The Supreme Court’s rejection of an Idaho challenge to a federal emergency medical law provided temporary relief for doctors and patients in the state but did not end questions about whether federal law allows doctors to perform abortions in medical emergencies.
The Supreme Court ruled 6-3 on Thursday to dismiss the case for “rashly approving,” meaning it should never have taken it up in the first place. The court sent the case back to the Court of Appeals and reversed a previous decision that had allowed Idaho’s law to apply as is.
This means that doctors in Idaho can perform emergency abortions despite state-level restrictions — at least while the case is before the courts, which continue in the U.S. Court of Appeals for the 9th Circuit.
But doctors and abortion rights advocates say the ruling is at best a short-term solution with no long-term prospects, leaving women with pregnancy complications who live in states that ban abortion in limbo.
“The Court should have provided the necessary clarification to end the confusion and confusion about what EMTALA is. [the Emergency Medical Treatment and Labor Act] “It should be a one-time mandate, or else we could end up with many more people being denied care,” Nancy Northup, president and CEO of the Center for Reproductive Rights, told reporters.
The case involved a nearly 40-year-old law that requires hospitals that receive federal funding to provide stabilizing care to emergency room patients regardless of their ability to pay.
The Biden administration has invoked EMTALA following the Supreme Court’s decision overturning Roe v. Wade, arguing that federal law preempts state laws and orders that adopt stricter definitions of emergency medical conditions.
But EMTALA doesn’t specifically mention abortion or outline what procedures must be provided, and Idaho argued that state law trumps federal regulations.
The state allows abortion when it is “necessary to prevent maternal death,” but not when the patient’s health or reproductive future is at risk due to catastrophic health consequences, such as loss of the uterus.
Idaho Attorney General Raul Labrador told reporters Thursday he is confident the appeals court will rule in his favor.
“We are confident that we will ultimately win this case,” Labrador said. “We are hopeful that the Ninth Circuit will actually read the Supreme Court’s decision and understand that the Biden administration’s abuse of power needs to end.”
But because the justices did not resolve the fundamental questions raised in the case, and because states have been reluctant to give doctors any substantial guidance about what constitutes a medical emergency, abortion care remains a legal gray area in many states.
“What we really wanted was for the Supreme Court to rule emphatically that doctors should be able to provide abortion care to their patients, including in emergency situations where abortion care is needed to stabilize a patient’s condition,” Nisha Verma, an obstetrician-gynecologist in Georgia, told a news conference.
Georgia’s “heartbeat” law bans abortions after about six weeks, with exceptions for medical emergencies and “medically futile” pregnancies, but what that means in practice varies from state to state, and there is no standard definition or guidelines.
“I think those of us working here in Georgia are constantly confused trying to understand a very confusing law that has exceptions that make absolutely no sense on the ground, and that law doesn’t take into account all of the complexities that we deal with every day,” Verma added.
The Supreme Court may not wait that long after all: The Fifth Circuit Court of Appeals ruled against the Biden administration regarding EMTALA in Texas earlier this year, and there is already a federal appeal pending in a similar case to Idaho.
The Biden administration appealed to the Supreme Court but asked the justices to put the appeal on hold until the Idaho case is resolved at the Supreme Court. The court will likely decide whether to hear arguments in the fall and then issue a ruling after the November election.
After the appeals court rules, the Supreme Court could also rehear Idaho’s case.
Labrador said he was speaking with hospitals and doctors to clear up any confusion about how Idaho’s abortion ban applies.
“They’ve always thought they would be prosecuted, but that’s never been the case,” he said.
But some doctors across the state say they remain nervous.
“Attorney General Labrador has chosen not to listen to the vast majority of physicians who have deep concerns and fears about the complications their patients suffer every day from abortion and general reproductive health care,” Idaho obstetrician-gynecologist Caitlin Gustafson told reporters.
Jessica Evans-Wall, an emergency physician in Idaho, said she anticipates the hospital’s legal team may need to step in if a situation arises where she or her physician partner are unsure about a pregnant patient.
“If I had a case where I was concerned about a pregnant patient’s health rather than her life, I would worry that I was in a grey area,” Evans-Wall said. “I think that, especially in an emergency situation, you have to make decisions based on minimal information. I think most of us physicians still feel a little vulnerable.”
