Supreme Court sidesteps ruling on emergency room abortion-access dispute

A group of doctors join abortion rights supporters at a rally outside the Supreme Court on April 24, 2024 in Washington, DC. Andrew Harnik | Getty Images

WASHINGTON — The Supreme Court on Thursday sidestepped a ruling on whether Idaho's strict abortion law conflicts with a federal law that requires stabilizing care for emergency room patients, including pregnant women suffering complications who may require abortions.

The court dismissed an appeal brought by Idaho officials, meaning a lower court ruling that allows doctors in the state to perform abortions in emergency situations remains in effect for now.

The decision, which leaves the legal question unresolved and has no impact in any other states, was widely expected after the Supreme Court on Wednesday inadvertently posted a copy online.

The court could take up the issue in a later case.

The case focuses on whether an exception in the Idaho law that allows for abortions when the life of the pregnant woman is in danger already allows for the kind of treatment required under the federal law.

The Biden administration argues that the state law would not allow for abortions when a woman is suffering from various health complications that are not necessarily immediately life-threatening.

The legal question is of importance not just in Idaho, but also in other states that have enacted similar bans that abortion-rights advocates say clash with the federal law because they do not include broad exceptions for the health of the mother.

But the court's failure to issue a ruling means confusion remains on whether the federal law trumps the state bans. In Idaho, the state's appeal of the lower court ruling will continue.

The litigation could get even more complicated if former President Donald Trump wins the election, as his administration could change its legal position and argue that the federal law does not conflict with state abortion laws.

The federal government said a handful of states would be affected if the court had issued a full ruling, while abortion opponents said a win for the Biden administration would potentially affect up to 22 states that have imposed abortion restrictions.

The Idaho abortion ban was enacted in 2020, with a provision stating it would go into effect if the Supreme Court overturned Roe v. Wade, the 1973 ruling that found women had a constitutional right to terminate a pregnancy.

The legislation, known as the Defense of Life Act, went into effect in 2022 when the Supreme Court rolled back Roe.

Idaho's law says anyone who performs an abortion is subject to criminal penalties, including up to five years in prison. Health care professionals found to have violated the law can lose their professional licenses.

The federal government sued, leading a federal judge in August 2022 to block the state from enforcing provisions concerning medical care that is required under the federal Emergency Medical Treatment and Labor Act, or EMTALA.

That 1986 law mandates that patients receive appropriate emergency room care. The Biden administration argued that care should include abortions in certain situations when a woman's health is imperiled even if death is not imminent.

The government and abortion rights groups cited as examples women whose water breaks early in a pregnancy, putting them at risk of sepsis or hemorrhage.

The federal law applies to health care providers that receive federal funding under the Medicare program.

The Idaho law includes an exception if an abortion is necessary to protect the life of the pregnant woman, although the scope of the exception was heavily contested in the litigation.

The Supreme Court in January allowed Idaho to enforce the provisions while agreeing to hear oral arguments in the case. Other provisions of the ban are already in effect and are not affected by the court's latest decision.

In blocking parts of the state law that conflict with federal law, U.S. District Court Judge B. Lynn Winmill described the state's actions as putting doctors "on the horns of a dilemma."

The 9th U.S. Circuit Court of Appeals, based in San Francisco, briefly put Winmill's ruling on hold in September, but it subsequently allowed it to go back into effect, prompting the state officials to turn to the Supreme Court.

The emergency room dispute is one of two abortion cases the Supreme Court considered this term, both of which arose in the aftermath of the 2022 decision to overturn Roe. In the other, the court rejected a challenge by anti-abortion doctors to the Food and Drug Administration's lifting of restrictions on mifepristone, the drug most commonly used for medication abortions.