Topline
The Supreme Court will hear oral arguments Wednesday in one of its biggest abortion-related cases since justices overturned Roe v. Wade, as it considers whether hospitals must provide abortions in emergency situations under federal law—even in states where abortion is banned.
Key Facts
The court will hear arguments in Idaho v. United States and Moyle v. United States, two consolidated cases that concern the federal government’s challenge against Idaho’s restrictive abortion ban, which outlaws the procedure and only provides narrow exceptions, such as when it’s necessary to prevent the pregnant person’s death.
The Biden administration argues the state-level ban conflicts with the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires hospitals that participate in Medicare to provide stabilizing emergency care when medically necessary, even in cases when a person might be uninsured or can’t pay.
EMTALA was enacted in 1986 to prevent “patient dumping”—turning patients away at hospitals because they couldn’t pay—and the Biden administration issued guidance in July 2022 saying the federal law requires hospitals to provide abortions when medically necessary, even in states that banned abortion after Roe v. Wade was overturned a month before.
The Biden administration sued Idaho after the state enacted one of the most restrictive abortion bans in the country, only allowing abortion when it’s “necessary to prevent the death of the pregnant woman”—with the federal government arguing that federal law also requires abortions to be provided in emergency situations that aren’t immediately life-threatening.
Idaho has argued there’s nothing in EMTALA that justifies requiring abortions under the law, claiming in a brief to the court the law “merely prohibits emergency rooms from turning away indigent patients with serious medical conditions” and “does not require emergency rooms to become abortion enclaves in violation of state law.”
A ruling in the Idaho case is expected to have impacts in other states with abortion bans: Texas is fighting a similar lawsuit over EMTALA, with a federal appeals court siding with the state in January, and 22 states filed a brief arguing the court should side with Idaho, claiming EMTALA “cannot be read to preempt state laws regulating medicine, including abortion restrictions.”
What To Watch For
The court will issue a ruling in the Idaho case sometime before its term wraps up in late June. Idaho’s abortion ban remains in full effect—without exceptions under EMTALA—while the court deliberates, after the Supreme Court let the law stay in effect while it considers the case.
Big Number
5. That’s the number of other states with abortion bans that don’t have health exceptions that allow abortions in cases when there might be a health risk, but not a life-threatening one: Arkansas, Mississippi, Oklahoma, South Dakota and Wisconsin (though that state’s abortion ban is not being enforced). Arizona may also be added to the list, should its 19th century abortion ban be allowed to take effect in June. It’s likely those states, in addition to Idaho, would be most affected by a ruling on EMTALA requiring abortion care.
Chief Critic
“In its plain inconsistency with federal law, the Idaho Law endangers the lives and well-being of vulnerable Idaho patients, and further limits all Idahoans’ access even to routine OB/GYN care. These devastating effects are directly contrary to the purpose of EMTALA,” medical groups including the American College of Obstetricians and Gynecologists, American College of Emergency Physicians and American Medical Association wrote in an amicus brief to the Supreme Court in favor of the federal government’s position. The physicians argued Idaho’s ban “prevents physicians from heeding the central tenet of the Hippocratic Oath: do no harm.”
What We Don’t Know
What other impacts a ruling in Idaho’s favor could have, as health and legal experts have suggested that a ruling saying abortions aren’t required under EMTALA could lead states to refuse other kinds of controversial care. “If Idaho was allowed to do what it wants to do, then essentially that is green lighting states to go after EMTALA for any disfavored population, or treatment or condition,” Sara Rosenbaum, the founding chair of George Washington University’s Department of Health Policy, told reporters on a press call, as quoted by Politico. “Whether it is barring all but terminal emergency care for people with HIV-AIDS, whether it is barring all but terminal emergency care for people who’ve been in auto accidents on the grounds that somehow having access to an emergency department encourages unsafe driving, the list goes on and on and on.”
Key Background
Idaho is one of more than a dozen states that have banned abortion since the Supreme Court overturned Roe v. Wade in June 2022, abolishing the federal right to an abortion. The abortion bans have led to a slew of reports on pregnant people who have been unable to access care when medically necessary due to state-level bans. Reports have emerged of people traveling to different states or facing medical complications because physicians—who face the threat of prosecution if they violate state bans—have refused to provide abortions even when necessary. Abortion bans with vague exemptions allowing abortions when only necessary to save the mother’s life have also sparked confusion among physicians who are unclear when abortion care is and isn’t allowed. Medical groups noted in their brief to the court, “At what point does the condition of a pregnant woman with a uterine hemorrhage deteriorate from health-threatening to the point that an abortion is ‘necessary’ to prevent death? … How many blood units does she have to lose? One? Two? Five?” The Biden administration has opened several investigations into hospitals that the federal government alleges violated EMTALA, after hospitals in Missouri and Kansas refused to provide an abortion for a woman who went into labor early and was told her fetus would not survive. Idaho’s restrictive law has gone back and forth on being in full effect as the federal government’s lawsuit has moved forward, with a district court first blocking the law and federal appeals judges then reinstating the restrictions—and then blocking them again—before the Supreme Court took up the case and let the law take effect again. Dr. Jim Souza, the chief physician executive of Idaho’s St. Luke’s Provider Health System, told reporters on a call reported by Politico that 20 pregnant patients who have come into their emergency room are expected to be “medically evacuated” to a different state this year as a result—as compared with only one patient who was evacuated last year while the federal government’s EMTALA rules were in effect.