3 Questions To Ask During Oral Arguments in Idaho v. United States

On April 24, 2024, the U.S. Supreme Court will hear oral arguments in Idaho v. United States, a case that will determine if medical providers can continue to provide emergency abortion care under the Emergency Medical Treatment and Labor Act (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 specific legal question the court will review is whether there is a direct conflict between the narrow carve-outs for abortion care under Idaho’s near-total abortion ban—which carries steep criminal and civil penalties for medical providers—and the broader mandated requirements for medical providers to provide emergency care under EMTALA.

However, the heart of this case goes beyond abortion access and highlights how the politicization of the judiciary is accelerating the politicization of medicine. Idaho v. United States is a moment of reckoning for the far-right Supreme Court majority, since it is a direct result of the widespread chaos and confusion faced by patients and medical providers as a consequence of Dobbs v. Jackson Women’s Health Organization. In Dobbs, the court upended 50 years of legal precedent and eradicated the constitutional right to abortion, leaving abortion access to the states.

Here are three questions that can help listeners understand oral arguments that speak to the future of emergency abortion care as well as how the politicization of the judiciary continues to hasten the politicization of medicine.

1. Will the justices defer to medical providers’ expertise in deciding if there is an irreconcilable conflict between Idaho’s law and EMTALA?

The outcome of this case depends on whether the justices believe that the conflict between Idaho’s law and EMTALA is “direct” and therefore whether the two laws are irreconcilable. This will in turn depend on whether the justices believe the lived experiences and the medical expertise of health care professionals working in emergency departments.

Although Idaho’s state law enacts criminal and civil punishments for anyone who provides an abortion outside of three narrow circumstances, Idaho’s law ultimately fails to recognize what EMTALA has always acknowledged: Abortions may be necessary to preserve the health—not just the life—of a pregnant woman.

The Supreme Court has been provided with a plethora of evidence proving that this conflict is indeed irreconcilable. Notably, there are five amicus briefs written by national medical associations, as well as briefs from Idaho-based medical providers that provide firsthand accounts of how the criminal and civil sanctions under Idaho’s state law have created an acute culture of fear for emergency care providers, which in turn leads to a delay in medical care for pregnant women requiring an abortion as stabilizing medical treatment. The amicus briefs also detail the grave long-term health consequences patients will experience because providers are forced to allow their patients’ condition to deteriorate to the point that an abortion is needed to save their lives. As discussed in multiple filings by the U.S. Department of Justice, these consequences can include severe sepsis requiring limb amputation, uncontrollable uterine hemorrhage requiring hysterectomy, kidney failure requiring lifelong dialysis, hypoxic brain injury, and permanent fertility issues.

For patients, the stakes are immeasurably high in this case; but they are also high for medical providers, the practice of emergency care, and for the politicization of medicine. In Idaho v. United States, if the Supreme Court disregards the testimony of medical providers on the dire medical needs of their patients, it will create a distributing precedent for justices to continue to replace medical expertise with their own political opinions.

2. Will the justices address the potential long-term consequence of allowing states to carve out exceptions to EMTALA?

A potential long-term consequence of Idaho v. United States is that state legislators may be granted the power to carve out exceptions to EMTALA. In this case, the Supreme Court could effectively grant Idaho state legislators permission to supersede medical expertise and carve out a single condition—pregnancy—from EMTALA’s federal protections. Professor Sara Rosenbaum, founding chair of the Department of Health Policy at the Milken Institute School of Public Health at George Washington University, has written that this “could open the door to state laws aimed at interfering with the reasonable practice of emergency medicine for other disfavored conditions or populations.” Examples of potential carve-outs range from AIDS-related emergencies to high-cost conditions such as care for chronic conditions or mental health conditions.

Enabling states to carve out exceptions to EMTALA politicizes medicine. Political actors will have the authority to decide what emergency care is available for specific populations based on their political and personal ideology. Enabling this behavior will also change the underlying nature of EMTALA itself, which has served as the bedrock of emergency care for every patient in the United States for the past 40 years.

3. Will the Justices admit that this case has nationwide implications and could run afoul of their promise in Dobbs?

Even though the Supreme Court majority in Dobbs “[left] the question of abortion for the people and their elected representatives in the democratic process,” the decision in Idaho v. United States will affect every state, even where voters have fought to ensure that abortion is legal. Notably, in oral arguments for Alliance for Hippocratic Medicine v. FDA, another controversial case on abortion access that reveals how the politicization of the judiciary is fueling the politicization of medicine, both Justice Ketanji Brown Jackson and Justice Neil Gorsuch asked questions on the potential nationwide implications of rolling back access to medication abortion, which suggests it is likely that the issue will be considered again.

Similarly, a ruling in Idaho’s favor would mean that pregnant women would be banned from receiving abortion care as a stabilizing medical treatment at every single EMTALA-certified hospital, effectively amounting to a nationwide ban. This will only exacerbate the mass chaos and confusion that has been created for patients and providers by the Dobbs decision, with vulnerable pregnant women in need of emergency medical care bearing the grave consequences of a delay or denial of care.

Conclusion

Every pregnant woman, medical provider, and EMTALA-certified hospital will be affected by the outcome of Idaho v. United States. If the Supreme Court rules that states can exercise carve-outs to EMTALA’s emergency care requirements, it will deepen the concerning trend of the politicization of the judiciary hastening the politicization of medicine. The answers to the questions outlined in this article can reveal during oral arguments how far the justices are willing to interfere with the expertise of physicians nationwide.