US Supreme Court dismisses appeal over Idaho’s abortion ban, allowing emergency care

Key takeaways:

• SCOTUS dismissed an appeal over Idaho’s strict abortion ban, allowing abortions to be performed in emergency situations.
• The ruling enforces the Emergency Medical Treatment and Labor Act.

On Thursday, June 27, the U.S. Supreme Court formally dismissed an appeal over Idaho’s current strict abortion ban, allowing for abortions to be performed in the state in emergency situations.

The ruling allows a lower court decision to stand. That decision permits abortion in emergency situations under the federal Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, which requires Medicare-participating hospitals that offer emergency services to provide treatment for an emergency medical condition, regardless of a patient’s ability to pay.

In the case, Idaho and Moyle, et al. v. United States, Mike Moyle, Idaho’s House Speaker, argued that EMTALA cannot override Idaho state law that prohibits abortion under most circumstances and allows prosecution of physicians for providing abortion.

Currently, Idaho’s Defense of Life act prohibits abortions in almost all cases except for saving the life of the women or when the pregnancy is a result of rape or incest. The Biden administration sued Idaho to block enforcement of the state’s abortion ban in situations where emergency abortion care would be required under EMTALA.

“Today we breathe a collective sigh of relief, as the Supreme Court’s actions will allow patients to continue to receive the emergency care they need,” Cynthia Gyamfi-Bannerman, president of the Society for Maternal-Fetal Medicine, said in a related press release. “This order enables Idaho physicians to continue to administer lifesaving care using the highest standards of medical practice, regardless of individual state laws. No physician should ever be forced to choose between treating a patient and committing a crime.”

This 6-3 opinion has been returned to the lower courts for further litigation.

Joanne Rosen, JD, MA

At the heart of the EMTALA case is a critical legal and constitutional question: When a conflict exists between a state abortion ban and the federal obligation under EMTALA to provide an abortion where it is necessary to stabilize a grave emergency medical condition, how should this conflict be resolved? Specifically, under the Constitution’s supremacy clause, does the federal EMTALA obligation prevail over a state abortion ban where a conflict exists between the two?

Two lower courts in Idaho considered this question and issued preliminary injunctions blocking the enforcement of Idaho’s abortion ban in circumstances where it conflicted with EMTALA. Consequently, in those rare and tragic situations in which continuation of a pregnancy seriously jeopardized the pregnant person’s health or life, physicians could provide abortions to stabilize patients’ medical conditions notwithstanding Idaho’s ban on abortions in these circumstances.

In January, when the Supreme Court agreed to hear Idaho’s appeal in this case, the Court stayed the lower courts’ preliminary injunction. In the intervening months, six gravely ill pregnant women could not obtain the treatment they required in Idaho and had to be airlifted to other states to obtain medically required abortions.

[On June 27], in an unusual decision, the Supreme Court reversed its decision to hear Idaho’s appeal and vacated its earlier stay of the preliminary injunction. For the time being, abortions that are necessary to stabilize emergency medical conditions will again be permitted in Idaho. But crucially, the Court dismissed this appeal without addressing the central preemption question and instead returned the case to the lower courts for determination. In effect, the Court kicked this case down the road for consideration at some later time.

As Justice [Ketanji Brown] Jackson wrote in her dissenting opinion, “Today’s decision is not a victory for pregnant patients in Idaho. It is a delay ... pregnant people experiencing emergency medical conditions remain in a precarious position.”

Rosen is a professor in the departments of Health Policy and Management and Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and co-director of the Johns Hopkins Center for Law and the Public’s Health.

Kristyn M. Brandi, MD, MPH, FACOG

It is exhausting to have to plan my clinical care around the Supreme Court. As an abortion provider, I knew my work would always be inherently political and that non-clinical interruptions in care happen, such as the anesthesiologist that doesn't want to care for my patient or the hospital administrator that says, "we don't do that care here.” But since the Dobbs decision, the barriers to providing care have gotten worse — even in states like New Jersey, where I practice, that have laws protecting abortion care. While we are lucky that SCOTUS did not turn back the clock on the use of mifepristone, the first pill in a two-drug abortion pill regimen, there was a lot of chaos and confusion leading up to this time. We had to make plans for the minute the ruling was out on how we would proceed with care. Things like having to change our counseling, change our consent forms, making sure patients were aware of what we were offering or not offering, depended on the whim of nine judges.

And I worry about the EMTALA ruling, which not only impacts people needing abortion care in emergency settings but sets a dangerous precedent. EMTALA helps patients access life-saving care without having to worry about insurance coverage or being shipped off to another hospital mid-emergency. Sometimes that emergency care includes ending a pregnancy, desired or not, when continuing the pregnancy could cause serious harm or death. Outside of abortion, if a state government can decide what is or is not an emergency, it can create dangerous precedent that could impact other types of necessary emergency care that are socially stigmatized. As a doctor, I want patients to get the best care possible. Unfortunately, these court decisions are making things more confusing for patients needing care and the health care providers just trying to do our jobs.

Brandi was the Darney-Landy Fellow at ACOG for 2022-2023 and is an OB/GYN physician and complex family planning subspecialist.

Stella M. Dantas, MD, FACOG

We are relieved that the US Supreme Court has reached a decision that will temporarily allow for stabilizing emergency abortion care to continue in the state of Idaho. However, we are truly disappointed that this decision affords no long-term clarity of the law for doctors, no comfort or peace of mind for pregnant people living under abortion bans across the country, and no real protection for the provision of evidence-based essential health care or for those who provide that care. Unfortunately, litigation in this case will continue — and with it will come serious concern for the future of abortion access and for the health and safety of the patients we treat.

Over the past 2 years, we’ve seen the harm caused to patients when abortion bans make essential health care unavailable. We’ve seen physicians forced out of Idaho and other restrictive states. We’ve seen disparities in access to reproductive health care widen. And, as obstetrician gynecologists, we know that should the right to stabilizing emergency abortion care ultimately be stripped away due to abortion bans, the situations that patients and clinicians find themselves in will only become more dire.

Patients should not have to worry about whether they will be able to receive care consistent with their own needs, values and priorities, or whether the doctor treating them in an emergency department may be prevented from providing evidence-based care consistent with their clinical expertise.

Physicians should not have to provide evidence-based care under threat of losing their medical license or imprisonment. Proper medical care must be determined by the science, expertise and experience of trained medical professionals, not by state laws passed through the political process. We need real protections for evidence-based, essential reproductive health care.

Litigation on this topic will undoubtedly continue. The fact that this case made it to the Supreme Court is startling, and knowing that attempts to chip away at emergency care will continue is frustrating. Doctors have a duty to treat the patients in front of them, especially in emergency situations. That duty should never be impeded by unscientific restrictions or bans — especially not those made on the grounds of ideology and at the behest of legislators and politicians.

The arguments before the Supreme Court in this case were a chilling example of what’s at stake when it comes to reproductive health care. While the decision today was a momentary victory for immediate access, we must continue to combat legislative and political interference in the practice of medicine and work to restore the sanctity of the patient–clinician relationship. We urge the courts to affirm the availability of stabilizing emergency abortion care in every single state.

Dantas is president of the American College of Obstetrics and Gynecologists.The statement from Dantas was issued in an ACOG news release.

Rosemary Morgan, PhD

Abortion is an essential component of women’s health care. When Roe v. Wade was overturned 2 years ago, it put women’s health and reproductive freedom under attack.

The recent SCOTUS decision protecting EMTALA in Idaho is a short-term win for women’s health and the Biden administration, which argues that under federal law, women are entitled to receive an abortion in emergency situations when their health, not just their life, is at risk. In Idaho, women are now able to receive an abortion in these circumstances as a result of this decision.

It is a short-term win, as SCOTUS did not issue a full ruling — this means there is still a lack of clarity on whether federal law supersedes state law — something which the constitution says it does. This has opened the door for inconsistencies between states and continued ongoing litigation.

Protecting women’s health should be nonnegotiable. It shouldn’t be left up to those with political and religious beliefs that do not align with what the science says. Protecting women’s reproductive health, including access to diverse forms of contraception and safe abortion, reduces maternal mortality and protects women’s lives, particularly women of color who suffer from increased rates of maternal mortality.

The diversity in access to abortion within the US puts women’s health within a game of roulette governed by postcodes and income. Women’s health needs to be protected federally. Without this protection, we will continue to see inequities in women’s health outcomes — including maternal mortality — across the country.”

Morgan is an associate research professor at Johns Hopkins Bloomberg School of Medicine.

Sarah Horvath, MD, MSHP, FACOG

I went to medical school to care for people. I spent a decade studying general medicine, then specializing in obstetrics and gynecology and then further subspecializing in complex contraception and abortion care. I care for patients by listening to them and centering their needs through a conversation rooted in evidence that was generated by robust research.

I did not go to law school.

But the care I am allowed to provide my patients is being dictated more and more often by lawyers, politicians, pundits and judges. Not by doctors. The rules that are being made assume a level of clarity rare in medicine — we deal in percentages of chances of outcomes, in probabilities, in shades of gray. These laws assume a certainty that does not exist in reproductive medicine. The recent Supreme Court cases on EMTALA and mifepristone were both decided on technicalities. SCOTUS declined to give clarity on the merits of either case, and so did not provide any long-term understanding of the care that is permitted in Idaho, via telehealth or in life-threatening emergencies. This leaves all of us doctors wondering when we can appropriately care for our patients without fear of going to jail.  We wonder when the rules will change again.

Similarly, state laws regarding access to abortion care are constantly shifting. Just this week, the Iowa Supreme Court allowed a 6-week ban to go into effect. Ohio had whiplash in the summer of 2022, when it’s trigger ban went into effect, only to be enjoined and then finally removed after a contentious and long process put a ballot measure before voters.  The voters in Ohio overwhelmingly approved enshrining the right to abortion care into their state constitution, as have all other states that have put the question directly to the people.  

These cases have real repercussions for real people. Patients with the resources to travel for care often come to see me from out of state. They may have delays in care, or fear of reprisal from their local governments for doing so. But they come anyway because abortion care is the safest medical care for them and the most loving decision they can make for their families. The recent SCOTUS cases have given only temporary answers to longstanding questions, obfuscating the practice of medicine and leaving me to wonder what care I can legally provide tomorrow.

Horvath provides complex family planning and is an assistant professor of obstetrics and gynecology at Penn State University College of Medicine.

References:

• ACOG Urges Protections for Emergency Abortion Care. www.acog.org/news/news-releases/2024/06/acog-urges-protections-for-emergency-abortion-care. Published June 27, 2024. Accessed June 27, 2024.
• SMFM Statement on Supreme Court Ruling on Emergency Abortion Care. www.smfm.org/news/smfm-statement-on-supreme-court-ruling-on-emergency-abortion-care. Published June 27, 2024. Accessed June 27, 2024.