Supreme Court Punts Idaho Abortion Case Back to Lower Courts

The U.S. Supreme Court has declined to resolve the issues in a case involving emergency abortion care for Idaho women and instead sent it back to lower courts for consideration.

The decision reinstates a lower-court ruling that paused the state's near-total abortion ban.

The federal government argued that the Emergency Medical Treatment and Labor Act, or EMTALA, supersedes Idaho's Defense of Life Act, which criminalizes abortion except if the physician determines in good faith that it would prevent death. Idaho subsequently amended its law to exempt certain conditions such as an ectopic pregnancy, but it does not have an exception for abortions necessary to prevent serious risks or consequences to women's health, such as the loss of fertility.

The EMTALA requires Medicare-funded hospitals to provide essential care to patients experiencing medical emergencies (42 U. S. C. §1395dd). In 2022, the Department of Health and Human Services issued guidance to Medicare-funded hospitals stating that if "abortion is the stabilizing treatment necessary to resolve" a pregnant woman's emergency medical condition, they "must provide that treatment." The guidance further stated that any conflicting state law is preempted.

Prior to the Idaho law's effective date, the federal government sued the state. The U.S. District Court ruled for the federal government and entered a preliminary injunction against Idaho. A three-judge panel of the 9th U.S. Circuit Court of Appeals granted a stay of a district court decision, and the government filed an emergency motion with the 9th Circuit for rehearing by the full court. The appeals court granted the motion and vacated the panel decision.

Before the appeals court could rule, however, Idaho filed a writ of certiorari before judgment to the Supreme Court, which granted it. A grant of certiorari before judgment presumes that a case is so important that the ordinary judicial process should be circumvented and the case should be immediately decided by the Supreme Court.

On Thursday, the Supreme Court decided 6-3 that it shouldn't have granted the writ and vacated its stays associated with the case. The decision sends the case back to the lower courts for consideration.

The Supreme Court further identified the issues that the lower courts must decide: whether EMTALA requires Medicare-funded hospitals to perform abortions "or any other treatment forbidden by state law as necessary and stabilizing care," and whether Congress can require recipients of federal funds to violate existing state law.

Susan Frederick is NCSL's senior federal affairs counsel.