Emergency abortions?

Today, the United States Supreme Court will hear oral argument in State of Idaho v. United States, a case challenging the Biden administration’s novel interpretation of the Emergency Medical Treatment and Active Labor Act (EMTALA) to require emergency room doctors to perform abortions. The Biden administration claims that the law—which forbids hospitals that receive Medicare funding from denying crucial care to patients who cannot afford care—preempts Idaho’s pro-life laws. That is nonsense.

In 2020, Idaho passed the Defense of Life Act to protect the lives of women and their unborn children. The law prevents doctors from performing abortions unless necessary to save the life of the mother. It does not apply to ectopic pregnancies and has an exception for rape and incest. Idaho’s law would have gone into effect shortly after the United States Supreme Court reversed Roe v. Wade and restored the rights of state to protect life in Dobbs v. Jackson Women’s Health Organization. But the Biden administration filed suit first.

The Biden administration claims that the Emergency Medical Treatment and Active Labor Act overrides Idaho’s pro-life law and forces emergency room doctors in Idaho (and elsewhere) to perform abortions that are unlawful under state law. But EMTALA has never been interpreted to require particular treatments that aren’t otherwise offered by a hospital—much less treatments that violate state law.

EMTALA is what’s known as an anti-dumping statute. It was enacted by a bipartisan Congress and signed by President Reagan nearly 40 years ago. It addressed a specific concern: “that hospitals were dumping patients who were unable to pay for care, either by refusing to provide emergency treatment to these patients, or by transferring the patients to other hospitals before the patients’ conditions stabilized.” The statute thus requires hospitals that accept Medicare to provide patients with a medical screening to determine whether an emergency condition exists. If one does, the hospital must provide stabilizing care “within the staff and facilities available at the hospital.” In short, EMTALA requires Medicare-receiving hospitals to provide stabilizing care to indigent patients. The law was passed to ensure that emergency rooms serve everyone, regardless of their ability to pay.

Nothing in the text of EMTALA requires abortions. Much the opposite. First, treatments that violate state law (like abortions) are not required by EMTALA because they are not “available at the hospital.” Second, EMTALA requires emergency rooms to care for both a pregnant woman and her “unborn child.” A statute that expressly mentions unborn life four times cannot possibly be interpreted to require an abortion when a mother’s life is not in danger.

There is no conflict between EMTALA and Idaho law, no matter what the Biden administration says. Both seek to protect the lives of women and their unborn children. In fact, 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. But the Biden administration is trying to hijack a law designed to ensure that the poor receive crucial medical care to prevent the people of Idaho from protecting life.

The Supreme Court has expressed skepticism about that interpretation. It stepped in when a lower federal court agreed with the administration and enjoined Idaho’s Defense of Life Act. The Supreme Court granted review and said that Idaho could enforce its law and protect the lives of unborn children as the litigation continues. While Supreme Court tea leaves are always difficult to read, this signals that the court is going to be very skeptical of the Biden administration’s argument. And that’s a good thing. Emergency room doctors should be free to save people's lives, not end them.

Editor’s note: The author and her ADF colleagues, along with attorneys from Cooper and Kirk, are assisting the Idaho Attorney General’s Office in defending Idaho’s pro-life law.