The massive constitutional implications of the Idaho abortion case

The Supreme Court heard oral arguments in Idaho v. United States last week. The case pits state and federal law between strict abortion bans and protecting women’s health in emergency situations. Unlike Roe v. Wade and Dobbs v. Jackson Women’s Health Organization, which challenged whether a woman had a constitutional right to decide for herself whether to terminate a pregnancy based on the Fourteenth Amendment’s Due Process Clause. , this case concerns statutory law.

Idaho has enacted a law that prohibits medical emergencies, including abortions, except to save the mother’s life. Under the Federal Emergency Treatment Act and Labor Law (emtara), federally funded hospitals must provide “stabilizing treatment” for “emergency medical conditions” even if the pregnancy is terminated.

The space between “death’s door approaching” and “death’s door actually opening” is the essence of this debate. Who should draw the line: Idaho or the federal government? How the court answers this question will have ramifications that are difficult to even imagine.

If the court sides with Idaho, at least a dozen Additional states” Strict anti-abortion laws will also engulf EMTALA, forcing pregnant women in these states who need emergency treatment elsewhere.As Justice Elena Kagan pointed out in her oral argument, in Idaho alone 6 seriously ill women Already this year, he was flown out of state by helicopter for emergency treatment. Under current Idaho law, the penalty for miscalculating “near death” is five years in prison. For doctors, the risk that prosecutors disagree with a medical verdict and press charges is dire, even if the verdict is medically and ethically correct.

Congress enacted EMTALA to allow hospitals participating in Medicare to provide emergency services to patients regardless of their ability to pay. The law corresponded to the so-called “.patient dumpingThe incident occurred when a hospital capable of treating a patient refused because the patient was unable to pay, leading to the hospital “dumping” the patient to another facility. The Idaho case raises the question of whether states with strict abortion laws can still dump patients into other states that allow doctors to terminate pregnancies to protect the mother’s health. ing.

It also raises two further questions of great constitutional importance. The question is whether federal law still supersedes state law under the Constitution, and whether Congress has the power to mandate emergency medical care in the first place. These are expensive items.

First, the constitution supremacy clause “The laws of the United States of America… shall be the supreme law of the land; and the judges of every state shall be bound by it, notwithstanding any provision to the contrary of the constitution or laws of any state.” When state laws conflict, federal law is supposed to prevail.

Idaho argues that it is possible for hospitals to comply with both Idaho law and EMTALA, and there is no conflict. During oral arguments, some conservative justices seemed sympathetic to this idea. But when Justice Sonia Sotomayor asked whether a doctor could perform an abortion in Idaho to prevent a woman from losing her organs or other serious complications, the Idaho attorney replied, “Idaho’s The law states that abortion is not permitted in this case.” ” If a majority of the Supreme Court sided with Idaho, which seems likely based on oral arguments, how would that circumvent the Supremacy Clause and what would the Constitution mean if it did? The impact on the rest is unknown.

Secondly, expenditure clause Gives Congress the power to pass laws to spend money, including money sent to states to implement federal programs like Medicare. Generally, the Supreme Court has interpreted the spending clause broadly, upholding laws like EMTALA that impose conditions on states receiving federal funds, as long as the conditions are clear and related to the purpose behind the federal program.

in NFIB vs. Sebelius, an Affordable Care Act case, the court added another requirement to the spending clause in 2012. Congress cannot impose “mandatory” conditions on states. Under the ACA, states could lose all of the additional funding for Medicaid if they refuse to accept it. The court found the transaction to be unconstitutionally coercive.

Idaho argues that EMTALA is a coercive violation of state rights under the Sebelius administration. They also argue that the terms of the law, passed in 1986, are unclear. The government responded as follows: simple: “EMTALA’s requirement that such participating facilities provide essential emergency medical care…is not “coercion, destruction or violation of state autonomy,” but rather targeted “appropriate conditions.”[]’attached to federal spending programs[]It’s for hospitals. ”

On the issue of clarity, the government added: “Congress…could have had no reason to be more ‘explicit’ to ensure that necessary emergency care included abortion care, if necessary.After all, at the time of enactment of EMTALA, no state… It would not have been possible to ban abortions required by law. [Idaho] Law. ” Roe v. Wade was the law of the day.

Justice Amy Coney Barrett asked Attorney General Elizabeth Preloger whether another administration could enact a bill under the spending clause that would ban Medicare funding to hospitals that perform abortions or permit gender reassignment surgeries. I asked if it was okay. Justice Neil Gorsuch wanted to know whether Congress could regulate the practice of medicine across 50 states. Preloger said she believes the Legislature has enough authority to do both, and that such a bill enacted under the spending clause would preempt state law.

If the Supreme Court disagrees and strengthens states’ ability to override the wishes of Congress, this case could shake up the nation for years to come.

Kimberly Wehr is the author of How to Read the Constitution and Why. Her upcoming book, Pardon Power: How the Pardon System Works – and Why, will be published in September.follow her @kimwehle.