The Supreme Court heard arguments Wednesday in two consolidated cases, Moyle v. Idaho and Idaho v. United States, to determine whether a federal law governing emergency rooms may be used to preempt state pro-life laws and impose a nationwide mandate for abortions.
In 1986, Congress passed the Emergency Medical Treatment and Labor Act, or EMTALA, to address the problem of hospitals that refuse to treat indigent patients in emergency rooms.
The law requires hospital emergency departments that accept Medicaid funds either to provide available treatment required to “stabilize” a patient’s emergency medical condition or transfer that patient to another medical facility.
Idaho prohibits abortions except when a physician determines “in his good faith medical judgment … that the abortion was necessary to prevent the death of the pregnant woman.”
These two cases before the Supreme Court are about whether Idaho’s Defense of Life Act conflicts with U.S. law, and if so, what happens. The Constitution’s supremacy clause requires that in the event of a conflict between federal and state law, a conflicting state law is preempted by federal law.
The Biden administration argues that state and federal laws are in conflict because the Emergency Medical Treatment and Labor Act allows doctors to perform abortions to address risks to a woman’s health, which the Idaho law doesn’t allow.
If this is the right reading, then EMTALA preempts state law.
Idaho contends that its law and the federal law are in sync because EMTALA doesn’t mandate a particular treatment for particular medical conditions. The federal law leaves that to doctors, who must exercise their best medical judgment in the context of laws and regulations of the states in which they practice.
If that’s the right view, then EMTALA does not preempt Idaho law.
The Biden administration sued Idaho in August 2022, seeking an injunction to prevent the state from enforcing its pro-life law. A U.S. District Court granted the injunction and the full U.S. Court of Appeals for the 9th Circuit agreed.
During Wednesday’s oral argument at the Supreme Court, liberal Justices Elena Kagan, Ketanji Brown Jackson, and Sonia Sotomayor asked attorney Joshua Turner, who argued on behalf of Idaho, whether the state law would allow an abortion in situations when a woman’s health, but not her life, is at risk.
These questions, however, had less to do with what the Emergency Medical Treatment and Labor Act says—the real issue in this case—and more to do with what the liberal justices think the Idaho law should have said.
The three liberal justices peppered Turner with hypotheticals about women who may be experiencing complications that would “impair a bodily function” but not imperil her life—would Idaho allow an abortion then?
Sotomayor in particular seemed keen to address every conceivable outcome in an effort to stump Turner and prove that EMTALA preempts the Idaho law, even though the Idaho law explicitly gives doctors the power to make medical judgments in emergency situations.
A key issue seemed to be what EMTALA means when it requires that hospitals provide “available” stabilizing treatment. Kagan argued that this was limited to physical availability, specifically whether staff and equipment are available to stabilize a patient’s emergency medical condition.
If so, then doctors must provide whatever treatment, including abortion, they choose. Idaho argues that a treatment may be unavailable not only because of insufficient staffing or equipment but, as in the case of most abortions, because doctors’ medical licenses don’t allow them to provide it.
Arguing for the United States, Solicitor General Elizabeth Prelogar urged the justices to accept the government’s view that EMTALA could impose a national standard of care. This was because EMTALA is a federal law enacted pursuant to the Constitution’s spending clause, which allows the federal government to put conditions on those who receive federal funding.
Justice Neil Gorsuch asked Prelogar: “Could the federal government essentially regulate the practice of medicine of the states through the spending clause? The answer, I think, is yes, Congress could prohibit gender reassignment surgeries across the nation, it could ban abortion across the nation, through the use of its spending clause authority, right?”
Prelogar answered: “Congress does have broad authority under the spending clause. And, yes, if it satisfies the conditions that the spending clause themself—itself requires, then I think that that would be valid.”
Congress passed the Emergency Medical Treatment and Labor Act almost 40 years ago to ensure better treatment of indigent emergency room patients, not to take over the practice of regulating the practice of medicine or to mandate a national abortion policy.
In 2022, the Supreme Court lifted the blockade against pro-life laws by overruling its decisions creating a right to abortion, but the Biden administration will not stop trying to impose its abortion agenda on the nation.
The version of EMTALA that the Biden administration and the Supreme Court’s liberal justices describe is fiction; it doesn’t dictate how medicine should be practiced and doesn’t prevent pro-life states from protecting the unborn.
If the Supreme Court is guided by the actual language of the Emergency Medical Treatment and Labor Act, as well as the general presumption against federal preemption of state law, it will lift the injunction and allow Idaho to enforce its pro-life law. A decision is expected on the case sometime in June.
