What federal law is at the heart of the Supreme Court’s latest abortion case?

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WASHINGTON (AP) — The Supreme Court appears poised to rule that despite Idaho’s strict abortion law, at least for now, the state’s hospitals can provide medically necessary abortions to stabilize patients, according to a copy of the opinion briefly posted on the court’s website Wednesday and obtained by Bloomberg News.

The filing indicated the court voted 6-3 to reinstate a lower court order allowing Idaho emergency rooms to provide abortions that save women’s health as a broader legal case unfolds.

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The Justice Department had sued Idaho over its abortion law, which says a woman can get an abortion only if her life, not her health, is threatened. Doctors in Idaho say they can’t provide the stabilization treatment required by federal law, which is usually the standard of care, and have had to fly at least six pregnant women to other states since the Idaho law took effect in January.

But Idaho lawyers said the state law allowing women in desperate situations to get abortions does not conflict with federal law.

The federal law, called the Emergency Medical Treatment and Active Labor Act (EMTALA), requires doctors to stabilize or treat any patient who shows up in an emergency room.

Let’s review the history of EMTALA, the rights it provides patients, and how the Supreme Court’s decision could change that.

What protections does EMTALA provide to patients in the emergency department?

The law requires that if you go to an emergency room, the emergency room must give you a physical exam. This law applies to almost all emergency rooms—any emergency room that accepts Medicare funding.

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If a patient does present with a medical emergency, these emergency rooms must stabilize the patient before discharge or transfer. If the emergency room does not have adequate resources or staff to properly treat the patient, staff must arrange for the patient to be transferred to another hospital after confirming that the facility can accept the patient.

For example, if a pregnant woman comes to the emergency room concerned that she is about to give birth but there are no obstetricians or gynecologists available to deliver the baby, hospital staff cannot simply direct the woman to go elsewhere.

Why is this law being enacted?

Flashback to Chicago in the early 1980s.

Doctors at New York City’s public hospitals face a huge problem: Thousands of patients, many of them black or Latino, are so sick they’re being sent to private hospitals in the city that they’re refusing to treat them. Some are shooting victims whose conditions haven’t stabilized. Most of them don’t have health insurance.

Chicago is not alone. Doctors at public hospitals across the country have reported similar problems. Media reports, including one in which a pregnant woman was turned away from two hospitals because she had no insurance and ended up giving birth to a stillborn baby, have increased public pressure on politicians to take action.

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Congress drafted a bill, with Minnesota Republican Senator David Durenberger saying at the time: “Americans, rich and poor, deserve access to quality health care. This is an issue that should be addressed at the federal, state and local levels.”

Then-Republican President Ronald Reagan signed the bill into law in 1986.

What happens if a hospital turns away a patient?

Hospitals will be subject to investigations by the Centers for Medicare and Medicaid Services. If they are found to have violated patients’ medical rights, they may lose Medicare funding, which is an important source of income for most hospitals to maintain operations.

However, when hospitals violate the Medical Claims Act, the federal government often imposes fines that can total hundreds of thousands of dollars.

Why is the Supreme Court reviewing this law?

Since the Supreme Court struck down the constitutional right to abortion, Democratic President Joe Biden has repeatedly reminded hospitals that his administration considers abortion to be part of the stable care that health facilities are required to provide under EMTALA.

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The Biden administration has argued that Idaho law prohibits emergency room doctors from providing abortions to women in the ER.

But Idaho’s attorney general noted that EMTALA also requires hospitals to consider the health of the “unborn child” during treatment. Idaho’s attorneys also said there is no conflict between state and federal law because Idaho allows doctors to perform abortions when a woman’s life is threatened.

What do advocates say?

Anti-abortion advocates have argued that state laws banning abortions can coexist with federal laws requiring hospitals to stabilize pregnant women in emergencies.

The Susan B. Anthony Defenders of American Life, a prominent anti-abortion group, called the Idaho lawsuit a “PR stunt.”

“The EMTALA case is based on a false premise that pregnant women cannot receive emergency care under anti-abortion laws,” Kelsey Pritchard, the group’s state public affairs director, said after hearing the case earlier this year. “The facts are clear that pregnant women can receive abortion care, ectopic pregnancy care and treatment for medical emergencies in all 50 states.”

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But many doctors say the situation is not as clear-cut as anti-abortion activists claim.

In rare cases, women could risk sepsis, hemorrhage or loss of reproductive organs if the pregnancy is not terminated, but doctors say Idaho law requires doctors to wait until a patient is near death before terminating a pregnancy.

Doctors who perform abortions face at least two years in prison if the woman’s life is not threatened.

“As a physician, there is nothing worse than knowing what a patient needs and not being able to give it to them,” Dr. Jessica Kroll, president of the American College of Emergency Physicians in Idaho, told reporters at a news conference earlier this month.

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