Court Dismisses the Case, Kicking Emergency Abortion Access Questions Down the Road and Forcing Pregnant Patients to Face the Consequences

On June 27, 2024, the United States Supreme Court released an opinion in a case called Moyle v. United States (combined with Idaho v. United States). The question in the case was whether a federal law called the Emergency Medical Treatment and Labor Act (EMTALA) “preempts,” or overrides, Idaho’s state abortion ban. The Supreme Court dismissed the case for being “improvidently granted,” meaning that the Court never should have taken the case in the first place. By refusing to issue an opinion on the merits of the case, the Court failed to clarify when doctors in states with abortion bans can legally provide emergency abortion care. Because of this, thousands of pregnant people may not be able to access health-preserving or life-saving abortion care. 

EMTALA is a federal law that requires doctors to provide stabilizing treatment to patients experiencing medical emergencies when their health or their life is in danger. In some cases, an abortion may be the best stabilizing treatment for a pregnant person experiencing a medical emergency. When this is true, EMTALA requires doctors to provide that treatment.

When the Supreme Court held that Americans no longer had a federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization (2022), Idaho’s “trigger” ban on abortion went into effect. The Idaho abortion ban makes it illegal for a doctor to provide an abortion unless the pregnant person’s life is in danger.

The U.S. Department of Justice (DOJ) challenged the abortion ban in federal court. The DOJ argued that the Idaho abortion ban conflicted with EMTALA, and therefore the Idaho abortion ban was preempted. The laws directly conflict because the Idaho ban prohibits abortion unless the pregnant person’s life is in danger, while EMTALA requires doctors to provide an abortion if it is the best treatment to stabilize a person whose health (not just their life) is in danger. This conflict meant that doctors in Idaho were uncertain when they could legally provide an abortion, which forced them to wait until a patient was on the brink of dying before offering an abortion.

The federal District Court found that the DOJ was likely to win its case, so it issued an order that paused the enforcement of Idaho’s abortion ban until the final decision in the case. The Supreme Court decided to hear the case to decide if Idaho could keep enforcing its abortion ban since it directly conflicted with EMTALA. The Court allowed Idaho to enforce its abortion ban for five months while this case sat on the Court’s docket. 

The Supreme Court did not decide the case based on the facts and the law. The Court dismissed the case for being “improvidently granted,” meaning that the Court never should have taken the case in the first place. Justice Barrett noted that the Court first took the case believing that Idaho faced harm if the Supreme Court did not step in.  This was based on the Court’s acceptance of Idaho’s arguments that: (1) the DOJ’s interpretation of EMTALA would require doctors to provide abortions when the pregnancy posed a threat to a pregnant person’s mental health, making it difficult to enforce the abortion ban and (2) that EMTALA would require doctors to provide abortions despite their conscience objections.

During briefing and oral arguments, the DOJ clarified that its interpretation of EMTALA did not require doctors to provide abortions in either of these situations. As such, the Supreme Court decided that it had granted review too early, and the parties needed more time to develop their cases in the lower courts. 

Now, Idaho cannot enforce its abortion ban until the case is decided. The problem with the Supreme Court’s dismissal is that doctors in states with abortion restrictions that conflict with EMTALA still do not know when they can legally provide abortions. In addition, real harm has occurred in Idaho in the five months that the Supreme Court allowed the abortion ban to take effect. 

In March, DREDF, Women Enabled International, Legal Voice, and the law firm of Covington & Burling, LLP filed an amicus brief in support of the DOJ highlighting the importance of this case to the disability community. The brief noted that disabled people are at significantly higher risk for almost all severe negative pregnancy outcomes and are eleven times more likely to die during childbirth than non-disabled people. People with disabilities also experience more barriers to obtaining medical care which may exacerbate these outcomes. As such, disabled pregnant people may be more likely to need access to the emergency stabilizing abortion care that EMTALA protects. 

The Court’s refusal to clarify when doctors can legally provide abortion care means that thousands of pregnant people and doctors in states with abortion restrictions that conflict with EMTALA are stuck in limbo. Pregnant people will continue to face unnecessary barriers to getting the emergency abortion care they need. For example, while the abortion ban was in place, the number of pregnant patients who were airlifted out of the state for emergency abortion care skyrocketed. Since disabled people are at significantly higher risk of severe negative pregnancy outcomes, people with disabilities will be disproportionately affected by barriers to emergency abortion care access. In addition, Justice Alito’s dissent opposed any interpretation of EMTALA that would allow a pregnant person to receive an emergency abortion for mental health reasons, even if their life was in danger.

Since the Supreme Court dismissed the case without releasing an opinion, the case will continue in the lower courts. Idaho may not enforce its abortion ban until the case is decided. Still, this ruling is NOT a win for reproductive rights.

As Justice Ketanji Brown Jackson wrote, “[t]oday’s decision is not a victory for pregnant patients in Idaho. It is a delay. While this Court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires. This Court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it.”

The fight to ensure abortion access does not end when this Supreme Court term ends. This dismissal only pushes the issue down the road, and it will continue to put people living in states with abortion restrictions in danger until it is resolved. DREDF believes everyone should have access to safe, affordable, accessible, culturally competent abortion care, and the ability to get an abortion should not hinge on the existence of a medical emergency. In light of this, DREDF is committed to continually fighting to protect the bodily and decisional autonomy for disabled and non-disabled Americans alike.