The Supreme Court’s Idaho Abortion Ruling Is a Mixed Bag

Hospitals in Idaho will be able to offer emergency abortion care to patients whose health is in danger, even if they are not close to death as the state’s near-total ban requires, the Supreme Court ruled on Thursday. The Court’s 6–3 decision in Moyle v. United States is far from a victory for abortion rights, however, as the justices did not rule on the case’s merits.

Instead, the Court dismissed the legal challenge as “improvidently granted,” meaning it should not have accepted the case in the first place. Moyle revolves around the Emergency Medical Treatment and Labor Act, better known as EMTALA, which requires hospitals receiving federal funding to stabilize patients who need emergency treatment. After Dobbs, the Biden administration issued guidance affirming that this Reagan-era law applies to pregnant people in need of emergency abortion care.

Rather than address this question, the Court reinstated a lower court’s ruling that would allow hospitals in Idaho to continue offering emergency abortions while litigation is ongoing. This means that the case is likely to reach the justices again in the near future. By not ruling on the merits, the decision also allows a Fifth Circuit Court of Appeals ruling saying that Texas can ban emergency abortions to take effect.

The unsigned decision, which was inadvertently uploaded to the Court’s website and quickly taken down on Wednesday, was first reported by Bloomberg. It is the Court’s second major abortion ruling since the conservative supermajority overturned Roe v. Wade two years ago. In mid-June, the Court unanimously rejected an attempt to restrict access to mifepristone, one of the two drugs used in medication abortions. The justices said the anti-abortion plaintiffs in that case had no standing to sue, but they did not rule on that case’s merits, either, leaving the door open for future legal challenges.

Taken together, the rulings show how, despite the Court saying in Dobbs that it was returning “the issue of abortion to the people’s elected representatives,” the matter is far from settled. The justices kicked the can down the road and postponed what was expected to be an unpopular decision in both cases — a canny move in the middle of an election year where abortion rights remain a top issue for voters. Notably, if Donald Trump wins a second presidential term in November and follows the Project 2025 transition plan — a playbook for the next Republican administration created by a group of conservative think tanks — he could both direct the FDA to reimpose restrictions on mifepristone and rescind Biden’s EMTALA guidance, making both cases pretty much dead in the water anyway.

Not everyone on the Court was happy with the ruling. In a concurring opinion, Justice Ketanji Brown Jackson said she wouldn’t have dismissed the case as the Court’s intervention has already distorted the litigation process. She also highlighted that patients across the country have been denied emergency abortion care ever since Dobbs because doctors are afraid of running afoul of their states’ abortion bans, putting those patients’ health, fertility, and lives at risk.

“Today’s decision is not a victory for pregnant patients in Idaho. It is delay,” Jackson wrote. “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. This Court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it. And for as long as we refuse to declare what the law requires, pregnant patients in Idaho, Texas, and elsewhere will be paying the price.”

The question of whether EMTALA applies to emergency abortion care made its way to the Supreme Court after the Biden administration sued Idaho over its near-total ban. The law went into effect in August 2022 and only allows abortion in cases where it is “necessary to prevent the death of the pregnant woman”; those who violate the law face up to five years in prison. The Biden administration argued in its lawsuit that, regardless of Idaho’s narrow exception, hospitals must provide emergency abortion care when a patient’s health is “in serious jeopardy” in order to comply with EMTALA.

When the Court took up the case in January, it allowed Idaho to enforce its ban while the case played out, effectively nullifying EMTALA for patients in the state who needed emergency abortions. Thursday’s decision vacates that ruling and will allow Idaho hospitals to continue providing abortions to patients whose health is compromised.

Justices Samuel Alito, Clarence Thomas, and Neil Gorsuch dissented. The three leaned into Idaho’s reasoning during oral arguments, appearing deeply skeptical of the idea that the Biden administration could compel hospitals that receive federal funding to circumvent states’s abortion bans. In his dissent, Alito called the majority’s ruling “baffling” and leaned on the fetal personhood arguments brought forward by Idaho, which claimed that fetuses have the same rights as people from the moment of conception. “Far from requiring hospitals to perform abortions, EMTALA’s text unambiguously demands that Medicare-funded hospitals protect the health of both a pregnant woman and her ‘unborn child,’” he wrote, referring to how EMTALA was amended in 1989 to include that phrase. At the time, Congress passed the amendment in an effort to address cases in which the fetus was at risk even though the pregnant person was not.

“That includes common things like a prolapse of the umbilical cord into the cervix, where the fetus is in grave distress, but the woman is not at all affected. Hospitals otherwise wouldn’t have an obligation to treat her and Congress wanted to fix that,” Solicitor General Elizabeth Prelogar told the Court about the amendment during oral arguments in April. “But to suggest that in doing so, Congress suggested that the woman herself isn’t an individual and that she doesn’t deserve stabilization — I think that is an erroneous reading.”

In Alito’s view, however, hospitals must “protect” the fetus — not the pregnant person — “at every stage from harm.”

The ruling also comes on the heels of several state-level cases addressing emergency abortion care. In May, the Texas Supreme Court ruled against 20 women who were denied medically necessary abortions, with the justices unanimously rejecting the plaintiffs’ argument that the exceptions spelled out in the state’s abortion ban are too vague and that, as a result, Texas doctors are turning away patients with critical pregnancy complications for fear of prosecution or civil liability. Similar civil cases brought by patients who were denied abortions are still ongoing in Idaho and Tennessee, so the legal battle over whether pregnant people deserve life-saving medical care is far from settled.

The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.