Will the Emergency Medical Treatment and Active Labor Act (EMTALA) be overruled by state abortion laws? This question lies at the heart of a case the Supreme Court is set to address on Wednesday. EMTALA, a Reagan-era law, mandates that any hospital accepting Medicare (the majority of hospitals in the US) must provide stabilizing treatment to anyone who arrives at their doorstep.
In response to Roe v. Wade’s overturning, the Biden Administration emphasized that EMTALA encompasses stabilizing abortion care. This implies that hospitals are federally obligated to provide such care to pregnant individuals with medical emergencies that can only be resolved through an abortion, regardless of state prohibitions.
Idaho, however, maintains that state abortion laws should take precedence over federal guidance and that state politicians should have the authority to prohibit hospitals from offering emergency abortion care. Idaho’s abortion ban only makes an exception for abortions “necessary to prevent the death” of a pregnant woman, excluding abortions necessary to prevent damage or loss of reproductive organs.
“The federal government cannot use EMTALA to override in the emergency room state laws about abortion any more than it can use it to override state law on organ transplants or marijuana use,” said Idaho’s Republican attorney general, Raúl Labrador, in a petition to the Supreme Court.
Typically, federal law takes precedence over state law in such situations. However, after a district court ruled that Idaho doctors could continue to provide emergency abortions under EMTALA, the Supreme Court intervened and permitted the state’s ban to take effect pending a hearing on the case’s merits.
Since the Supreme Court allowed the Idaho law to take effect, the state’s largest hospital has transported at least six women out-of-state due to pregnancy complications, presumably to seek care that doctors are hesitant to provide under Idaho law. This number could reach 20 from that hospital alone by year’s end if pregnancy-related air transports continue at the current rate. Before the law went into effect last year, only one woman was transported for similar reasons.
“We have limited resources in terms of helicopters, fixed-wing transports, and ambulances,” stated Jim Souza, chief medical officer at St. Luke’s Medical Center in Boise, to States Newsroom. “If we occupy an air transport with a patient who could completely receive the totality of her care right here, safely, it’s potentially dangerous for other patients.”
A separate Idaho doctor who provided testimony in the case said that before the Dobbs decision, he encountered roughly a dozen cases annually where “pregnancy termination is the only medical intervention that can preserve a patient’s health or save their life.” However, under Idaho’s ban, a doctor can now face up to five years in prison for performing an abortion for any reason other than saving the patient’s life.
Since the Dobbs decision, roughly a quarter of Idaho’s OB-GYNs (22%) have left the state. According to an analysis by the Idaho Coalition for Safe Health Care, half of the state’s counties currently lack a practicing obstetrician.
Idaho is not alone in having providers who are concerned about the repercussions of providing standard-of-care treatment to pregnant patients. A report by Lift Louisiana and Physicians for Human Rights indicates that doctors in Louisiana are performing unnecessary C-sections and delaying miscarriage care to avoid the perception of providing an abortion. Doctors in that state face potential sentences of up to 15 years in prison and fines of $200,000 for violating the abortion ban.
According to documents obtained by the Associated Press, at least a dozen women have filed complaints about emergency pregnancy care nationwide since Dobbs. These complaints illustrate the profound suffering women have experienced after being denied treatment. Examples include a woman who miscarried in the ER bathroom in Marlin, Texas, after the hospital refused to admit her, and a woman who gave birth in her car in Roxboro, North Carolina, after being unable to access the necessary care at a hospital. Sadly, her baby did not survive.
On Wednesday, the Supreme Court will deliberate on whether doctors should be permitted to perform their duties without political interference or whether such tragedies will become commonplace in certain states.
