The Supreme Court on Thursday said it would 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.
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 Biden administration sued the state of 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 has argued that abortion procedures in certain extreme circumstances constitute medically stabilizing treatment under the Emergency Medical Treatment and Labor Act, or EMTALA. The agency has argued that Idaho’s state 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, or PROM, 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.
Josh Turner, chief of constitutional litigation for the state of Idaho, said during oral arguments that no part of the state’s statute required that the medical condition either immediately or certainly threaten the mother in order 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.
Justices Elana Kagan and Sonya Sotomayor pushed back against Turner’s argument in April, saying that the law is too ambiguous in severe cases.
“If objective medical care requires you to treat women who present the potential of serious medical complications, and the abortion is the only thing that can prevent that, you have to do it” under EMTALA, Sotomayor said. “Idaho law says the doctor has to determine not that there’s really a serious medical condition but that the person will die. That’s a huge difference.”
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 a 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 the state of Idaho and its 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.”
Idaho isn’t 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 currently suspended.
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Justice Brett 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.
But unlike the major question on Dobbs that dealt with the extent to which states can impose gestational limits on abortion, the EMTALA dispute seeks to answer whether federal emergency guidance trumps state efforts to protect the life of unborn children.