Pregnant people in Idaho should be able to access abortion in a medical emergency in Idaho, at least for now.
The Supreme Court formally dismissed an appeal over Idaho’s strict abortion ban on Thursday, blocking enforcement of the state’s law where it conflicts with federal law. With Thursday’s decision, the state would not be allowed to deny an emergency abortion to a pregnant person whose health is in danger, at least while the case makes its way through the courts.
On Wednesday, the decision was mistakenly posted on the US Supreme Court website, and was first reported by Bloomberg News. The final opinion on Thursday was a sigh of relief, but doctors and legal experts acknowledged it’s a temporary reprieve.
“Today’s decision is not a victory for pregnant patients in Idaho,” Justice Ketanji Brown Jackson wrote in a separate opinion. “It is a delay.”
“Storm clouds loom ahead,” she wrote.
Idaho’s strict ban criminalizes performing most abortions and does not allow a doctor to perform an abortion if the patient’s health is in danger from the pregnancy itself in most circumstances. The Biden administration argued that the law violates the federal Emergency Medical Treatment and Labor Act, also known as EMTALA.
EMTALA requires all US hospitals that have received Medicare money — essentially nearly all of them — to screen everyone who comes into their emergency rooms to determine whether the person has an emergency medical condition without regard for their ability to pay for those services.
The 1986 law requires hospitals, to the best of their ability, to stabilize anyone with an emergency medical condition or to transfer them to another facility that has that capacity. The hospitals must also treat these patients “until the emergency medical condition is resolved or stabilized.”
Pregnant people were singled out in the law in 1989, after reports that some hospitals were refusing to care for uninsured women in labor. Congress expanded EMTALA to specify how it included people who were pregnant and having contractions.
In 2021, the Biden administration released the Reinforcement of EMTALA Obligation, which says a doctor’s duty to provide stabilizing treatment “preempts any directly conflicting state law or mandated that might otherwise prohibit or prevent such treatment,” although it did not specify whether an abortion has to be provided.
In July 2022, the Biden administration’s guidance clarified that EMTALA includes the need to perform stabilization abortion care if it is medically necessary to treat an emergency medical condition.
The Supreme Court’s decision means a hospital must provide an abortion if it’s medically indicated in an emergency situation, even in states that have abortion bans or restrictions that don’t provide an exception to protect the health of the mother – at least as the case makes it way through the courts.
But the move would only delay the issue, says Molly Meegan, chief legal officer for the American College of Obstetricians and Gynecologists (ACOG), a professional organization that represents the majority of practitioners in the United States.
“It doesn’t solve the problem at all. In fact, pregnant patients are still trying to obtain care and unable to get it, and physicians are trying to provide care without clear parameters and with draconian criminal penalties hanging over their heads if they get the question wrong,” she said.
Dr. Stella Dantas, president of the American College of Obstetricians and Gynecologists, said that the Supreme Court’s decision shows exactly why clinicians need to be protected from outside interference in their relationship with patients, particularly when they need emergency care. Dantas said a law created by politicians that restricts a doctor’s ability to provide care in an emergency is like having someone who has never flown a plane create restrictions on what a pilot could do during a flight emergency.
“If that person couldn’t do x, y, or z, when they were trained, in a split-second, if something flew into the engine, you wouldn’t feel safe, and it wouldn’t be the best for any of those people flying on a plane,” Dantas said at a news conference on Thursday.
“This case has illustrated for many how critical abortion care is for all of us. For clinicians who care about their patients, for patients who may someday need an abortion and for the people that love them.
“Depriving patients of evidence-based care is unacceptable.”
Idaho’s abortion law had an immediate effect on hospitals in the state. On January 5, the Supreme Court lifted an injunction so Idaho no longer had EMTALA protections for pregnancy complications. St. Luke’s, the state’s largest provider of emergency services, said in April it had to send six pregnant patients from its emergency department out of state via air transport to protect their health.
The year before, when the injunction was in effect, the hospital had to do this only once.
Meegan said the law hasn’t just hurt patient care. Physicians have told the group that they are leaving the state because they don’t feel that they can practice medicine in a way that’s consistent with their ethical obligations, training and judgment.
“It’s an untenable situation,” Meegan said.
Dr. Kara Cadwallader, a doctor who works in Idaho and is a member of the Idaho Coalition for Safe Healthcare, said that even last week, her hospital had to send a pregnant person out of state for care even though they typically could have treated her. She said Wednesday she was “very excited” about the ruling, even if it is a “small step.”
“Beyond all the political reasons, it’s incredibly important for pregnant patients here in Idaho, who now will be able to access emergency care appropriately,” Cadwallader said.
US Department of Health and Human Services Secretary Xavier Becerra said that with this decision, the Biden administration will continue to uphold the law and the right to emergency care. The administration also plans to make it easier for someone who is denied care to be able to file a complaint.
“When the Court overturned Roe v. Wade, it unleashed an unprecedented assault on reproductive rights, and every day we see the consequences,” Becerra said in a statement. “Under President Biden’s leadership, we have worked directly with providers, hospitals, and community leaders across the country to navigate the chaos that the decision introduced.”
Still, abortion regulations around the country are murky. Professor Elizabeth Sepper, of the University of Texas at Austin School of Law, said that “in every other state with an abortion ban, confusion will continue to reign.”
“Even where states have ‘health’ exceptions in their laws, they typically are narrower than what EMTALA requires,” Sepper wrote in an email.
Forty-one states have abortion bans in effect with only limited exceptions, and 14 states have total bans. Around the country, doctors are confused about what they are allowed to do, said Amy Hagstrom Miller, founder and CEO of Whole Woman’s Health, a privately owned health care company that provides abortion care.
“So this isn’t only about Idaho. This is really something that all eyes and ears are watching from multiple states across the country to try to figure out what we’re able to do to provide basic health care, even if abortion has been restricted,” Hagstrom Miller said.
“Abortion saves lives. Abortion is absolutely necessary, oftentimes in emergency room settings to protect the health of the pregnant person. I think providers really understand that their hands have been tied post-Roe here, since the Dobbs decision, in numerous states and numerous parts of the country.
Standard care for a woman who needs an emergency abortion does not vary from state to state, said Dr. Nisha Verma, an obstetrician-gynecologist at Emory University in Georgia. However, she said, the kind of care a patient will receive is totally dependent on where she lives.
The Supreme Court’s decision in this case did not address the medical complexities this kind of care requires, and it will lead to confusion, fear and delays in what can be life-saving care, she said.
“What we had really hoped for is the Supreme Court to come down very firmly that doctors should be able to provide care for patients, including in emergency situations where abortion care can often be needed to stabilize patients. I think that working here in Georgia, we are constantly in a state of confusion trying to navigate incredibly confusing laws with exceptions that just don’t make sense on the ground, that don’t take into consideration all of the complexity that we deal with every day,” Verma said.
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The ruling does not change the situation in Texas, reproductive legal advocates say. Texas sued the US government over EMTALA guidance, and in 2022 a federal judge allowed the EMTALA to be blocked. The federal government has asked the Supreme Court to review the law. That case could potentially go before the Supreme Court next term.
“We should have never been in a place where states like Idaho, Texas, and others across the country could have state bans that seek to ignore federal law, forcing providers to forfeit their best medical judgment and second guess the care they can provide out of fear of criminalization and other penalties,” Alexis McGill Johnson, president of Planned Parenthood said at a news conference Thursday. She called Thursday’s decision “supreme gaslighting” that will allow the court to come back to the decisions down the road, “perhaps leaving it for when it’s more politically convenient.”
“Our bodies, lives and futures are still under deliberation,” McGill said.
Alexa Kolbi-Molinas, deputy director of the ACLU’s Reproductive Freedom Project, said she sees Idaho as a “very cruel case study” of what happens when the law strips pregnant people of their right to emergency abortion care. She said Wednesday that she was disappointed in the ruling because the court had the opportunity to uphold a law that gives everyone access to care — but failed to do so.
“The right to emergency care is perhaps one of the most basic rights there is,” Kolbi-Molinas said. “We were fighting for scraps in this case, and even with that, a majority of the Supreme Court was not willing to recognize the humanity of pregnant people, that they would be entitled to this basic right to emergency care.”