Shanae Smith-Cunningham’s arrival at Memorial Regional Hospital on December 21, 2022, presented a life-threatening situation. Despite her water breaking five days prior, she was only halfway through her pregnancy. Hospital staff in Hollywood, Fla., denied her pleas for treatment, citing Florida’s new abortion restrictions.
The decision to send Smith-Cunningham home endangered her life, according to health officials. It also violated the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals receiving federal funds to provide emergency care regardless of a patient’s insurance status or other factors.
In October 2023, the Centers for Medicare and Medicaid Services (CMS) warned Memorial Regional to take corrective steps or risk losing hundreds of millions of dollars in federal funding. The Supreme Court will hear arguments on Wednesday regarding the Biden administration’s authority to impose penalties on hospitals like Memorial Regional that fail to provide emergency abortions.
The case centers on whether the White House can apply the nearly 40-year-old EMTALA law to justify access to abortions in emergency situations. The Biden administration insists it needs this authority to protect women’s health, citing the confusion and delays in lifesaving care caused by state abortion bans.
Conservatives counter that the administration is twisting the law, which does not specifically mention abortion. They argue that hospitals should have the authority to make such decisions.
The Supreme Court’s decision will hinge on the interpretation of EMTALA’s text. A narrow interpretation favoring states’ rights could empower them to pick and choose how to apply the federal emergency-care law beyond abortion.
The case has raised concerns among health experts, particularly after the White House lost twice in federal appeals court. Some Biden officials anticipate a defeat at the Supreme Court as well.
The Biden administration turned to EMTALA in late 2021 as a way to ensure access to abortion in limited situations. CMS issued guidance to hospitals that emergency room doctors must terminate pregnancies in some circumstances, even if state law prohibits the procedure.
The administration has also challenged Idaho’s strict abortion law, which bans all abortions except to save the life of the pregnant woman. The Biden administration argues that EMTALA’s protections are broader than Idaho’s law and help protect against emergencies that can still have devastating effects, such as organ failure or loss of fertility.
Idaho’s physicians have received conflicting messages from federal courts. A district court judge initially blocked Idaho from punishing doctors who performed abortions to protect a patient’s health, but a three-judge panel of the U.S. Court of Appeals for the 9th Circuit allowed the state to enforce the law. A broader panel of 9th Circuit judges again blocked Idaho’s ability to punish emergency physicians, leading the Supreme Court to intervene in response to Idaho’s emergency request.
The conservative U.S. Court of Appeals for the 5th Circuit has ruled against the Biden administration in a separate case in Texas, stating that Texas hospitals and doctors are not obligated to perform abortions under EMTALA.
The Biden administration has been cautious about using EMTALA to penalize hospitals and enforce abortion access. Despite dozens of reported cases in which pregnant women were turned away from emergency care, only four instances have been identified where CMS officials formally warned hospitals of EMTALA violations and threatened their Medicare participation.
One of those hospitals, Memorial Regional, underwent two surprise inspections and was told to submit a plan of correction. Federal officials later determined that the hospital had successfully addressed its emergency-care issues and was no longer at risk of termination from Medicare.
Some health workers have welcomed the Biden administration’s stance on EMTALA, saying it has clarified their obligations. Others have expressed concerns about the potential for confusion and fear among healthcare providers.
Even Smith-Cunningham, the patient turned away by Memorial Regional, does not blame the hospital. She believes the government and its restrictive abortion laws are responsible for her experience.
The Supreme Court’s decision in this case will have significant implications for abortion access and the application of the Emergency Medical Treatment and Labor Act.
