Supreme Court to Decide if States Can Ban One Specific Type of Emergency Care

Should where a woman lives determine whether she receives necessary medical care? That’s the heart of the question the Supreme Court will confront on Wednesday when it takes up a case concerning the Emergency Medical Treatment and Active Labor Act, a Reagan-era law that says that any hospital that accepts Medicare (most hospitals in this country) must provide stabilizing treatment to any person who shows up on their doorstep.

In the wake of the Supreme Court decision overturning Roe v. Wade, the Biden Administration was compelled to clarify that the law includes stabilizing abortion care, i.e. if a pregnant person has a medical emergency that can only be treated with an abortion, the hospital is required by federal law to provide it — regardless of state prohibitions.

But Idaho has argued that the federal guidance should be superseded by state abortion laws — and that state politicians should be allowed to ban hospitals from providing emergency abortion care. Idaho’s ban on abortion contains an exception only for abortions “necessary to prevent the death” of a pregnant woman — not abortions necessary to prevent, say, the damage or loss of her reproductive organs.

“The federal government cannot use EMTALA to override in the emergency room state laws about abortion any more than it can use it to override state law on organ transplants or marijuana use,” Idaho’s Republican attorney general, Raúl Labrador, wrote in a petition to the high court.

Federal law is supposed to trump state law in instances like this, but after a district ruled Idaho doctors could continue providing emergency abortions in accordance with EMTALA, the Supreme Court stepped in and allowed the state’s ban to take effect before the case was heard on its merits. The court will hear arguments on Wednesday in the case, Moyle v. United States.

Since the Supreme Court allowed the law to take effect, Idaho’s largest hospital has airlifted at least six women out-of-state because of pregnancy complications — presumably to receive care that doctors don’t feel comfortable providing under Idaho law. If pregnancy-related air transports continue at that rate, the number could reach 20 from that one hospital alone by the end of the year. Last year, before the law went into effect, just one woman was transported for similar reasons.

“We have limited resources in terms of helicopters, fixed-wing transports and ambulances,” Jim Souza, chief medical officer at St. Luke’s Medical Center in Boise, told States Newsroom. “If we occupy an air transport with a patient who could completely receive the totality of her care right here, safely, it’s potentially dangerous for other patients.”

A different Idaho doctor who provided a declaration in the case said that before the Dobbs decision, he encountered roughly a dozen cases a year in which “pregnancy termination is the only medical intervention that can preserve a patient’s health or save their life.” But under Idaho’s ban, a doctor can now be punished with up to five years in prison for performing an abortion for any reason other than to save the patient’s life.

Roughly a quarter of Idaho’s OB-GYNs — 22 percent — have left the state since the Dobbs decision. Today, according to an analysis by the Idaho Coalition for Safe Health Care, half of the state’s counties do not have a practicing obstetrician.

But Idaho is not the only state where providers are fearful about the consequences of providing standard-of-care treatment to pregnant patients. In Louisiana, a report by Lift Louisiana and Physicians for Human Rights, indicated doctors are performing unnecessary c-sections and delaying miscarriage care to avoid the appearance of providing an abortion. Doctors in that state face up to 15 years in prison and $200,000 in fines if they are found to have violated the abortion ban.

At least a dozen women have filed complaints about emergency pregnancy care nationwide since Dobbs, according to documents obtained by the Associated Press. The complaints detail the profound tragedies women have endured after being refused treatment in places like Marlin, Texas, where a woman miscarried in the ER’s bathroom after the hospital would not admit her, or Roxboro, North Carolina, where a woman gave birth in the car after she couldn’t obtain the care she needed at a hospital. Her baby did not survive.

On Wednesday, the Supreme Court will consider whether doctors will be allowed to do their jobs without political interference, or whether these tragedies will become routine fact of life in some states.

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