SCOTUS 23-726: 6-3 Concurring

A case challenging Idaho's near-total abortion ban, was accidentally uploaded to the court's website, and the error shows that the justices are poised to rule against Idaho

The decision reinstates a lower court ruling that temporarily allowed hospitals in Idaho to perform emergency abortions to protect the life of the mother, and the health of the mother.

Facts of the Case

In August 2022, after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which eliminated the constitutional right to an abortion, the Biden administration brought a legal challenge to a restrictive Idaho abortion law. The Biden administration argued that the state law, which criminalizes providing an abortion except in a few narrow circumstances, including to save the life of the mother, is preempted by a federal law, the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA requires hospitals receiving Medicare funding to offer “necessary stabilizing treatment” to pregnant women in emergencies.

The district court ruled in favor of the Biden administration and barred Idaho from enforcing its law to the extent that it conflicted with EMTALA. The U.S. Court of Appeals for the Ninth Circuit, sitting en banc, declined to stay the district court's ruling while the state appealed.

Question

Does the federal Emergency Medical Treatment and Labor Act preempt an Idaho law that criminalizes most abortions in that state?

Syllabus

Nos. 23–726 and 23–727

MIKE MOYLE, SPEAKER OF THE IDAHO HOUSE OF

REPRESENTATIVES, ET AL., PETITIONERS

23–726 v.

UNITED STATES

IDAHO, PETITIONER

23–727 v.

UNITED STATES

ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF

APPEALS FOR THE NINTH CIRCUIT

[June 27, 2024]

Opinion of the Court Delivered Per Curiam

The writs of certiorari before judgment are dismissed as improvidently granted, and the stays entered by the Court on January 5, 2024, are vacated.

It is so ordered.

Kagan, Concurring with Sotomayor; Jackson in part

The statute’s references to protecting an “unborn child” do not lead to a different result. Contrary to JUSTICE ALITO’s view, none alters EMTALA’s [Emergency Medical Treatment and Active Labor Act] command when a pregnancy threatens the woman’s life or health. Three of the four provisions JUSTICE ALITO cites concern the treatment of women in labor (including all those with healthy pregnancies). Those provisions ensure that a hospital, in considering the transfer of a woman to another facility, takes account of risks to not only the woman but also her “unborn child.” §1395dd(c)(1)(A)(ii), (2)(A), (e)(1)(B)(ii). The provisions have no application to women who are not in labor, but instead are experiencing a different pregnancy related condition. The fourth provision (included within the definition of “emergency medical condition”) specifies that a hospital must treat a condition that “plac[es] the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.” §1395dd(e)(1)(A)(i). The parenthetical there, added in an amendment to EMTALA, ensures that a woman with no health risks of her own can demand emergency-room treatment if her fetus is in peril. It does not displace the hospital’s duty to a woman whose life or health is in jeopardy, and who needs an abortion to stabilize her condition. Then, the statute requires offering that treatment to the woman.* Because the Idaho law conflicts with that requirement— prevents hospitals from doing what EMTALA commands— the Court is right to dissolve its stay of the District Court’s injunction. Doing so will again give Idaho women access to all the needed medical treatments that EMTALA guarantees.

Barrett Concurring with Roberts , Kavanaugh Joining

To be sure, the text of the two laws differs: Idaho’s Act allows abortion only when “necessary to prevent the death of the pregnant woman,” Idaho Code Ann. §18–622(2)(a)(i), while EMTALA requires stabilizing care to prevent “serious jeopardy” to the woman’s health, 42 U. S. C. §1395dd(e)(1)(A)(i). But Idaho represents that its exception is broader than the United States fears, and the United States represents that EMTALA’s requirement is narrower than Idaho fears. That matters in assessing Idaho’s irreparable harm for purposes of the stay. The dramatic narrowing of the dispute—especially the Government’s position on abortions to address mental health and conscience exemptions for healthcare providers—has undercut the conclusion that Idaho would suffer irreparable harm under the preliminary injunction. Contrary to Idaho’s concerns at the stay stage, the Government’s interpretation of EMTALA does not purport to transform emergency rooms into “federal abortion enclaves governed not by state law, but by physician judgment, as enforced by the United States’s mandate to perform abortions on demand.” Stay Reply Brief in No. 23A470, p. 6 (citation omitted). Nor does it purport to deprive doctors and hospitals of conscience protections. Cf. id., at 15. Thus, even with the preliminary injunction in place, Idaho’s ability to enforce its law remains almost entirely intact.

Jackson, Dissenting in Part and Dissenting in Part

After today, there will be a few months—maybe a few years—during which doctors may no longer need to airlift pregnant patients out of Idaho. As JUSTICE KAGAN emphasizes, portions of Idaho’s law will be preliminarily enjoined (at least for now). Ante, at 2, 4. But having not heard from this Court on the ultimate pre-emption issue, Idaho’s doctors will still have to decide whether to provide emergency medical care in the midst of highly charged legal circumstances with no guarantee that this fragile detente over the State’s categorical prohibitions will be maintained. Cf. ante, at 8 (BARRETT, J., concurring) (“Even with the preliminary injunction in place, Idaho’s ability to enforce its law remains almost entirely intact”). So, to be clear: Today’s decision is not a victory for pregnant patients in Idaho. It is delay. 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. 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. Because we owe them—and the Nation—an answer to the straightforward pre-emption question presented in these cases, I respectfully dissent.

Alito, Dissenting with Thomas Joining and Gorsuch Joining in Part

Today’s decision is puzzling. Having taken the unusual step of granting certiorari [our note: a court process to seek judicial review of a decision of a lower court or government agency] before Idaho’s appeal could be heard by the Ninth Circuit, the Court decides it does not want to tackle this case after all and thus returns the appeal to the Ninth Circuit, which will have to decide the issue that this Court now ducks. What is more, the Court vacates the stay it issued earlier this year even though the majority fails to provide any facially plausible explanation for doing so. I cannot endorse this turn of events and therefore respectfully dissent.