Moyle v US; Idaho v US
Issue: Is Idaho’s state law prohibiting abortion preempted by the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospital emergency departments to provide abortion care when necessary to stabilize an emergency medical condition that seriously threatens a pregnant person’s health?
Background: Idaho’s state abortion ban is among the strictest in the nation: it prohibits abortions unless necessary to prevent a pregnant person’s death and contains no exceptions for abortion care necessary to prevent serious harm to the pregnant person’s health. The law also imposes criminal penalties on physicians who violate it. The fundamental issue at stake is whether Idaho physicians may act in emergency situations to preserve a pregnant person’s health, or if they must wait until the person faces imminent death to intervene.
In 2022, the Biden Administration sued Idaho, arguing that the state’s abortion ban conflicts with Medicare-funded hospital emergency departments’ duty under EMTALA to stabilize any conditions which endanger a patient’s health, including the provision of abortions when medically appropriate. The district court entered a preliminary injunction preventing Idaho from enforcing its law while the lawsuit was pending. The state then appealed to the 9th Circuit, which allowed the preliminary injunction to remain in effect. The state then sought emergency review in the Supreme Court, which stayed the preliminary injunction thereby allowing the Idaho law to take effect. The Supreme Court also agreed to hear the case even though the lower courts had not yet issued a final decision on the merits.
However, in July 2024, the Supreme Court in a 5:4 decision dismissed the case as improvidently granted, sending it back to the 9th Circuit for a final decision on the merits. A six-justice majority voted to lift the stay and allow the district court’s preliminary injunction barring enforcement of the Idaho law to again take effect while the case is pending. However, the extent to which the preliminary injunction will actually protect pregnant people in Idaho remains to be seen. As Justice Jackson pointed out in her concurring opinion, Idaho healthcare providers still face uncertainty about when emergency abortions violate state law, since the Idaho Supreme Court is the final arbiter of state law.
The 9th Circuit heard oral argument in December 2024, but had not issued a decision.
In March 2025, the Trump Administration and Idaho agreed to dismiss the case. This dismissal means that the preliminary injunction that prevented Idaho from enforcing its ban is no longer in effect.
However, in March 2025, a new preliminary injunction was entered by a federal district court in another case, St. Luke's Hospital System v. Labrador, that still prevents Idaho from enforcing its ban against St. Luke’s (the largest hospital system in Idaho) and any of its medical providers.
Current Status: Case dismissed
9th Circuit of Appeals, Amicus Brief, Oct. 22, 2024
Amici: American Public Health Association, Robert Wood Johnson Foundation, Network for Public Health Law, American Medical Women’s Association, and 134 deans and scholars
Argument Summary: EMTALA protects women throughout pregnancy, and nothing in the special statutory protections for labor and delivery subordinates the health of pregnant women to fetal health. The history and purpose of EMTALA demonstrate Congress’ intent to protect pregnant women. EMTALA’s references to the “unborn child” expand protections during labor and delivery and do not create a wholesale abortion ban. EMTALA does not convert emergency departments into non-emergent, elective care centers for abortion services.
U.S. Supreme Court Amicus Brief, March 28, 2024
Amici: American Public Health Association, Robert Wood Johnson Foundation, Network for Public Health Law, American Medical Women’s Association, and 133 deans and scholars
Argument Summary: EMTALA guarantees all individuals access to emergency health care. It creates a federal duty for Medicare participating hospitals with emergency departments to provide emergency care to all individuals. Congress explicitly deferred to the professional judgment of the treating physician to determine the care needed to stabilize a patient. EMTALA preempts conflicting state laws. EMTALA emphasizes labor and delivery, but nothing in the law subordinates the health of pregnant women to fetal health.
The federal government has well-established authority to protect the health and safety of patients through the regulation of federal healthcare programs. Compliance with EMTALA is a condition of participation in Medicare. EMTALA’s conditions on participating facilities – like innumerable other conditions of participation in federal healthcare programs – do not offend the prohibition on federal interference in the practice of medicine. EMTALA does not permit states to limit a hospital’s screening and stabilization obligations. EMTALA preempts state laws that would limit stabilizing care.
Idaho’s assertion that pregnant patients will use emergency departments as “abortion enclaves” to circumvent state abortion bans misunderstands the role and capacity of hospital emergency departments and will disrupt access to emergency pregnancy care. Idaho’s law prohibits necessary care and creates obligations that directly contravene EMTALA. Idaho’s position would allow states to carve out any form of stabilizing emergency care and would directly contravene the federal guarantee of emergency hospital care established by Congress.
Outside Counsel: Foley Hoag LLP
Related Resources:
GW Media Relations. Public health brief urges court to preserve EMTALA’s protections for pregnant women. Oct. 28, 2024. https://mediarelations.gwu.edu/public-health-brief-urges-court-preserve-emtalas-protections-pregnant-women
Rosenbaum S. Moyle review ‘improvidently granted,’ but justices’ positions on EMTALA, emergency abortions on display. Health Aff. Forefront. July 1, 2024. https://www.healthaffairs.org/do/10.1377/forefront.20240701.185483/full/
GW Media Relations. SCOTUS ruling upholds emergency abortions for now. July 1, 2024. https://mediarelations.gwu.edu/scotus-ruling-upholds-emergency-abortions-now
GW Media Relations. Amicus brief urges Supreme Court to protect public health and uphold EMTALA. April 2, 2024. https://mediarelations.gwu.edu/amicus-brief-urges-supreme-court-protect-public-health-and-uphold-emtala
Funding Acknowledgement:
Supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.