The U.S. Supreme Court ruled on Thursday to allow abortions to be performed in Idaho when pregnant women face medical emergencies. The decision came with a 6-3 vote, with three conservative justices dissenting.

The Supreme Court’s decision effectively reinstates a lower court ruling that Idaho's near-total abortion ban must defer to the 1986 Emergency Medical Treatment and Labor Act (EMTALA) when the two laws are in conflict. EMTALA ensures that patients can receive emergency care at hospitals that receive federal Medicare funding. Idaho is one of six states with stringent abortion bans that provide no exceptions to protect the health of pregnant women.

EMTALA: The Emergency Medical Treatment and Labor Act

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 that requires hospitals receiving Medicare funding to provide emergency medical treatment to all patients, regardless of their ability to pay, insurance status, or citizenship. The primary aim of EMTALA is to prevent "patient dumping," a practice where hospitals refuse to treat or transfer patients based on their financial circumstances or other discriminatory factors.

Key Provisions of EMTALA

1. Medical Screening Requirement: Under EMTALA, hospitals must perform a medical screening examination for any person seeking treatment in the emergency department. This examination is intended to determine whether an emergency medical condition (EMC) exists.

2. Stabilization Requirement: If an emergency medical condition is identified, the hospital must provide necessary stabilizing treatment. Stabilization refers to medical care that ensures the patient’s condition does not deteriorate during transfer or discharge.

3. Transfer Provisions: If a hospital cannot stabilize a patient due to a lack of resources or capability, it must arrange an appropriate transfer to a facility that can provide the necessary treatment. The transfer must be conducted under medically safe conditions, ensuring that the receiving facility has agreed to accept the patient and can provide the required care.

4. Enforcement and Penalties: Hospitals that violate EMTALA can face significant penalties, including civil fines and exclusion from the Medicare program. Additionally, patients who suffer harm due to a hospital’s failure to comply with EMTALA can file lawsuits for damages.

EMTALA and Abortion Rights

EMTALA has become a focal point in the debate over abortion rights, particularly in states with strict abortion bans. The law mandates that hospitals provide stabilizing treatment for emergency medical conditions, which can include life-threatening complications during pregnancy. This requirement can conflict with state laws that severely restrict or ban abortions, as seen in the recent legal challenges in Idaho.

Idaho’s Abortion Ban and EMTALA

In the context of Idaho’s near-total abortion ban, EMTALA plays a critical role in ensuring that pregnant women receive necessary medical care during emergencies. The Biden administration argues that EMTALA preempts state abortion bans when the two are in conflict, as the federal law mandates care that might include abortion to stabilize a patient’s condition.

In Thursday’s Supreme Court ruling, the justices temporarily allowed abortions to be performed in Idaho when facing medical emergencies, citing EMTALA’s requirements. The court's decision underscored the importance of EMTALA in safeguarding patients' rights to emergency medical care despite restrictive state laws.

While the ruling provides temporary relief, it does not resolve the underlying legal dispute. The Supreme Court dismissed the case as "improvidently granted," opting not to decide on the merits. The one-line order lifted a stay the justices had placed on the lower court's decision in January.

Liberal Justice Ketanji Brown Jackson, in a separate opinion, agreed with lifting the stay but criticized the dismissal of the case, describing the legal situation as a "fragile detente." Jackson emphasized the need for clarity and certainty in such tragic situations and expressed concern that the refusal to declare what the law requires would continue to harm pregnant patients in states like Idaho and Texas.

The decision comes against the backdrop of heightened tensions following the Supreme Court’s landmark ruling in 2022 that overturned the 1973 Roe v. Wade decision, which had legalized abortion nationwide. This reversal led to a wave of state-level abortion bans, including Idaho's "trigger" law, which imposes severe restrictions on abortion and penalties for doctors.

Idaho's law, adopted in 2020, took effect upon the reversal of Roe and bans nearly all abortions unless necessary to prevent a mother’s death. Violating doctors face two to five years in prison and loss of their medical license.

Medical experts have highlighted the risks posed by the ban, noting that conditions such as gestational hypertension, excessive bleeding, and other complications can necessitate an abortion to stabilize the patient and prevent severe health consequences.

EMTALA requires hospitals to "stabilize" patients with emergency medical conditions, and violations can lead to lawsuits, civil fines, and the loss of Medicare funding. Following the demise of Roe, the Biden administration issued guidance that EMTALA takes precedence over state abortion bans in instances where the two conflict, leading to the lawsuit challenging Idaho's ban.

Boise-based U.S. District Judge B. Lynn Winmill initially blocked the enforcement of Idaho’s law in cases where abortions are needed to prevent serious jeopardy to the woman’s health or avoid serious impairment to bodily functions.