Conflict Between State and Federal Abortion Ban Laws Heads to U.S. Supreme Court

In June 2022, the U.S. Supreme Court overturned the 1973 Roe v. Wade ruling which legalized abortion nationwide. Since then, several states have adopted Republican-backed bans that threaten medical practitioners with license revocation and criminal penalties if they perform abortions. 

On Wednesday, the court will hear arguments in a case between a federal law that ensures patients can receive emergency care and Idaho’s strict abortion ban. The court which has a conservative 6-3 majority will be forced to revisit the legal distress it created with its 2022 Dobbs v. Jackson Women’s Health Organization ruling that ended Roe.

Idaho is appealing the decision made by a judge in a 2022 lawsuit by Biden’s administration that said the Emergency Medical Treatment and Labor Act (EMTALA) (a 1986 federal law) takes precedence over state law.

“The Supreme Court is having to reckon with, yet again, litigating abortion rights in an era that the majority opinion in Dobbs suggested would return it to the states and out of the courts,” said Rachel Rebouché, dean of the law school at Temple University in Philadelphia. “In the cross-hairs here are providers, many of whom just want to deliver care and know it's legal.”

According to EMTALA, hospitals receiving funding under the federal Medicare program must “stabilize” patients with emergency medical conditions. The contention at the moment is whether the strict abortion ban in Idaho should yield to EMTALA when a doctor deems abortion necessary in “stabilizing care”.

Idaho’s abortion ban is one of the strictest in the country

After Roe’s reversal, Idaho’s infamous “trigger” law took effect automatically. The law was passed by the Republican-led state legislature and signed by Republican Governor Brad Little in 2020. The law forbids all forms of abortions except when it is a necessary procedure to prevent a mother’s death. According to a U.S. Justice Department filing, Idaho is one of the seven states in the country with no exception to protect pregnant patients’ health. 

Some Idaho doctors have criticized the strict abortion ban in the state. Doctors in the state face two to five years imprisonment or medical license revocation if found guilty of performing what the state’s law terms “criminal abortion”.

Earlier this month, Amelia Huntsberger, an obstetrician-gynecologist who practiced in Idaho for ten years before packing to Oregon due to the strict abortion law wrote an open letter to Idaho’s legislature saying, “Criminalization of doctors providing healthcare is dangerous for patients, for doctors and for our communities”.

In just 15 months after the abortion ban took effect in Idaho, the number of obstetricians dropped to 210 from 268 as reported by Idaho Physician Well-Being Action Collaborative, an organization founded by doctors in the state.

The conflict between Idaho’s abortion ban and EMTALA

Several emergency conditions can threaten the woman’s life and health. National groups representing gynecologists, obstetricians, and emergency physicians listed some of the emergency conditions to the Supreme Court, including excessive bleeding and gestational hypertension.

According to the groups, emergency abortion can help stabilize the patient to prevent loss of the uterus, vital organ damage and failure, or seizure. However, Idaho’s law only allows abortion to prevent the woman’s death. That makes it hard for physicians to comply with the state’s law and EMTALA.

“At what point,” they asked in their filing, “does the condition of a pregnant woman with a uterine hemorrhage deteriorate from health-threatening to the point that an abortion is ‘necessary’ to prevent death? When is it certain she will die but for medical intervention? How many blood units does she have to lose?”