Supreme Court Allows Emergency Abortions in Idaho—For Now

The Supreme Court on Thursday ruled that hospitals in Idaho that receive federal funds are allowed to temporarily provide emergency abortions when a patient faces serious health risks, even though a state law currently bans the procedure.

The highly-anticipated decision, however, largely sidesteps the issues at the heart of the case. The Justices declined to rule on whether Idaho's near-total abortion ban conflicts with federal mandates requiring hospitals to provide emergency care, choosing instead to dismiss the case by a 6 to 3 vote on procedural grounds.

The Justices wrote in the majority opinion that the case was “improvidently granted” and that the Supreme Court should not have stepped in so quickly, effectively reinstating a lower court ruling that permits doctors in Idaho to perform abortions in emergency situations without fear of prosecution or penalty under state law.

The court could take up the issue in a later case, but for now clears the way for Idaho hospitals to provide emergency abortions.

Justice Ketanji Brown Jackson wrote that she would not have dismissed the case, and that the issue should have been resolved by the Supreme Court. “Today’s decision is not a victory for pregnant patients in Idaho. It is delay,” she 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.”

The ruling signifies a partial victory for the Biden Administration in its protracted effort to safeguard abortion access. The case marked the second abortion-related challenge to come before the Justices this term, following the Court's decision in Dobbs v. Jackson Women’s Health Organization in 2022 that overturned the Constitutional right to an abortion and left abortion policy to the states. (Earlier in June, the Supreme Court dismissed a challenge that would have curtailed access to the abortion pill mifepristone.)

At the heart of the Idaho case was a clash between the state’s stringent abortion restrictions and the federal Emergency Medical Treatment and Labor Act (EMTALA), which mandates hospitals to stabilize patients facing life-threatening conditions regardless of their ability to pay. Idaho contended that EMTALA's language requires equal treatment for both the pregnant patient and the "unborn child," arguing that its near-total abortion ban does not conflict with federal legislation.

The decision, however, was not entirely a surprise. It came one day after Bloomberg reported that a draft opinion was inadvertently posted on the court’s website in a rare breach of protocol.

The legal battle in Idaho is part of a broader wave of challenges following the 2022 Dobbs decision that overturned Roe v. Wade, when a so-called “trigger” law automatically came into effect in Idaho prohibiting all abortions except in cases where it is deemed necessary to prevent the mother's death. In legal filings, Idaho has noted that the term "abortion" is absent from the EMTALA statute enacted by Congress in 1986, arguing that abortion care was not intended as one of the required stabilizing treatments under the law. The statute does, however, include the phrase "unborn child," which the state contends necessitates consideration of the fetus's well-being when addressing medical emergencies.

Conservative justices Samuel Alito, Clarence Thomas and Neil Gorsuch wrote in the dissent that the court had prematurely dismissed the case without fully addressing the conflict between federal and state laws. Alito criticized the majority's decision as avoiding a critical legal issue ripe for resolution, asserting that EMTALA does not mandate abortions and citing congressional intent to protect unborn children under federal law.

"Here, no one who has any respect for statutory language can plausibly say that the government's interpretation is unambiguously correct," he wrote.

The Biden Administration sued Idaho over its abortion ban in 2022, resulting in a temporary injunction preventing its enforcement in emergency care situations, but the case has raised questions about the ongoing struggle between federal and state authority in shaping reproductive healthcare policy. 

Fourteen states have already banned abortion since the fall of Roe v. Wade, and while each of these bans include some kind of exception for the mother’s life, patients, doctors, and lawyers have run into challenges interpreting the statutes’ language. As a result, some women seeking abortions have been turned away from hospitals in life-threatening situations. 

Several Idaho-based medical providers wrote in amicus briefs that the state’s abortion law does not match up with common medical judgment, forcing doctors to violate their oath and delay medical care until their patient’s condition deteriorates to the point that an abortion is necessary to save their lives. Some OB-GYNs have decided to leave Idaho over fear of being prosecuted for treating patients, according to the briefs.