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Idaho abortion decision leaves both sides in long-term limbo

Decision centers on a 1986 law that requires hospitals to provide “necessary stabilizing treatment” and whether that can include abortion

Women’s March holds a 'die-in' outside of the Supreme Court before the court’s oral arguments in Moyle v. United States in Washington on April 24.
Women’s March holds a 'die-in' outside of the Supreme Court before the court’s oral arguments in Moyle v. United States in Washington on April 24. (Bill Clark/CQ Roll Call)

The Supreme Court’s decision that Idaho’s near-total ban on abortions does not preempt federal rules requiring certain treatment in emergency rooms is the second major ruling to bolster the Biden administration on abortion rights since the overturn of Roe v. Wade.

The ruling, at least for now, also preserves a key tool the Biden administration has increasingly relied upon since the Supreme Court overturned Roe v. Wade on June 24, 2022 — a 1986 law known by the acronym EMTALA that requires hospitals to provide “necessary stabilizing treatment” to all patients as a condition of receiving Medicare funding.

The Biden administration issued guidance in 2022 clarifying that patients in states with bans on most abortions are entitled to emergency abortions in their states in critical medical situations. 

President Joe Biden Thursday praised the decision, saying it ensured that women “can access the emergency medical care they need while this case returns to the lower courts.”

He and other Democrats have made reproductive health their top campaign issue for 2024.

“The stakes could not be higher and the contrast could not be clearer. My Administration is committed to defending reproductive freedom and maintains our long-standing position that women have the right to access the emergency medical care they need,” said Biden in a statement.

If former President Donald Trump is elected in November, this interpretation of the 1986 law could change. Project 2025, which has been vetting individuals and providing policies for a possible transition to a Trump administration, has urged rescinding this interpretation of the law. 

Some advocates expressed dismay that the decision may only temporarily clarify the law’s interpretation.

Stella M. Dantas, president of the American College of Obstetricians and Gynecologists, said she was “truly disappointed that this decision affords no long-term clarity of the law for doctors.”

“Litigation on this topic will undoubtedly continue,” said Dantas. “We urge the courts to affirm the availability of stabilizing emergency abortion care in every single state.”

Idaho Chief of Constitutional Litigation and Policy Josh Turner, who argued the case for the state, said that while the court decided to “punt” on the merits of the case, he had “zero doubt” that the Idaho law was not preempted by federal law and “will be vindicated in full.”

As in a case preserving the Food and Drug Administration’s ability to regulate abortion drug mifepristone, the decision was met with cautious praise from reproductive rights advocates and Democrats, who said it left them in limbo.

[Related: Advocates see ‘temporary’ victory in abortion drug ruling]

“The justices had an opportunity to take a legitimate stand on the right to basic, life-saving health care that includes abortion and instead chose to do the bare minimum, dismissing the case and returning it to the lower courts for further litigation,” said Oriaku Njoku, executive director for the National Network of Abortion Funds.

“While the women of Idaho can breathe a sigh of relief today, the Supreme Court has senselessly declined to affirm the universal right to emergency medical care. The fact that this is still in question underscores the dark reality of post-Roe America,” said House Democratic Whip Katherine M. Clark.

“Today is a minor reprieve, but pregnant women and doctors nationwide deserve the certainty of the Court validating emergency abortion care,” said Rep. Judy Chu, D-Calif.

Conservatives also said there was an opportunity for additional action.

“Abortion is not medical care. Even if the Court ultimately allows the Biden administration and its abortion lobbyists to twist federal laws … policymakers can correct this horrible outcome,” said The Heritage Foundation’s Sarah Parshall Perry and Melanie Israel in a joint statement. 

But Sen. Bill Cassidy, R-La., the ranking Republican on the Senate Health, Education, Labor and Pensions Committee, said the 1986 law “was clearly intended to protect both pregnant women and their unborn children.”

“Every state in the country allows for doctors to treat a woman experiencing an ectopic pregnancy, miscarriage, or other life-threatening condition,” he said. “That is called health care, not an abortion. Yet, the Biden administration continues to fearmonger for election year politics.”

Voter impact

The decision, which remands the case to the 9th Circuit Court of Appeals, means that the issue isn’t over. A separate case regarding the 1986 law, State of Texas v. Becerra, is still ongoing.

The ruling could give the Democrats fodder for what has become their key 2024 campaign argument, but they will need to maintain energy on the issue after the two recent Supreme Court wins on abortion rights.

The Biden campaign released a new ad Thursday messaging on protecting physicians and patients in emergency situations that require an abortion.

“When you’re the only person in the emergency room at 2 in the morning, and someone comes in hemorrhaging, and they are pregnant, you’re responsible,” reads OB-GYN Lauren Miller in the ad. Miller left Idaho because of the abortion ban, according to the Biden-Harris campaign.

Some argue the decision could affect voter motivation, regardless of party.

“While this litigation continues, it’s a reminder and a wake-up call that the stakes of the coming election are higher than ever for unborn children and their mothers,” said SBA Pro-Life America President Marjorie Dannenfelser. “That is why we are working relentlessly to reach 10 million voters — with 4 million visits directly to their homes — across eight key battleground states that will determine who has control in Washington.”

“The Supreme Court’s ruling that preserves EMTALA in Idaho aligns with the public’s overwhelming concern and underscores the vital role this law plays in protecting patients’ lives,” said Lindsay Vermeyen, a partner at Benenson Strategy Group, a Democratic polling firm.

Her firm’s survey found that the case was important to 77 percent of respondents, and 80 percent of respondents would be more motivated to vote in November if the Supreme Court ruled against federal law protecting emergency abortions.