Legal Alerts
5.28.24
In the consolidated cases Moyle v. United States and Idaho v. United States, the Supreme Court will determine whether the federal Emergency Medical Treatment and Labor Act (EMTALA) preempts Idaho’s state law criminalizing most abortions in the State.
In 1986, Congress amended the Medicare Act to add new requirements, known today as EMTALA. EMTALA requires hospitals to “provide for an appropriate medical screening examination within [its] capability” to identify “emergency medical condition[s]” for any individual who comes to an emergency department. Later, Congress amended EMTALA to clarify that it applied to an “unborn child” whether or not a woman is in labor. In 2020, Idaho passed abortion restriction laws that would take effect 30 days after any decision by the Supreme Court that “restores to the states their authority to prohibit abortion.” After the Supreme Court’s 2022 decision in Dobbs overruling Roe v. Wade, Idaho’s abortion law was set to take effect. The federal government moved to preliminarily enjoin Idaho’s law, arguing EMTALA preempted the state law. The district court granted the injunction, finding that the Idaho law conflicted with EMTALA and thus barring the State from enforcing the abortion law restrictions. The Ninth Circuit stayed the injunction, finding no conflict between EMTALA and Idaho law and finding that EMTALA required hospitals to provide emergency medical services to indigent patients, but did not require that a hospital “provide whatever treatment an individual medical professional may desire.” The government sought en banc review, and the en banc court vacated the stay.
During oral argument before the Justices, counsel for Moyle and Idaho argued that the Medicare Act forbids the federal government from controlling the practice of medicine and that the Supreme Court’s own presumption against preemption of state regulations skews against finding preemption by EMTALA. Justice Thomas questioned whether there even was a relationship or quasi-contractual relationship between the parties sufficient to support a preemption question. Justice Barrett questioned whether differences in judgment between the doctors and prosecutors could lead to prosecution of doctors based on their judgment calls. Justice Alito questioned whether a good faith medical standard leaves doctors a certain amount of leeway to make judgment calls.
Justice Kagan questioned the scope of EMTALA’s stabilization requirement on state hospitals. Justice Sotomayor questioned whether objective standards of medical care requiring abortion in certain emergency situations preempted Idaho’s prohibition on abortion except in life-threatening situations. Justice Jackson questioned what exact situations would arise that would cause a physician to be conflicted between following EMTALA in light of Idaho’s abortion statute.
The government’s counsel argued that under EMTALA, a woman who comes into the emergency room with certain medical conditions must be offered pregnancy termination as a treatment and Idaho’s abortion statute puts hospitals in an untenable position by tying the threat of prosecution to certain treatments. Justice Alito questioned how EMTALA could impose restrictions on what Idaho can criminalize simply because hospitals in Idaho participate in Medicare. The Chief Justice questioned what a hospital would be forced to do if all of the doctors in a hospital asserted conscientious objections to performing an abortion, even in a life-threatening situation.
The case was argued on April 24, 2024. A decision is expected by the end of the term. Stay tuned for Dykema’s client alert discussing the Court’s opinion.
For more information, please contact Chantel Febus, James Azadian, Christopher Sakauye, Monika Harris, A. Joseph Duffy, IV, or Puja Valera.
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