicting federal law, a doctor cannot be punished for performing an abortion to protect a patient’s health.
Then a three-judge panel of the U.S. Court of Appeals for the 9th Circuit allowed the state to enforce the law, after which a full panel of judges from the same appeals court again blocked Idaho’s ability to allow emergency room doctors punishments while the appeals were still pending.
In Thursday’s ruling, three justices who often serve as the court’s focal points said it was too early for the high court to weigh in on the merits of the Idaho case, describing the positions of both the state and the Biden administration as “still evolving.”
Barrett, joined by Chief Justice John G. Roberts Jr. and Justice Brett M. Kavanaugh, said the gap between what the government says EMTALA requires in emergency abortion care and what Idaho says the law allows has narrowed since the justices agreed to hear the case on an emergency basis.
“Idaho’s ability to enforce the law remains virtually intact,” Barrett wrote.
Liberal Justice Ketanji Brown Jackson wrote separately that the court should have resolved the issue permanently after its initial involvement in January temporarily put Idaho’s ban in full effect.
“It is too little too late for the Court to take a Mulligan and simply tell the lower courts to carry on as if none of this happened,” she wrote.
Jackson warned that “dark clouds are looming” and asked rhetorically whether the court would “continue to delay this issue altogether, creating chaos where lower courts allow states to flagrantly undermine federal law, thereby facilitating the suffering of people in desperate need of medical treatment.”
The ruling — coming just hours before President Biden and presumptive Republican challenger Donald Trump meet in a prime-time presidential debate — underlines the stakes of the November election, advocates said. While Biden has worked to protect access to abortion, Trump has imposed new restrictions on abortion funding during his four years in office and promised to nominate judges who Roe v. Wade. Trump chose three of the five justices who voted to end the nation’s right to abortion.
In a statement after the ruling, Biden said: “No woman should be denied care, allowed to wait until she is near death, or forced to flee her home state just to get the health care she needs. This should never happen in America. Yet this is exactly what has been happening in states across the country since the Supreme Court ruling Deer.“
Democrats also suggested Thursday that the Supreme Court was trying to sidestep political pressure over abortion this year.
“The Supreme Court decided to wait until after the election to tell Americans whether women in crisis can get the emergency medical care they need,” Sen. Elizabeth Warren (D-Mass.) said in a statement. “The Supreme Court does not have the final say on abortion — the American people do.”
