Did the Supreme Court rule on “emergency abortions”?

In one of the biggest surprises of the Supreme Court term, the court put off deciding whether the Biden administration had properly interpreted the Emergency Medical Treatment and Active Labor Act to require emergency room doctors to perform abortions contrary to state law. Instead, in Idaho v. United States, the court dismissed the case. In Supreme Court parlance, the court dismissed it as improvidently granted, or “DIGged,” sending the case back to the lower courts without a decision on the merits. In an even more unusual twist, while a DIG is usually a single-line order, this DIG was accompanied by several separate opinions. These opinions clarify that Idaho may continue to protect unborn life and that its ability to enforce its pro-life law “remains almost entirely intact.”

In 2022, shortly after the Supreme Court reversed Roe v. Wade and restored the right of states to protect life, Idaho enacted the Defense of Life Act. This law prohibits abortion unless it is necessary to save the life of the mother. The act does not apply to ectopic pregnancies or miscarriage management and has an exception for rape and incest. But before the law could go into effect, the Biden administration sued the state.

The Biden administration claimed that EMTALA preempts the Defense of Life Act and forces emergency room doctors to permit abortions in circumstances other than those allowed by Idaho law. But that statute was enacted with a much different purpose in mind. Passed by a bipartisan Congress and signed by President Ronald Reagan, EMTALA is what is known as a patient dumping statute. It was enacted to prohibit hospitals that receive Medicare funding from denying emergency care to individuals who could not afford to pay. Instead, the hospitals are required to provide stabilizing treatment. Now, the Biden administration says that stabilizing care includes abortions—even where those abortions would not be necessary to save a woman’s life and even when they violate state law.

Justice Amy Coney Barrett, in an opinion joined by Chief Justice John Roberts and Justice Brett Kavanaugh, explained that the court’s dismissal was occasioned by two events that post-dated the U.S. District Court decision in that case. First, the Idaho Legislature and Idaho Supreme Court clarified that the state law did not apply to treatment for ectopic pregnancies and would allow doctors to perform procedures the federal government said EMTALA required to save a woman’s life.

Second, once the Supreme Court had granted review, the United States had made a series of concessions that “clarified that EMTALA’s reach is far more modest” than the one first propounded by the Biden administration. For one, the United States “emphatically disavowed the notion that an abortion is ever required as stabilizing treatment for mental health conditions.” “That is an important concession,” Justice Barrett wrote. Plus, Barrett also found it “critical” that “the United States clarified that federal conscience protections, for both hospitals and individual physicians, apply in the EMTALA context.”

The Biden administration’s narrowing of its interpretation of EMTALA illustrates what has been true all along. EMTALA (properly interpreted) and the Idaho law both seek to protect the lives of women and their unborn children. All 50 states allow doctors to save the life of a mother if her life is in danger. Emergency room doctors in every state can always treat women who have ectopic pregnancies, miscarriages, and life-threatening conditions. Yet, these facts didn’t stop the Biden administration from trying to hijack a law designed to ensure that the poor receive crucial medical care to prevent the people of Idaho from protecting life.

Justice Samuel Alito’s separate opinion, joined by Justices Clarence Thomas and Neil Gorsuch, explains the errors in the Biden administration’s novel interpretation of EMTALA and why the lower courts should rule in favor of Idaho as the case continues. As Justice Alito explained, far from requiring doctors to perform abortions contrary to state law, its text demands that Medicare-funded hospitals “protect the health of both a pregnant woman and her unborn child.” EMTALA expressly mentions protecting unborn life four times. It would be passing strange for the statute to be interpreted to require an abortion when a mother’s life is not in danger.

Ultimately, the Supreme Court’s ruling delays a final decision on the merits of the Biden administration’s aggressive reinterpretation of a federal law. That is lamentable. Nevertheless, the various opinions in the case clarify that Idaho can enforce its law protecting unborn life in the vast majority of circumstances. And that is a win for life.

Editor’s note: Erin Hawley and her Alliance Defending Freedom colleagues, along with attorneys from Cooper and Kirk, are assisting the Idaho Attorney General’s Office in defending the state’s pro-life law.