SCOTUS Weighs If Federal Law Trumps State Abortion Law

WASHINGTON D.C. – Today, the U.S. Supreme Court heard oral arguments in Moyle v. United States and Idaho v. United States, two consolidated cases questioning whether the 1986 Emergency Medical Treatment and Labor Act (EMTALA) supersedes Idaho’s near-total abortion ban and can force emergency room doctors to perform abortions in emergency situations.

Idaho’s “Defense of Life Act” 

The case involves Idaho’s “Defense of Life Act,” which makes it a felony for doctors to perform an abortion unless it’s necessary to save the life of the mother. The law was a trigger ban that took effect when the Supreme Court overturned Roe v. Wade in June 2022. Soon thereafter, the Biden administration sued the State of Idaho arguing EMTALA trumps the state’s abortion law and requires doctors to perform abortions under a broader set of exceptions than just to preserve the life of the mother. Secretary Xavier Becerra of the U.S. Department of Health and Human Services (HHS) issued policy guidance in July 2022 to hospitals stating that state abortion laws with more narrow exceptions than EMTALA are “preempted,” and that physicians “must” perform an abortion if they feel abortion is “the stabilizing treatment necessary” to resolve an emergency medical condition. Under the guidance, hospitals could lose federal funding for failing to perform abortions.

Notably, EMTALA explicitly requires emergency rooms to provide care to a pregnant woman and her “unborn child” without discrimination, including if they cannot pay for the treatment.

Biden administration’s reading of EMTALA lacks any “limiting principle”

In January 2024, the High Court granted an emergency request from the State of Idaho and its Speaker of the House Mike Moyle to enforce the ban in hospital emergency rooms while it decides the issue, which temporarily denies a Biden administration effort to force hospitals to perform abortions in the state.

During the oral arguments, the Justices questioned both sides on the meaning of EMTALA’s text, as well as the standard of care the law implies doctors to provide, and Congress’ overall power in drafting the law.

Attorney Joshua Turner, arguing for Idaho, opened his argument by telling the Justices that “states regulate the practice of medicine” as well as the licensing of doctors. Turner explained that the Biden administration’s reading of EMTALA lacks any “limiting principle” which would leave emergency rooms virtually unregulated allowing doctors to ignore any state regulation, such as laws regarding other things like opioid use or informed consent requirements, and not just abortion.

“It’s unsurprising that no court has endorsed such an expansive view of EMTALA,” stated Turner. “Licensing laws limit medical practice, that’s why a nurse isn’t able to perform open heart surgery no matter the need, no matter her knowledge. The answer doesn’t change just because we’re talking about abortion.”

Support Canada Free Press

Turner also noted the federal government is “misreading” the law and that “nothing in EMTALA” preempts Idaho’s law. He noted throughout today’s arguments that Idaho’s abortion law and EMTALA, as they are written, are not in direct conflict because EMTALA’s stabilization requirement requires doctors exercise their medical judgment in accordance with standards of care.

Justices Elena Kagan, Sonja Sotomayor, and Ketanji Brown Jackson all fervently pushed back on Idaho’s argument that the two laws do not conflict. Justices Sotomayor and Jackson noted EMTALA requires hospitals to “stabilize anyone” and that abortion is often the “stabilizing treatment.” But, in particular, Justice Kagan rejected the argument that medical regulation is strictly a state responsibility. She noted that EMTALA is “not all the state’s way” and may require abortions in not just life-threatening cases, but also when a woman could lose her ability to have children.

“Now that is the category of cases where EMTALA says, ‘my gosh,’ of course abortion is necessary,” stated Justice Kagan. “But Idaho says, ‘sorry, no abortion here’ and the result is these patients are now helicoptered out of state.”

While the three Justices gave little room for Turner to respond, he was able to quickly say that Idaho has a life-saving exception when the mother’s life is in danger, as well as that standards of care are determined by the state, and that doctors need to consider that there are two lives at stake.

“Idaho…and 22 other states, even Congress and EMTALA recognizes that there are two patients to consider in those circumstances.” Turner stressed the “government’s rigid view” of EMTALA suggests if a condition calls for abortion, and the hospital can do it, then “it must be done there and then.”

Justices Samuel Alito and Neil Gorsuch homed in on EMTALA’s reference to a woman’s “unborn child.” Both Justices found it strange that Congress would insert that term if they meant the law to be a mandate for terminating unborn children. Justice Alito asked U.S. Solicitor General Elizabeth Prelogar, who argued on behalf of the Biden administration, to explain EMTALA’s use of “unborn child.”

“Isn’t that an odd phrase to put in a statute that imposes a mandate to perform abortions,” Alito asked. “Have you ever seen an abortion statute that uses the phrase unborn child?”

“It’s not an odd phrase when you look at what Congress was doing in 1989,” stated Prelogar. “It tells us that Congress wanted to expand the protection for pregnant women so that they could get the [stabilizing treatment] when they have a condition that is threatening the health and well-being of the unborn child.”

Prelogar further stated Congress never “displaced the independent preexisting obligation” for hospitals to treat the woman facing a life-threatening situation.

Regarding federal funding that is attached to EMTALA, Justices Amy Comey Barrett and Gorsuch asked Prelogar how far the government could go in imposing restrictions and requirements in exchange for that funding. Justice Gorsuch asked if the federal government could “regulate the practice of medicine” and “ban abortion across the nation” through the spending clause.

Prelogar essentially stated “yes,” and that “Congress does have broad authority.”

In his closing argument, Turner stated federal regulations require hospital staff to comply with state law and there have been “115,000 enforcement instances” of EMTALA nationwide, and not one of those instances involved overriding a state law.

Turner cautioned the High Court that the federal government’s “untethered” reading of EMTALA will not end with abortion or with Idaho.

“This question will come up in state after state after state,” stated Turner. “If the federal government can pay private actors to violate…state criminal laws…it leaves the federal government unbound by enumerated powers.”

Liberty Counsel Founder and Chairman Mat Staver said, “The Emergency Medical Treatment and Active Labor Act does not preempt state abortion laws, nor does it require the killing of an innocent life. Emergency rooms are only required to stabilize patients, which includes the unborn patient. This so-called ‘guidance’ by the Secretary of Health and Human Services is another lawless act of the Biden administration that should be struck down.”

VIEW Comments