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SCOTUS Allows Emergency Abortions to Continue in Idaho, for Now

— Case will go back down to the lower courts for further adjudication

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A photo of the Supreme Court courtroom in Washington, DC.

Idaho hospitals must continue to provide emergency abortions if the mother's life is in danger, the Supreme Court ruled on Thursday.

The court decided that it got involved too early in a case on whether the state's law banning nearly all abortions is illegal because it conflicts with a federal law requiring emergency departments that receive federal funds to provide abortions to preserve the life or health of the mother.

The court agreeing to take up the case "presumes that further proceedings below are unnecessary to the court's resolution of the question presented," Justice Amy Coney Barrett wrote in a concurrence with the court's 6-3 opinion. "That was a miscalculation in these cases, because the parties' positions are still evolving." Barrett's use of the phrase "these cases" was referring to the fact that two cases -- Moyle v. United States and Idaho v. United States -- were combined in this decision.

The ruling means that the case will go back down to the lower courts for further adjudication. In the meantime, under part of the court's decision, Idaho will not be able to enforce its abortion ban.

The decision comes a day after the court accidentally released it briefly on its website and then took it down.

"The Court's Publications Unit inadvertently and briefly uploaded a document to the Court's website. The Court's opinion in Moyle v. United States and Idaho v. United States will be issued in due course," said court spokeswoman Patricia McCabe in a statement.

The ruling in these cases centered around a federal law known as the Emergency Medical Treatment and Active Labor Act (EMTALA), which was enacted in 1986 and states that any patient who is in active labor or otherwise has a medical emergency threatening their life or health is entitled to be treated at any emergency department to stabilize their condition, regardless of their ability to pay. The law applies to any hospital that participates in the Medicare program, which includes nearly every U.S. hospital.

With the overturning of Roe v. Wade, control over abortion rights has returned to the states, and 14 states have passed or enacted laws almost entirely banning abortion, while another seven states have banned the procedure after a certain number of weeks' gestation (anywhere from 6 to 18 weeks).

In the case of Idaho, its outlaws all abortions except in cases of rape, incest, or to save the life of the pregnant person; anyone who performs an abortion not covered by the exceptions faces up to 5 years in prison. The rape and incest exceptions only apply in cases where those crimes have previously been reported to the police.

During oral arguments in April, the fact that EMTALA encompasses conditions that could affect a person's health -- not just whether they live or die -- was a particular point of interest for Justice Elena Kagan.

"All of these cases are rare, but within these rare cases, there's a significant number where the woman's life is not imperiled, but she's going to lose her reproductive organs," Kagan said. "She's going to lose the ability to have children in the future unless an abortion takes place. Now, that's the category of cases in which EMTALA says, 'My gosh, of course, the abortion is necessary to assure that no material deterioration [of her health] occurs.' And yet Idaho says, 'Sorry, no abortion here,' and the result is that these patients are now helicoptered out of state."

Justice Brett Kavanaugh wanted to know about differences between EMTALA and the Idaho law. "Is there any condition that you're aware of where the Solicitor General says EMTALA requires that an abortion be available in an emergency circumstance where Idaho law, as currently stated, does not?" he asked Idaho Solicitor General Joshua Turner.

Turner said there was, and it had to do with mental health emergencies. He noted that "the [Biden] administration says [abortion] is not on the table" as the only treatment for a pregnant person experiencing a mental health emergency, and also says that "there are no professional organizations that set abortion as a standard of care." However, he continued, "the American Psychiatric Association in a says that abortions are imperative for mental health conditions."

Although she was in the majority for the decision, Justice Ketanji Brown Jackson dissented in another part of the case.

"Today's decision is not a victory for pregnant patients in Idaho. It is delay," she 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."

Justice Samuel Alito was one of the three justices who dissented entirely. "This about-face is baffling," he wrote of the court's declaration that it became involved too early. "Nothing legally relevant has occurred since January 5. And the underlying issue in this case -- whether EMTALA requires hospitals to perform abortions in some circumstances -- is a straightforward question of statutory interpretation."

The Associated Press contributed to this story.

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    Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy.