Most Supreme Court justices seemed inclined to accept Idaho’s argument on April 24 that the state’s strict abortion law does not conflict with a federal law that prevents hospitals from refusing to treat indigent emergency room patients.
At the same time, liberal justices vigorously questioned whether the Idaho law is putting women in danger.
The court heard oral arguments in Moyle v. United States, which has been consolidated with Idaho v. United States. Lead applicant-petitioner Mike Moyle is the Republican speaker of Idaho’s House of Representatives. The conservative Alliance Defending Freedom is on Idaho’s legal team.
The case is about whether a state law that restricts abortion conflicts with a federal law that forbids “patient dumping,” the practice of hospitals refusing emergency treatment to people who can’t afford to pay for medical services.
The Biden administration says the state law runs afoul of the federal law, which requires that emergency room patients be provided stabilizing care. The administration also says that state abortion restrictions such as Idaho’s have confused patients and health care professionals and delayed critical care for pregnant women.
At the same time, Idaho argues that federal law and the state law are not in conflict. Idaho says the federal government is trying to stretch the reach of the federal law to override the state’s abortion law, as part of an effort to create a federal right to abortion.
The Idaho case goes back to 2020, when the state enacted the Defense of Life Act with a built-in triggering provision, allowing it to take effect if Roe v. Wade (1973) were ever overturned. The law took effect in 2022 after the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization. That decision, which reversed Roe v. Wade, found the U.S. Constitution does not protect a right to abortion and returned its regulation to the states.
Idaho’s Defense of Life Act forbids abortions except when “necessary to prevent the death of the pregnant woman” or during the first trimester when the pregnancy was a result of rape or incest.
After the state law took effect, the Biden administration committed itself to undermining Dobbs and weakening state laws that restrict abortion, critics say.
The Emergency Medical Treatment and Labor Act (EMTALA) was passed by Congress in 1986 “to ensure public access to emergency services regardless of ability to pay,” according to a Centers for Medicare and Medicaid Services summary.
The Biden administration takes the position that Idaho’s Defense of Life Act is preempted by EMTALA, which requires hospitals that receive Medicare funding to provide stabilizing treatment for emergency patients, and that such treatment includes abortions. Federal preemption means that a state law that conflicts with federal law is invalid.
In September 2023, a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit reversed the Idaho District Court’s decision, finding that EMTALA and the state statute did not conflict, but two months later, the court reinstated the District Court’s injunction.
The full circuit was preparing to hear the case, but on Jan. 5, the Supreme Court granted Idaho’s request to lift the injunction, pending the outcome of the case at the high court.
During oral arguments on April 24, Idaho Deputy Solicitor General Joshua N. Turner said EMTALA and the Idaho statute do not conflict.
“And nothing in EMTALA requires doctors to ignore the scope of their license and offer medical treatments that violate state law,” he said.
The administration’s misreading of EMTALA “lacks any limiting principle,” the attorney said.
“If ER doctors can perform whatever treatment they determine is appropriate, then doctors can ignore not only state abortion laws, but also state regulations on opioid use and informed consent requirements.”
Justice Elena Kagan asked what would happen if a state modified its abortion laws to prevent the treatment of ectopic pregnancies, in which a fetus begins growing outside the uterus.
In such a situation, the federal government should not intervene, Mr. Turner said.
“That understanding is a humble one with respect to the federalism role of the states,” he said.
Justice Kagan replied, “It may be too humble for women’s health.”
Justice Neil Gorsuch asked Mr. Turner to explain how close to death a patient needs to be under the state law for an abortion to be allowed. The justice also cited ectopic pregnancies, which can be life-threatening, but not always immediately.
“It doesn’t matter whether it happens tomorrow or next week or a month from now?” the justice said.
“There is no imminence requirement,” Mr. Turner replied. “This whole notion of delayed care is just not consistent with the Idaho Supreme Court’s reading of the statute and what the statute says.”
Justice Samuel Alito said EMTALA requires that stabilizing care also be provided to the unborn baby.
“The hospital must try to eliminate any immediate threat to the child, but performing an abortion is antithetical to that duty,” he said.
“How can you impose restrictions on what Idaho can criminalize simply because hospitals in Idaho have chosen to participate in Medicare?” he later added.
U.S. Solicitor General Elizabeth Prelogar said the situation “on the ground in Idaho is showing the devastating consequences” of the conflict between the state and federal law.
Doctors and women are “in an impossible situation,” she added.
“If a woman comes to an emergency room facing a grave threat to her health, but she isn’t yet facing death, doctors either have to delay treatment and allow her condition … to materially deteriorate, or they’re airlifting her out of the state so she can get the emergency care that she needs.
“One hospital system in Idaho says that right now it’s having to transfer pregnant women in medical crisis out of the state about once every other week. That’s untenable, and EMTALA does not countenance it.”
Liberal justices seemed concerned that Idaho allows abortions to save a woman’s life but not to safeguard her health.
Sometimes abortions are carried out to head off other medical problems, Justice Kagan said.
“Within these rare cases, there’s a significant number where the woman … her life is not in peril but she’s going to lose her reproductive organs, she’s going to lose the ability to have children in the future, unless an abortion takes place.”
When situations like this arise, EMTALA requires an abortion “to assure that no material deterioration occurs. And yet Idaho says, sorry, no abortion here. And the result is that these patients are now helicoptered out of state.”
Mr. Turner said in those circumstances, Idaho, 22 other states, and EMTALA all recognize “that there are two patients to consider in those circumstances,” he said, referring to a woman and her unborn baby.
“And the two-patient scenario … is tough when you have these competing interests,” he said.
Justice Brett Kavanaugh asked Ms. Prelogar to respond to Idaho’s assertion that EMTALA addresses patient dumping, not “abortion or other specific kinds of care.”
The solicitor general said although lawmakers did not list every possible emergency condition and treatment in EMTALA, “it was very clear that Congress set a baseline national standard of care to ensure that, no matter where you live in this country, you can’t be declined service and the … urgent needs of your medical condition [have to be] addressed.”
“Idaho cannot criminalize the essential care that EMTALA requires,” she said.
After the hearing concluded, Idaho Attorney General Raul Labrador, a Republican, told The Epoch Times that the federal government was “going to all these worst-case scenarios that are not realistic in any way.”
“They’re exaggerating what this decision would do. This decision is a simple preemption decision—whether the federal law preempts the state of Idaho from having life-affirming legislation and it doesn’t and I hope that the Supreme Court agrees with us.”
Kristen Waggoner of the Alliance Defending Freedom said in her view Idaho’s presentation went well.
EMTALA has been in place for 38 years, she said.
“It was passed by a bipartisan Congress. It was signed by Ronald Reagan a pro-life president. The idea that it was ever intended to be a national abortion mandate is absolutely absurd to suggest,” Ms. Waggoner said.
The Idaho case comes as the Supreme Court deliberates another abortion-related appeal, Food and Drug Administration v. Alliance for Hippocratic Medicine, which the court heard on March 26. A doctors’ group sued the Food and Drug Administration for loosening regulations pertaining to the abortion pill mifepristone, claiming the relaxation of the rules violates federal law.
Advocates for mifepristone say the current system for dispensing the drug is safe, while opponents say it puts women at risk by ignoring safety measures that used to be in place.
The Supreme Court is expected to rule on the mifepristone case and the Idaho case by the end of June.
