A divided Supreme Court heard oral arguments on Wednesday in a case that will determine whether federal law requires pro-life states to have broader exceptions for women who seek abortions in emergency situations. 

The crux of the case focuses on whether Idaho’s Defense of Life Act conflicts with a federal rule that requires hospitals to provide stabilizing health care that is consistent with standard medical practice in certain emergency situations.

The Department of Justice (DOJ) filed a lawsuit that argues Idaho’s law prevents hospitals from providing this care in some situations because it only allows abortions in cases of rape and incest and when “necessary to prevent the death of the pregnant woman.”

The lawsuit, Moyle v. United States, is based on the Emergency Medical Treatment and Labor Act (EMTALA), which Congress enacted in 1986 to ensure that everyone has access to emergency medical care even if they can’t afford to pay for that care. 

Under EMTALA, hospitals that receive Medicare funds must provide stabilizing care when the absence of care could put the patient’s health in serious jeopardy or cause the impairment of bodily functions or serious dysfunction of bodily organs. The law does not specifically reference abortion, but the Department of Justice is arguing that an abortion will sometimes be the standard care necessary to meet these rules.

According to the DOJ, Idaho’s threshold for when it permits abortion is too strict, because it only permits abortions when necessary to prevent the death of the mother and does not include any exceptions that would cover the other health risks considered in EMTALA.

The Supreme Court’s decision in this case could have far-ranging effects on protections for unborn children in Idaho and more than 20 other states that have passed pro-life laws in the past few years.

Idaho Claims There Is No Conflict

In oral arguments presented to the justices, Idaho’s lawyer, Joshua Turner, said Idaho’s law does not conflict with EMTALA in any way and claimed the DOJ is “misreading” the statute when it makes that assertion.

Turner argued that states can legally regulate the practice of medicine and that they frequently impose such regulations. As an example, he noted that states control medical licensing and the legality of certain treatments. He referenced the different approaches among states related to how long a doctor can prescribe opioids to someone who is dealing with chronic pain and said there are “countless examples” of this.

The DOJ’s interpretation, according to Turner, would prevent the state from enforcing any of these regulations because it “lacks any limiting principle” and essentially “leaves emergency rooms unregulated under state law.” He further said that proper “professional standards” change from day to day and that it is limited to available treatments, according to the text: “Illegal treatments are not available treatments.” 

Turner added that the provisions in EMTALA have never been used to challenge a state regulation or criminal statute. He claimed that for EMTALA to override a state’s criminal law, it would need to be very clear. 

“Congress must speak clearly,” Turner said. “It has not done so here.”

Some of the judges challenged Turner on his interpretation and probed him with questions about when abortions would be allowed under Idaho’s law. Justice Elena Kagan argued with Turner about whether EMTALA was clear, claiming “the federal government has plenty to say about [when care must be provided] in this statute.”

Justice Sonia Sotomayor pressed Turner with questions about whether Idaho’s law would permit an abortion in various hypothetical situations. Turner said the law permits an abortion when the life of the mother is threatened, which is based on “the doctor’s good-faith medical judgment,” but was repeatedly interrupted when he sought to explain further.

The line of questioning and frequent interruptions provoked the ire of Justice Samuel Alito, who commented that Turner was presented with quick hypotheticals and “asked to provide a snap judgment of what would be appropriate” and “hardly given an opportunity to answer.”

DOJ Asserts Abortion Is Covered Under EMTALA

U.S. Solicitor General Elizabeth Prelogar, who provided the legal arguments on behalf of the DOJ, said Idaho’s law conflicts with the text of EMTALA, which has real implications for what is “happening on the ground.” She asserted that Turner is “gravely mistaken” in saying that there is no conflict. 

“This case is about how [EMTALA] applies to pregnant women in a medical crisis,” Prelogar said. 

Prelogar challenged Turner’s interpretation that the DOJ’s position would threaten all state medical regulations, asserting that EMTALA is “textually very narrow.”

According to Prelogar, if abortion is necessary to provide stabilizing care for a woman under the conditions set in EMTALA, “the statute protects her and gives her that choice.” She said the patient must “be offered pregnancy termination [when it is] the necessary treatment.”

Some of the justices challenged Prelogar’s interpretation of the law. Justice Clarence Thomas noted that EMTALA imposes a rule on hospitals as a condition to receive Medicare funding but that the law does not make demands of the state. 

“In this case, you are bringing an action against the state, and the state’s not regulated,” Thomas said.

Thomas and other judges noted that EMTALA concerns spending and questioned Prelogar on whether it would preempt a state’s criminal laws. 

“Congress has broad power under the spending clause to impose [these rules],” Prelogar responded. 

The judges also questioned Prelogar about whether EMTALA respects conscience objections made by doctors and hospitals who have moral objections to providing abortions, and she said those protections are still in place. They also asked her whether a mental-health crisis could ever permit an abortion under EMTALA, to which she replied that abortion is “not the accepted standard of practice to treat any mental-health emergency.”