“Today’s decision is not a victory for pregnant patients in Idaho. It is delay. While this Court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires.”
– Justice Ketanji Brown Jackson
On June 27, 2024, the U.S. Supreme Court issued a 6-3 decision in Idaho v. United States that dismissed the case entirely on procedural grounds and explicitly stated that the merits of the case—or the legal substance—would not be addressed. The court effectively reinstated the preliminary injunction from the U.S. District Court of Idaho (Southern Division), which in turn paused the criminal and civil penalties under Idaho’s near-total abortion ban from going into effect for the remaining duration of the case.
This means that abortion care can be provided in Idaho as a stabilizing medical treatment under the federal Emergency Medical Treatment and Labor Act (EMTALA). The decision also means that legal questions will return to the lower courts to be litigated, with the possibility of the case being revisited by the Supreme Court if the 9th U.S. Circuit Court of Appeals issues a decision that is subsequently appealed. Notably, it is the second case on abortion access that the Supreme Court dismissed on procedural grounds in the 2023-2024 term.
The key legal question at the heart of this case is whether there is a direct conflict between the narrow exceptions for abortion care under Idaho’s near-total abortion ban—which carries steep criminal and civil penalties for medical providers—and the broader federally mandated requirements for medical providers to provide emergency care under EMTALA. EMTALA requires hospitals that offer emergency services and participate in Medicare to provide stabilizing medical treatment—which has always included abortion care—to patients experiencing a medical emergency.
The ruling can be divided into three parts, which highlight how the politicization of the judiciary is fueling the politicization of medicine, with vulnerable pregnant patients experiencing dire medical emergencies bearing the consequences.
1. The Supreme Court vacated its own legal stay that directly harmed pregnant patients in medical emergencies
“As a practical matter, this Court’s intervention meant that Idaho physicians were forced to step back and watch as their patients suffered, or arrange for their patients to be airlifted out of Idaho.”
– Justice Ketanji Brown Jackson
In their decision, the majority ruled to vacate the very stay—a judicial action that stops a legal proceeding—that they put into place on January 5, 2024. This stay completely changed the lives of pregnant patients and medical providers in Idaho because it allowed Idaho’s near-total abortion ban to go into effect for the first time. Previously, the case was guided by a preliminary injunction—or temporary legal pause—issued by the U.S. District Court of Idaho (Southern Division) on August 24, 2022, that prevented specific sections of Idaho’s abortion ban criminalizing medical providers from becoming law. The injunction provided a degree of legal certainty for EMTALA-certified hospitals, medical providers, and pregnant patients that emergency abortion care was still permissible under EMTALA.
However, the Supreme Court’s January 2024 stay suspended EMTALA’s protections and upended legal and medical norms in Idaho. After the stay went into effect, St. Luke’s hospital in Boise airlifted six patients experiencing pregnancy complications from January 2024 to April 2024. By comparison, for the entirety of 2023—when EMTALA’s protections were in effect in Idaho and the provision of necessary care was still permitted—only one pregnant patient was airlifted.
It is beyond reproach that, if not for the Supreme Court’s arbitrary legal stay upending the legal and medical norms in Idaho, these patients would not have been flown out of their home state for federally guaranteed medical care. There are few clearer and starker examples of how women disproportionately bear the consequences of the politicization of medicine at the hands of a politicized judiciary.
2. The Supreme Court acknowledged it made another “miscalculation” in dismissing the writ of certiorari as being “improvidently granted”
“We cannot simply wind back the clock to how things were before the Court injected itself into this matter. Our intervention has already distorted this litigation process. … It is too little, too late for the Court to take a mulligan and just tell the lower courts to carry on as if none of this has happened.”
– Justice Ketanji Brown Jackson
In Idaho v. United States, the Supreme Court majority dismissed the writ of certiorari they originally granted and couched their admitted “miscalculation” as being “improvidently granted,” which is another way of saying that they should not have taken the case. The Supreme Court first granted a writ of certiorari—or petition to have a case heard—on January 5, 2024, to an emergency application for relief submitted by the extremist Idaho Legislature. The U.S. Department of Justice (DOJ) filed a corresponding rebuttal to the emergency application. At the time, the case was being adjudicated by the 9th Circuit Court of Appeals. However, by granting the certification, the Supreme Court directly placed itself in the middle of ongoing litigation and deviated from normal appellate practice of allowing the lower court to issue a ruling. Notably, the court gave no explanation at the time as to why the writ of certiorari was granted.
In her concurring opinion, Justice Amy Coney Barrett—joined by Chief Justice John Roberts and Justice Brett Kavanaugh—attempted to explain that this “miscalculation” occurred because the “shape of these cases has substantially shifted” and that the DOJ clarified later on that “EMTALA’s reach is far more modest than it appeared when we granted certiorari and a stay.” However, these exact issues were already briefed to the Supreme Court in the DOJ’s rebuttal to the emergency stay application. The DOJ explicitly used the term “narrow” six times in its filing when describing the specific and clearly delineated circumstances in which EMTALA overrides Idaho’s ban. This miscalculation was so out of step with normal appellate practice that even Justice Samuel Alito denounced it as “unusual” and “extraordinary” in his dissenting opinion.
If not for this miscalculation, medical providers and pregnant patients in Idaho would not have spent the past seven months without EMTALA’s protections. The Supreme Court’s premature interference into this case is a clear sign of how the politicization of the judiciary amplifies the politicization of medicine and further exacerbates the mass chaos and confusion for medical providers and patients.
3. Justice Samuel Alito’s dissenting opinion brazenly attempted to reframe EMTALA in a way that serves his personal anti-abortion ideology
Justice Alito’s six pages of politically charged dissent—joined by Justice Clarence Thomas in full and Justice Neil Gorsuch in part—inaccurately attempted to reframe EMTALA in a manner that serves a far-right anti-abortion ideology and highlighted just how politicized the judiciary has become.
First, Justice Alito attempted to reframe EMTALA as having a “dual stabilization requirement” to both the pregnant patient and the “unborn child,” thereby implying that, under EMTALA, providers have an obligation to “treat, not abort, an ‘unborn child.’” The dual stabilization requirement argument has long been associated with extremist anti-abortion organizations such as the Charlotte Lozier Institute, which submitted an amicus brief in this case advocating the viewpoint. The majority opinion rebuked Justice Alito’s revisionist argument at length and explicitly called out the many errors in his analysis, ranging from his inaccurate citations to his seemingly deliberate oversight of congressional testimony, which repeatedly confirmed that EMTALA’s inclusion of the term “unborn child” still “does not displace the hospital’s duty to a woman whose life or health is in jeopardy.”
Second, despite a complete lack of evidence, Justice Alito spent an entire section of the dissent on Idaho’s claim that the DOJ’s reading of EMTALA would authorize abortions for “mental-health reasons,” which can potentially be read as outlining a pathway for anti-abortion arguments to relitigate EMTALA. During oral arguments, the DOJ explicitly disavowed that an abortion is required as stabilizing treatment for a mental health condition and cited the complete lack of congressional testimony discussing the issue. Despite Justice Alito’s lack of medical or scientific training, he still put forward a hypothetical example of a woman experiencing depression in her 10th week of pregnancy and speculated that medical providers might feel required to give patients an abortion if it “seriously jeopardizes the woman’s mental health.” Notably, there is no real-life example in either the Idaho Legislature’s legal filings nor the scores of amicus briefs submitted by anti-abortion advocates of an abortion provided under EMTALA because a patient was depressed.
Justice Alito’s dissenting opinion clearly demonstrates the dangers of justices dismissing medical expertise in favor of their personal opinions.
See also
Conclusion
Idaho v. United States will go down in history as a case where the Supreme Court’s premature interference into ongoing litigation highlighted how the politicization of the judiciary fuels the politicization of medicine, with pregnant patients bearing the consequences of a delay or outright denial of urgently needed medical care.