States’ Abortion Fight With Biden to Continue After Idaho Ruling

The Supreme Court’s decision to let emergency abortions temporarily continue in Idaho sets the stage for more lawsuits in the battle between states and the Biden administration over whether federal requirements ultimately trump state reproductive laws.

Whether the Emergency Medical Treatment and Labor Act overrides state abortion bans is a question the justices left unresolved in Thursday’s Moyle v. United States. The justices’ decision reinstates a federal court order allowing Idaho hospitals to perform emergency abortions and sends the case back to the US Court of Appeals for the Ninth Circuit.

While the Supreme Court outcome marks a temporary reprieve for Idaho physicians and abortion-seeking patients, policy watchers say it only delays the preemption fight, a critical issue for the future of abortion in the US. Attorneys say the justices’ current indecision on how state laws square up against EMTALA means the patchwork of abortion access across the country will continue until the question comes back before the court.

“There’s going to be inconsistent application of EMTALA across the country because the court decided against making a final judgment about what it means,” said Laura Portuondo, a reproductive and constitutional law professor at the University of Houston Law Center.

Idaho is one of 14 states that completely bans abortion with limited exceptions that physicians and medical groups say allow little flexibility for providing emergency abortion care.

“They are essentially allowing EMTALA to govern in Idaho, but in the rest of the country, they’re essentially allowing EMTALA to be superseded by state law,” Portuondo said.

Among the states with complete bans is Texas, which is challenging the Biden administration over EMTALA as well. The administration has since urged the Supreme Court to wade into that fight.

State Battles

The lack of clarity on EMTALA leaves it open for courts to review whether abortion bans in Idaho, Texas, and elsewhere still allow providers to meet the federal law’s requirement to provide “necessary stabilizing treatment for emergency medical conditions and labor.”

Both the Biden administration and Idaho say the battle between state and federal reproductive policies is set to continue.

Health and Human Services Secretary Xavier Becerra said in a statement that the administration would “continue to uphold the right to emergency care,” and that it stands by the position that EMTALA requires patients get necessary treatment “irrespective of any conflicting state laws or mandates.”

Meanwhile, Idaho Attorney General Raúl Labrador said in a press conference that he expects the case will return to the Supreme Court “in some form,” noting the Texas case as an example.

“Whether it’s a combination of both cases, or whether it’s the Texas case or the Idaho case, I think this issue will definitely go before the Supreme Court again,” Labrador said.

In Texas, abortion is completely prohibited, with an exception for conditions that a physician has certified would place a patient “in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.”

The Texas Medical Board on June 21 issued guidance to physicians attempting to clarify the law’s emergency exception, but physicians and health groups continue to argue that the law in Texas and other states is limited in addressing the wide range of circumstances that would lead a physician to perform emergency abortions.

“There’s been a tremendous chilling effect,” on physicians providing reproductive health care, Molly Meegan, chief legal officer of the American College of Obstetricians and Gynecologists (ACOG), said in a press call Thursday.

Texas has directly taken issue with the Biden administration’s views on EMTALA.

In 2022, shortly after the Supreme Court stripped federal abortion protections, the HHS put out a guidance document laying out its EMTALA position. Texas then sued.

The US Court of Appeals for the Fifth Circuit blocked the HHS from enforcing the document, and the Biden administration appealed to the US Supreme Court.

Texas is “the next frontier” for the state preemption battle as “the case is already teed up,” said Jaime Santos, partner at Goodwin. Though she said the battle will likely play out in other cases as well.

And with other states having heightened abortion restrictions, Santos said it’s likely the government hadn’t sued them given that the Idaho and Texas cases were pending. “The results of Moyle was probably going to dictate what happened nationwide, so there was no point starting new lawsuits,” she said.

“Now that Moyle is kind of back in flux, I think we could see more lawsuits brought in other states, or we could see the government try to kind of vigorously continue to litigate this in the Fifth and Ninth Circuits,” Santos said.

Legal Fights Ahead

The Supreme Court’s ruling does provide temporary relief for abortion providers, but a long battle lies ahead, said Stella Dantas, ACOG’s president and an Oregon-based obstetrician–gynecologist.

The decision “does not reflect the Supreme Court asserting the sanctity of the patient-physician relationship,” Dantas said in a press call.

The federal government’s willingness to continue fighting state abortion bans, however, will depend on who is in the White House in 2025, said Mary Ziegler, a professor at the University of California, Davis School of Law.

“If you have the Trump administration, they’re likely to withdraw the EMTALA guidance and kill any ongoing litigation,” Ziegler said.

The Heritage Foundation’s Project 2025, which lays out a number of policy priorities for a Republican presidential administration, calls on the Department of Health and Human Services to rescind the EMTALA guidance, and “end investigations into cases of alleged refusals to perform abortions.”

“EMTALA requires no abortions, preempts no pro-life state laws, and explicitly requires stabilization of the unborn child,” Roger Severino, who served as the director of the HHS Office for Civil Rights under President Donald Trump, wrote in the group’s HHS policy document.

In the meantime, the Biden administration’s Centers for Medicare & Medicaid Services—which enforces EMTALA—issued a statement Thursday setting that people who believe their rights were violated should report them to the agency, or their state’s survey agency.

“I have personally spoken to women who were denied this essential health care, and their health suffered as a result,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “CMS will continue to enforce these protections, to the maximum extent permitted under federal law.”

The Supreme Court’s conservative wing, however, seems from their writing in the Idaho case willing to “allow state policy to trump what ultimately should be the supreme federal authority on the question of abortion,” Portuondo said.

“They’re evidencing a willingness and desire to leave this up to states, particularly when those states are making policies that are restricting abortion,” she said.