Supreme Court officially allows emergency abortions in Idaho — for now

Hospitals in Idaho that receive federal funds must allow emergency abortion care to stabilize patients even though the state strictly bans the procedure, the Supreme Court ruled on Thursday, one day after the opinion was prematurely posted on its website.

The court’s unsigned decision does not address the substance of the case. Instead, while litigation in the matter continues, the justices temporarily reinstated a lower court ruling that had allowed hospitals to perform emergency abortions without being subject to prosecution under Idaho’s abortion ban.

At issue is the nearly four-decade-old Emergency Medical Treatment and Labor Act, known as EMTALA, which requires certain hospitals to stabilize or transfer patients needing emergency care.

The Biden administration sued Idaho in 2022, saying the state’s strict abortion ban conflicts with federal law that requires emergency abortions if needed to address threatening health conditions short of death, such as organ failure or loss of fertility.

Abortion rights groups cast the ruling as a temporary victory that ensures emergency care in Idaho for now but does not settle the question of whether federal law preempts strict state bans, including in other states.

The Idaho case was one of two before the high court this term to address abortion access nationwide two years after the justices overturned Roe v. Wade, which had guaranteed a constitutional right to abortion. The justices in early June unanimously rejected a challenge to the widely used abortion medication mifepristone, saying the antiabortion doctors who brought the lawsuit did not have standing to do so.

The Biden administration first turned to EMTALA in late 2021 as a way to try to ensure access to abortion in limited situations. That effort ramped up after the Supreme Court struck down Roe the following summer.

In July 2022, the administration told hospitals receiving Medicare funds that emergency room doctors must terminate pregnancies in some circumstances, even if a state’s law bars the procedure. Hospitals that do not comply face penalties of up to $120,000 per violation.

The White House and abortion rights advocates say the administration is applying the emergency-care law as originally designed, pointing to years-old cases they say show a consistent pattern of enforcement.

Idaho bans all abortions except those necessary “to prevent the death of the pregnant woman” and imposes penalties of up to five years on doctors who perform the procedure. There have been harrowing reports of hospitals turning away women with high-risk pregnancy complications. Health-care workers have reported uncertainty and confusion about when state abortion bans apply, resulting in delays for some procedures.

Conservatives and abortion opponents say the administration is twisting EMTALA’s intent to secure abortion access post-Roe.

The text of the federal statute requires hospitals to offer “any individual” with an emergency medical condition “such treatment as may be required to stabilize the medical condition.” There is no reference to abortion in the statute or to any other type of care, and GOP officials say the Biden administration cannot use EMTALA to force hospitals that receive federal funds to violate a state law.

Lower courts had issued conflicting decisions about the application of the federal law. A district judge in August 2022 sided with the Biden administration and temporarily blocked the contested provision of the Idaho law. The judge left the state’s ban on most abortions in place but said that because of the obligation of hospitals under conflicting federal law, a doctor cannot be punished for performing an abortion to protect a patient’s health.

Then a three-judge panel of the U.S. Court of Appeals for the 9th Circuit allowed the state to enforce the law — before a full complement of judges on the same appeals court again blocked Idaho’s ability to punish emergency room doctors while the appeals continued.

The Supreme Court in January agreed to take the case, Idaho v. United States, in response to Idaho’s emergency request and allowed the law to take effect while litigation continued.

This is a developing story. It will be updated.

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