On June 27, 2024, the Supreme Court issued a one-sentence per curiam order in Moyle v. United States and Idaho v. United States, consolidated cases involving whether the federal Emergency Medical Treatment and Active Labor Act (EMTALA) preempts Idaho’s pro-life law. The Biden administration claims that EMTALA requires hospitals to provide abortions when a pregnant woman’s health is in “serious jeopardy,” while Idaho’s law permits abortion only when “necessary to prevent the death of the pregnant woman.” For more information about the cases, you can read my summary here.
The Court’s order, foreshadowed by a “website snafu,” dismissed the cases as improvidently granted, also known as a “DIG.”
Procedurally, these cases are unusual. After the district court enjoined Idaho’s law, a Ninth Circuit panel stayed the injunction. But in an unreasoned order, the en banc Ninth Circuit vacated the stay.
Idaho then filed an emergency application in the Supreme Court. The Court stayed the injunction and, treating the application as a petition for certiorari, granted the petition before the en banc Ninth Circuit could hear oral argument and issue a judgment on the merits.
After the Supreme Court heard oral argument, the Justices split 5-4 on dismissing the case and 6-3 on vacating the stay. The Chief Justice and Justices Kagan, Sotomayor, Kavanaugh, and Barrett voted to send the case back down to the Ninth Circuit and vacate the stay. Justice Jackson also voted to vacate the stay but would have ruled on the merits in favor of the federal government. Justices Thomas, Alito, and Gorsuch would have ruled in favor of Idaho and kept the stay in place.
The Justices wrote four separate opinions elaborating on their votes.
Barrett’s Concurrence
Concurring in the judgment, Barrett, joined by Roberts and Kavanaugh, wrote that the Court’s decision to take the cases before judgment at the Ninth Circuit was a “miscalculation.” Because “the shape of these cases has substantially shifted” since the Court granted cert and the “parties’ positions are still evolving,” she was “now convinced that these cases are no longer appropriate for early resolution.”
Before ruling on the merits, proceedings should be permitted “to run their course in the courts below.” It appears the three Justices were not ready to rule on the “difficult and consequential” Spending Clause argument, which Barrett claimed Idaho did not discuss in the stay applications. Idaho did, in fact, raise the Spending Clause argument in the stay applications and opening briefs.
In support of vacating the stay, Barrett explained, “The dramatic narrowing of the dispute—especially the Government’s position on abortions to address mental health and conscience exemptions for healthcare providers—has undercut the conclusion that Idaho would suffer irreparable harm under the preliminary injunction.” In her view, “Idaho represents that its exception is broader than the United States fears, and the United States represents that EMTALA’s requirement is narrower than Idaho fears.”
Barrett concluded that even with the injunction, “Idaho’s ability to enforce its law remains almost entirely intact.”
Kagan’s Concurrence and Jackson’s Opinion
Kagan, joined by Sotomayor, concurred in the judgment to lift the stay and “put[] the case back where it belongs.” In her view, the Court “short-circuit[ed] the proceedings below” and “Idaho’s arguments about EMTALA do not justify, and have never justified, either emergency relief or our early consideration of this dispute.”
Addressing Alito’s dissent, Kagan, joined by Sotomayor and Jackson, explained that she agreed with the Biden administration’s statutory interpretation of EMTALA: “EMTALA unambiguously requires that a Medicare-funded hospital provide whatever medical treatment is necessary to stabilize a health emergency—and an abortion, in rare situations, is such a treatment.” Kagan concluded, “Because the Idaho law conflicts with that requirement—prevents hospitals from doing what EMTALA commands—the Court is right to dissolve its stay” and “give Idaho women access to all the needed medical treatments that EMTALA guarantees.”
Jackson agreed with the Court’s decision to lift the stay, which she said “should not have been entered in the first place.” But she wrote separately (concurring in part and dissenting in part) because she thought the case should not have been dismissed. For her, there is “clarity of the legal issue”—“Idaho law prohibits what federal law requires, so to that extent, under the Supremacy Clause, Idaho’s law is pre-empted.” Because of the “dire need for an answer from this Court,” she would have ruled in favor of the federal government and recognized “the rights that EMTALA protects.”
Alito’s Dissent
Dissenting, Alito, joined by Thomas and Gorsuch, would have ruled in favor of Idaho and “put that matter to rest.”
In Alito’s view, “Having already taken the extraordinary step of granting certiorari before judgment in order to decide whether the Government’s new interpretation of EMTALA is correct, we have no good reason to change course now.” This is especially true as the decision to vacate the stay involved an assessment of Idaho’s likelihood of success on the merits—a question related to whether Idaho or the Biden administration has the correct interpretation of EMTALA.
According to Alito, “the Government’s new interpretation of EMTALA is refuted by the statutory text, the context in which the law was enacted, and the rules of interpretation that we apply to Spending Clause legislation.”
Elaborating further, Alito, joined by Thomas but not Gorsuch, explained that “there is no excuse for vacating the stay of the preliminary injunction” because Idaho is likely to prevail on the merits and faces irreparable harm by being unable to enforce its law in its entirety. In his view (and that of the parties and five other Justices), “there is a real potential for conflict between the Idaho law and the Government’s interpretation of EMTALA.”
EMTALA Back at SCOTUS
The Idaho cases have returned to the Ninth Circuit for further proceedings. Depending on the result—and depending on which administration is in power—the Supreme Court could see these cases again.
In the meantime, the Supreme Court has another opportunity to address the merits of the Biden administration’s EMTALA interpretation.
In April 2024, before the Supreme Court’s decision in the Idaho cases, the Biden administration filed a related petition for certiorari, appealing a Fifth Circuit decision affirming an injunction against the Biden administration’s interpretation of EMTALA within Texas or against any member of the plaintiff medical organizations.
The question presented is whether EMTALA “preempts state law in the narrow but important circumstance where terminating a pregnancy is required to stabilize an emergency medical condition that would otherwise threaten serious harm to the pregnant woman’s health but the State prohibits an emergency-room physician from providing that care.”
Briefing in that case will conclude this summer, and the Court is expected to review the petition during its long conference in the fall.
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