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Thursday, June 27, 2024 | Back issues
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Idaho must provide emergency abortion access, Supreme Court rules

The justices said states must abide by a federal mandate protecting access to emergency reproductive care.

WASHINGTON (CN) — The Supreme Court on Thursday ruled that Idaho must provide abortion care to women facing serious health emergencies even if they were not at risk of dying. 

In an unsigned opinion, the justices said Idaho should not have been granted emergency relief allowing the state to ignore federal health care protections in favor of its abortion ban. In a set of concurring opinions, six justices indicated their support for the ruling.

Justice Elena Kagan said the ruling “will prevent Idaho from enforcing its abortion ban when the termination of a pregnancy is needed to prevent serious harms to a woman’s health.”

Justices Samuel Alito, Clarence Thomas and Neil Gorsuch dissented from the ruling. Alito said there was no good reason for the court to change course.

“Apparently, the court has simply lost the will to decide the easy but emotional and highly politicized question that this case presents,” Alito wrote in an opinion joined by his two conservative colleagues. “That is regrettable.”

The highly anticipated ruling was inadvertently leaked on Wednesday when a court staffer briefly uploaded the opinion.

The Emergency Medical Treatment and Labor Act guarantees that any patient who walks into the emergency room of a federally funded hospital will be given treatment. The 1986 law was enacted to prevent hospitals from turning away patients with health emergencies because of their health insurance or ability to pay. 

In the months after the U.S. Supreme Court overturned Roe v. Wade, President Joe Biden said the law protected the right to emergency abortion access in states with bans on the procedure. Under that logic, the act would force states to provide abortion care when a patient’s health was at risk, even if the state’s ban only allowed abortions when death was a risk. 

Idaho’s Defense of Life Act is one such ban. The law forced doctors to weigh whether a patient was close enough to death to qualify for an abortion. Hospitals had to either wait until the patient’s condition deteriorated further or send them out of state to receive care. 

The Biden administration sued Idaho, claiming the Emergency Medical Treatment and Labor Act preempted Idaho’s abortion ban. A lower court ordered Idaho to allow emergency abortion care while the litigation proceeded. An en banc review in the Ninth Circuit maintained federal protections for the procedure until the Supreme Court jumped in and said Idaho could continue prohibiting emergency abortions. 

The justices heard arguments in April to decide if the federal mandate could be ignored permanently. 

Now the ruling sends the case back to the lower courts to consider evidence and arguments on the merits of the conflict. Kagan, a Barack Obama appointee, said Idaho was not entitled to anything more, noting that the state argued that the Emergency Medical Treatment and Labor Act never requires hospitals to provide medical care that violates Idaho law.

“In my view, that understanding of EMTALA is not ‘likely to succeed on the merits,’ and so cannot support a stay of the injunction,” Kagan wrote in an opinion joined by her liberal colleagues. “Neither does the state’s argument provide any basis for this court to short-circuit the proceedings below.”

Some of the justices acknowledged that the court errored when it paused federal protections in Idaho in favor of the state’s law. Justice Amy Coney Barrett, a Donald Trump appointee, said the court miscalculated when granting certiorari before judgment because the parties’ evolving positions indicate that further proceedings in the lower courts are necessary.

Barrett said she joined the court’s judgment because the shape of the cases substantially shifted since the court agreed to hear the dispute. In a concurrence joined by Chief Justice John Roberts and Justice Brett Kavanaugh, Barrett said briefing and oral argument shed more light on the case than when the court considered Idaho’s emergency applications.

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“The dramatic narrowing of the dispute — especially the government’s position on abortions to address mental health and conscience exemptions for health care providers — has undercut the conclusion that Idaho would suffer irreparable harm under the preliminary injunction,” Barrett wrote.

Barrett was persuaded by the government’s declarations at oral arguments disputing claims that the Emergency Medical Treatment and Labor Act would turn emergency rooms into abortion enclaves and force doctors to perform the procedure regardless of conscience objections. She said the government’s declaration that abortion would never be required as stabilizing treatment for mental health conditions was also key.

“That is an important concession: If restricted to conditions posing serious jeopardy to a woman’s physical health, the government’s reading of EMTALA does not gut Idaho’s Act,” Barrett wrote.

Justice Ketanji Brown Jackson was more explicit in her critique of the court’s prior decision. The Joe Biden appointee said the court forced Idaho doctors to “step back and watch as their patients suffered, or arrange for their patients to be airlifted out of Idaho.”

“This months-long catastrophe was completely unnecessary,” Jackson wrote. “More to the point, it directly violated federal law, which in our system of government is supreme.”

The court’s correction was the right decision, but Jackson said her colleagues stopped short of rectifying the dispute. She said the court should not use that procedural mechanism as a tool to avoid issues the justices do not want to decide.

“It is delay,” Jackson wrote. “While this court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires.”

Unlike Barrett, Jackson said developments increased the need for the justices to weigh in on the issue, adding that Idaho tried to frame stabilizing abortions as life-saving care permitted under Idaho’s law.

While Jackson said some of her colleagues viewed the maneuver as a material change, she argued it is implausible to claim that Idaho’s new argument made any difference.

“The conflict between state and federal law still exists — in real life,” Jackson wrote.

Alito said the court’s about-face on the case was baffling, claiming that the government’s theory was plainly unsound. The government said the Emergency Medical Treatment and Labor Act required hospitals to perform abortions, but Alito said the opposite was true.

“Far from requiring hospitals to perform abortions, EMTALA’s text unambiguously demands that Medicare-funded hospitals protect the health of both a pregnant woman and her ‘unborn child,’” Alito wrote.

Alito placed significant weight on the Emergency Medical Treatment and Labor Act’s protection of “unborn children,” a term often used by advocates of fetal personhood.

The government said pregnant women should be able to make decisions about their health, not the state but Alito said the right to consent to be treated did not work in reverse. Alito explained this theory by comparing cancer patients to pregnant women seeking stabilizing abortions.

“Cancer patients have the right to refuse treatment that their doctors recommend, but they do not have a right to obtain whatever treatment they want, such as the administration of a drug that cannot legally be used in this country,” Alito wrote. “Likewise here, a woman’s right to withhold consent to treatment related to her pregnancy does not mean that she can demand an abortion.”

Alito claimed that allowing the government to prevail in this case could lead to far-reaching consequences, such as lawmakers paying doctors to perform third-trimester elective abortions or eugenic abortions.

After deconstructing the government’s arguments, Alito turned to his colleagues' explanation for their ruling. Alito criticized the six justices in the majority for not explaining the per curiam ruling.

Taking particular aim at Barrett’s opinion, Alito said rejecting Idaho’s argument because of its inability to prove it would be irreparably harmed by complying with federal health care protections was unsound because states are always harmed when courts prevent their laws from being enacted.

Alito claimed that forcing the state to provide this care would lead to more abortions, including in cases where the fetus is viable.

“I cannot endorse this turn of events and therefore respectfully dissent,” the George W. Bush appointee wrote.

The court could be forced to revisit the conflict sooner rather than later. The Biden administration brought a similar case in Texas that is more developed than Idaho’s appeal. The justices could be asked to jump into that dispute next term.

Follow @KelseyReichmann
Categories / Appeals, Courts, Health, National, Politics

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