Moyle v. United States
603 U.S. 324 (2024)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
The federal Emergency Medical Treatment and Labor Act (EMTALA) requires Medicare-funded hospitals to provide stabilizing treatment, which may include abortion, for any emergency medical condition that places a pregnant patient's health in serious jeopardy, and this federal requirement may preempt state laws that only permit abortions when necessary to save the patient's life.
Facts:
- Idaho enacted the Defense of Life Act, which criminalizes performing or attempting to perform an abortion, with an exception for abortions a physician determines in 'good faith medical judgment' are 'necessary to prevent the death of the pregnant woman.'
- The federal Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals that accept Medicare funding to provide necessary 'stabilizing treatment' to any individual with an 'emergency medical condition.'
- EMTALA defines an 'emergency medical condition' as one with acute symptoms such that the absence of immediate medical attention could reasonably be expected to result in 'placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.'
- A conflict arises in medical situations where an abortion is necessary to prevent grave harm to a pregnant woman's health—such as loss of fertility or organ failure due to conditions like PPROM or preeclampsia—but is not yet deemed necessary to prevent her imminent death.
- After the Supreme Court stayed a lower court injunction against the Idaho law, the state's largest provider of emergency services began airlifting pregnant patients out of Idaho for emergency care approximately every other week.
- During the prior year, when the injunction was in effect, only one such airlift had been necessary.
- Following the initial court ruling, the Idaho Legislature amended the Defense of Life Act to make the life-saving provision an exception to criminal liability rather than an affirmative defense, and to explicitly exclude treatment for ectopic and molar pregnancies from its definition of abortion.
Procedural Posture:
- The United States sued the State of Idaho in the U.S. District Court for the District of Idaho, seeking to enjoin Idaho's abortion law.
- The District Court granted a preliminary injunction, preventing Idaho from enforcing its law to the extent it conflicted with EMTALA's requirements.
- Idaho appealed the injunction to the U.S. Court of Appeals for the Ninth Circuit.
- A three-judge panel of the Ninth Circuit issued a temporary stay of the District Court's injunction.
- The full U.S. Court of Appeals for the Ninth Circuit, sitting en banc, then vacated the panel's stay, allowing the injunction to take effect again while the appeal proceeded.
- Before the Ninth Circuit could hear arguments on the merits of the appeal, Idaho filed an emergency application with the U.S. Supreme Court.
- The Supreme Court stayed the District Court's injunction and granted certiorari before judgment, agreeing to hear the case before the Ninth Circuit could rule.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does the Emergency Medical Treatment and Labor Act (EMTALA) preempt an Idaho law that prohibits abortions unless necessary to prevent the pregnant patient's death, by requiring hospitals to provide abortions as stabilizing care for emergency medical conditions that pose a serious threat to the patient's health?
Opinions:
Per_curiam - Per Curiam
The Court did not reach a decision on the merits of the issue. The Court dismissed the writ of certiorari before judgment as improvidently granted and vacated its prior stay of the District Court's preliminary injunction, allowing the injunction to go back into effect and the case to proceed in the lower courts.
Concurring - Justice Kagan
Yes, EMTALA preempts Idaho's law because the two are in direct conflict. EMTALA unambiguously requires a Medicare-funded hospital to provide whatever medical treatment is necessary to stabilize a health emergency, and an abortion is sometimes that necessary treatment. When a pregnancy results in a condition that seriously threatens a woman's health, such as through kidney failure or loss of fertility, but not necessarily her life, EMTALA requires offering an abortion while Idaho law prohibits it. The statute's references to an 'unborn child' were added to ensure a fetus in peril could receive care; they do not displace the hospital's primary duty to stabilize a pregnant woman whose own health is in serious jeopardy.
Concurring - Justice Barrett
The Court should not decide the issue at this time. The writ of certiorari before judgment was improvidently granted because the shape of the case has substantially shifted, making it no longer appropriate for immediate resolution. The United States disclaimed that EMTALA requires abortions for mental health conditions or overrides federal conscience protections, narrowing the scope of the potential conflict. Simultaneously, Idaho has represented that its law permits emergency abortions for many of the conditions the U.S. cited, such as PPROM and preeclampsia. This 'dramatic narrowing of the dispute' undercuts the irreparable harm Idaho claimed for purposes of the stay and shows that granting review before the lower courts could fully develop the record was a 'miscalculation'.
Dissenting_in_part - Justice Jackson
Yes, EMTALA plainly preempts Idaho's conflicting law, and the Court was wrong to dismiss the case as improvidently granted. The legal conflict is clear, the need for a national answer is urgent, and the Court's delay inflicts harm on pregnant patients and their doctors who are left in a state of uncertainty. Idaho's litigating position that its law permits abortions for certain health conditions is a 'convenient rhetorical maneuver' that does not reflect the reality on the ground or a definitive interpretation by the Idaho Supreme Court. By 'dawdling,' the Court squandered its chance to provide clarity on a critical issue and will inevitably have to confront it again in the future.
Dissenting - Justice Alito
No, EMTALA does not preempt Idaho's law because it does not create an abortion mandate. EMTALA’s text unambiguously requires hospitals to protect the health of both a pregnant woman and her 'unborn child.' Far from requiring abortions, the statute obligates hospitals to treat the unborn child. Furthermore, as Spending Clause legislation, any condition like an abortion mandate would have to be stated unambiguously, which it is not. The government’s interpretation is a novel theory developed after Dobbs that intrudes on the states' traditional power to regulate the practice of medicine.
Analysis:
This procedural decision has significant immediate consequences, as vacating the stay reinstates the preliminary injunction and allows emergency abortions to protect health in Idaho. However, by dismissing the writ as improvidently granted, the Supreme Court avoids setting a national precedent on the conflict between EMTALA and state abortion bans. The Court's refusal to decide the merits leaves the core preemption question unresolved, fostering legal uncertainty and ensuring the issue will return, likely through cases from other circuits like the Fifth Circuit, which has reached a contrary conclusion.
