On Thursday, the Supreme Court issued a 6-3 decision dismissing as “improvidently granted” a case out of Idaho concerning apparent conflicts between state and federal policy regarding the provision of emergency abortions.
This case centered on the question of whether or not federal law mandates doctors to perform abortions in a wide range of emergency circumstances regardless of what may be permitted by the state.
The Justices also vacated the stay they issued in January, thus allowing for emergency abortions to be performed in Idaho for a variety of reasons regardless of any state law to the contrary.
At the center of this case was the Emergency Medical Treatment and Labor Act (EMTALA), which requires the provision of stabilizing medical care to patients whose health is in “serious jeopardy” or when there is the risk of “serious impairment to bodily functions, or serious dysfunction of bodily organs,” regardless of insurance coverage or a patient’s ability to pay.
In accepting this case, the Justices were tasked with deciding if the requirements outlined in EMTALA preempt existing state law allowing for abortions to be performed only when the life of the mother is in jeopardy, as is the case in Idaho.
Thursday’s dismissal, however, did not offer guidance on the substantive question of whether or not EMTALA ought to be read as requiring abortions or preempting state law when apparent conflicts arise.
[RELATED: Dispute Over Emergency Abortion Requirements Considered by SCOTUS]
Although the opinion itself was only one sentence long, the Justices authored several more extensive concurring and dissenting opinions explaining their individual reasoning.
One of the concurring opinions — written by Justice Elena Kagan and joined by Justice Sonia Sotomayor — explained that they agreed with the Court’s ruling because they believe “Idaho’s arguments about EMTALA do not justify, and have never justified, either emergency relief or our early consideration of this dispute.”
“With this Court’s stay dissolved, the District Court’s preliminary injunction will again take effect,” they said. “That 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.”
“Today’s ruling thus puts the case back where it belongs, and with the preliminary injunction in place,” the Justices concluded.
Justice Amy Coney Barrett authored a separate concurring opinion — onto which Chief Justice John Roberts and Justice Brett Kavanaugh joined — in which it is explained that they agreed with the Court’s decision to dismiss because the case “has substantially shifted” since cert was granted.
“The parties dispute whether EMTALA requires hospitals to provide abortions—or any other treatment forbidden by state law—as necessary stabilizing care,” the Justices said. “They also disagree about whether EMTALA, as a statute enacted under Congress’s spending power and that operates on private parties, can preempt state law (an issue aired for the first time in this Court).”
“In my judgment, it would be imprudent to answer these important questions now. Since this suit began in the District Court, Idaho law has significantly changed—twice,” they concluded. “And since we granted certiorari, the parties’ litigating positions have rendered the scope of the dispute unclear, at best.”
“A grant of certiorari before judgment presumes that further proceedings below are unnecessary to the Court’s resolution of the question presented,” the Justices explained. “That was a miscalculation in these cases, because the parties’ positions are still evolving.”
These Justices go on to explain that not only has “the United States has clarified that EMTALA’s reach is far more modest than it appeared when we granted certiorari and a stay,” but also that “Idaho law has materially changed since the District Court entered the preliminary injunction.”
“Based on the parties’ arguments before us,” they said, “it seems that the framing of these cases has not had sufficient opportunity to catch up.”
Justice Ketanji Brown Jackson authored an opinion that concurred in part and dissented in part. While Justice Jackson agreed with the Court’s decision to lift its stay, she expressed opposition to their dismissal of the case.
Instead, she argues, the Court ought to have ruled that abortions are required to be performed under EMTALA and that this dictate supersedes any state law to the contrary.
“If anything, the need for a clear answer to the Supremacy Clause question has only increased in the intervening months,” Jackson wrote. “Other States across the country have enacted legislation that gives rise to the same sort of legal conflict that Idaho has created. This pre-emption issue is not going away anytime soon and will most certainly return to this Court.”
“The Government continues to maintain (correctly, in my view) that EMTALA’s plain text requires hospitals to provide certain emergency abortions when doing so is the only way to stabilize an emergency condition,” Jackson said. “Idaho continues to criminalize the provision of such abortions unless doing so is necessary to prevent the patient’s death. And both Idaho and the United States still agree that Idaho law directly criminalizes emergency care that the Federal Government reads EMTALA to require.”
“Today’s decision is not a victory for pregnant patients in Idaho. It is delay,” Jackson concluded. “This Court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it. And for as long as we refuse to declare what the law requires, pregnant patients in Idaho, Texas, and elsewhere will be paying the price.
Justices Samuel Alito, Clarence Thomas, and Neil Gorsuch issued a dissenting opinion of their own in which they argued that the Court was wrong to dismiss the case at this stage and instead ought to have ruled that EMTALA “does not require hospitals to perform abortions.”
“The Government’s preemption theory is plainly unsound,” they wrote. “Far from requiring hospitals to perform abortions, EMTALA’s text unambiguously demands that Medicare-funded hospitals protect the health of both a pregnant woman and her ‘unborn child.'”
“And even if there were some ambiguity in the statutory text, we would be obligated to resolve that ambiguity in favor of the State because EMTALA was enacted under the Spending Clause, and as we have held time and again, conditions attached to the receipt of federal funds must be unambiguous.”
“Nothing legally relevant has occurred since January 5. And the underlying issue in this case—whether EMTALA requires hospitals to perform abortions in some circumstances—is a straightforward question of statutory interpretation,” they said. “It is squarely presented by the decision below, and it has been exhaustively briefed and argued.”
“Even if it were possible to read EMTALA as requiring abortions prohibited by Idaho law, it is beyond dispute that such a requirement is not unambiguously clear,” they said. “The statute does not mention abortion, let alone expressly bind hospitals to perform abortions contrary to state law.”
“The Government’s new interpretation of EMTALA is refuted by the statutory text, the context in which the law was enacted, and the rules of interpretation that we apply to Spending Clause legislation,” they concluded. “We should reject the Government’s interpretation and put that matter to rest.”
The Ninth Circuit will now resume its consideration of this case and, in the meantime, non-lifesaving abortions intended to protect the health of the mother may be performed in Idaho.
According to Bloomberg News, the Court appears to have accidentally posted this opinion on its website a day early before quickly removing the document.
Click Here to Read the Full Opinion
Golly. Wouldn’t it be nice if women of reproductive age could get actual healthcare without their case being dragged into court(s)?
With our modern medical technology, pregnancies that actually endanger the life of the mother are very rare. Typically less than 1 in 1,000.