Background

Following the overturning of Roe v. Wade  in  Dobbs v. Jackson, the federal government issued guidance saying the Emergency Medical Treatment and Labor Act (EMTALA) provided federal protections to providers performing abortions in emergency situations, even in states with abortion restrictions. EMTALA was passed in 1986 to prevent hospitals from refusing emergency care to patients who couldn't pay.

Soon after, the Department of Justice (DOJ) filed a lawsuit challenging an Idaho law that only allows for abortions to save the life of a pregnant person, arguing the exception was "extremely narrow" and violated EMTALA.

"For some pregnant women suffering tragic emergency complications, the only care that can prevent grave harm to their health is termination of the pregnancy. In those circumstances, EMTALA requires participating hospitals to offer such care — yet Idaho law forbids it," DOJ argued in a brief to the Supreme Court.

Idaho and anti-abortion activists argued that the Biden administration is attempting to subvert the Supreme Court's decision in Dobbs, which left abortion regulations up to the states.

"In nearly four decades since EMTALA was enacted, neither the statute nor previous federal guidance ever stated 'obligations' requiring hospitals and physicians to provide any particular procedure, much less an abortion," Idaho's brief said.

Idaho also noted that EMTALA provides protections for a mother and an "unborn child" equally, and the law does not mention abortion.

DOJ argued those provisions were added to the law to clarify that hospitals needed to provide emergency care for an unborn child even if the mother's health wasn't at risk.

SCOTUS rules emergency abortions are allowed

On Thursday, the court issued a ruling in Moyle v. United States, saying that appeals from Idaho are being dismissed as "improvidently granted." The court will not resolve broader questions around the case, instead reinstating a lower court order ensuring hospitals in Idaho can perform emergency abortions.

The ruling will allow emergency abortions in Idaho but doesn't have bearing in other states with strict abortion bans. However, it will allow a San Francisco-based federal appeals court to consider the case.

The court voted 6-3 in favor of dismissing the appeals, with Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch dissenting.

In a concurring opinion, Justice Amy Coney Barrett said that the "shape of these cases has substantially shifted" since the court said it would take up the cases in January and the parties' positions had "rendered the scope of the dispute unclear, at best."

In an opinion joined by Chief Justice John Roberts and Justice Brett Kavanaugh, Barrett pointed to what she said was a clarification issued by the Biden administration about the reach of federal law and noted that Idaho's law had changed since the district judge considered the case.

In another concurring opinion, Justice Elena Kagan said the court's decision "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."

Kagan noted that, in her view, EMTALA "unambiguously requires" a hospital receiving federal funding to provide whatever medical treatment is necessary to stabilize a patient. Kagan added that language was added to EMTALA by bipartisan majorities of Congress to ensure a pregnant woman could "demand care for her unborn child as well as herself."

Meanwhile, Justice Ketanji Brown Jackson issued a separate partial agreement and partial dissent, saying she would have found that federal law overrides Idaho's abortion ban, and that the Supreme Court should immediately consider the merits of the case rather than sending it back to the lower court.

"Today's decision is not a victory for pregnant patients in Idaho," 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."

"We cannot simply wind back the clock to how things were before the court injected itself into this matter," Jackson added. "There is simply no good reason not to resolve this conflict now."

In a dissenting opinion, Justice Alito also argued the court should rule on the merits of the case, saying the decision was "puzzling."

"That question is as ripe for decision as it ever will be," Alito wrote. "Apparently, the court has simply lost the will to decide the easy but emotional and highly politicized question that the case presents. That is regrettable."

Alito added that he believes EMTALA clearly "does not require hospitals to perform abortions in violation of Idaho law." Rather, Alito said he believes EMTALA requires hospitals receiving federal funding "to treat, not abort, an 'unborn child.'"

Reaction

Advisory Board's Gabriela Marmolejos noted that the case as a whole continues to show "the impact of abortion restrictions like those of Idaho on the recruitment and retention of ob/gyns. This means ob/gyn employers in these states will increasingly need to differentiate themselves as the employer of choice by offering physicians meaningful autonomy, ample time, and seamless support."

Many abortion rights advocates welcomed the outcome of the case, but noted it didn't amount to a clear victory.

Alexa Kolbi-Molinas, deputy director of the American Civil Liberties Union's Reproductive Freedom Project, said that the court's ruling indicates "it is clear that pregnant people are not out of the woods — not by a long shot. Make no mistake: The Supreme Court had the opportunity to hold once and for all that every pregnant person has the basic right to emergency abortion care, but … it failed to do so."

According to Gretchen Borchelt, VP for reproductive rights and health at the National Women's Law Center, the court's decision "means pregnant patients in Idaho get the abortion care they need and that's critical. But at the same time, this isn't comfort to pregnant people across the country. It seems this is leaving the situation unresolved."

"The language we saw today does not affirm that hospitals are required to treat pregnant people who need emergency abortions," said Beth Brinkmann, U.S. senior litigation director for the Center for Reproductive Rights. "It doesn't say anything either way and punts the issue down the road."

Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said the Supreme Court "had the opportunity to be clear that the federal EMTALA law protects the right to abortion in an emergency in every state — regardless of a state's abortion ban — and they chose not to. Access is still under threat across the country, but for now, this means that patients in Idaho will be able to get the care they need, according to federal law — after seven months of pregnant people suffering in an unnecessary and possibly deadly legal limbo." (Stohr et al., Bloomberg, 6/26; VanSickle, New York Times, 6/26; Marimow, Washington Post, 6/26; Owermohle, STAT, 6/26; Hurley, NBC News, 6/27; VanSickle, New York Times, 6/27; Rubin, Axios, 6/27)

Advisory Board resources on women's health

• Expert Insight: Abortion laws are continuing to change. Here's how to help your clinical workforce right now
• Our take: 5 steps to improve women's health and well-being
• Market insights: Health plans' top 3 maternal care priorities
• Research: Top drivers of change in the maternal and reproductive health market
• Maternal & reproductive health market trends