Hospitals in limbo after Supreme Court defers abortion ruling

Hospitals and medical professionals waiting for the Supreme Court to untangle contradictory federal and state laws on abortion and emergency medicine will just have to keep waiting.

The high court issued a decision that wasn't actually a decision Thursday in a dispute between Idaho and the federal government. That means providers in states with strict abortion laws — except Idaho — will still confront problematic legal and ethical dilemmas every time a pregnant patient presents with a medical emergency that may require an abortion.

The only tangible action the Supreme Court took was to reimpose an injunction against Idaho enforcing its near-total abortion ban, and the criminal and professional penalties it entails, when hospitals and clinicians opt to terminate pregnancies to preserve the lives or health of patients in compliance with the federal Emergency Medical Treatment and Active Labor Act of 1986, or EMTALA.

The Supreme Court’s 6-3 ruling in Idaho v. United States and Moyle v. United States returns the twin cases to the U.S. Court of Appeals for the 9th Circuit. Chief Justice John Roberts announced the decision one day after Bloomberg Law obtained a draft the court accidentally published online.

By withholding a final answer, the Supreme Court failed to alleviate uncertainty that has proliferated since many states adopted new abortion laws in the wake of the 2022 Supreme Court ruling that overturned Roe v. Wade and empowered states to impose new restrictions on the procedure.

Related: Supreme Court allows emergency abortions in Idaho for now

Providers in jurisdictions with strong antiabortion laws are caught in the middle of a ideological power struggle between conservative states and a federal government helmed by Democratic President Joe Biden, who supports abortion rights. The Biden administration insists that EMTALA preempts state laws. States such as Idaho and Texas are not backing down.

In the meantime, hospitals and doctors face a choice every time a patient arrives with a medical emergency for which abortion may be recommended: Break state law and possibly lose their licenses or go to prison, or break federal law and risk fines or termination from Medicare, said Molly Meegan, chief legal officer and general counsel for the American College of Obstetricians and Gynecologists.

“All of the legal liabilities that were on the books to begin with — this opinion doesn't get rid of any of those,” Meegan said. “It might provide a reprieve from the Idaho law, but the Idaho law still exists and it doesn't provide a final decision that it won't go back into effect.”

Moreover, physician societies such as ACOG and the American Medical Association object to physicians being compelled to inaction when they could save lives.

"Today’s decision failed to confirm that patients in every state are entitled to prompt, complete and unbiased emergency healthcare that is medically and scientifically sound and provided in compliance with [EMTALA]", AMA President-elect Dr. Bobby Mukkamala said in a news release Thursday.

The American Hospital Association likewise criticized the Supreme Court's action.

“We are disappointed that physicians, nurses and other clinicians across the country still do not have needed clarity,” General Counsel Chad Golder said in a news release Thursday. “Caregivers must be able to exercise their professional judgment about a patient’s care as federal law requires under the Emergency Medical Treatment and Active Labor Act without the fear of criminal prosecution.”

The Health and Human Services Department has already been investigating hospitals reported to be out of compliance with EMTALA and will enforce the statute, Secretary Xavier Becerra said in a news release Thursday. "We will continue to uphold the law and the right to emergency care, to inform people of their rights under EMTALA, and to make it easier for someone denied care to file a complaint, he said.

This Supreme Court likely won't revisit the Idaho cases for at least a year while the lower courts reconsider them, said Laurie Sobel, associate director for women's health policy at KFF. But the federal government challenged a U.S. Court of Appeals for the 5th Circuit ruling that a Texas abortion law supersedes EMTALA, and the Supreme Court hasn't said whether it will accept it.

More than a dozen states, including Idaho and Texas, have near-total abortion bans on the books and a handful of others don't allow the procedure past six weeks of pregnancy. Each state's law is a target for an EMTALA case, and multiple courts making different decisions would create a patchwork of standards for providers to follow, Sobel said.

The legal ambiguity has already affected the healthcare system, and will continue to do so, said MaryBeth Musumeci, a professor at the George Washington University Milken Institute of Public Health.

Medical students are increasingly choosing to pursue residencies in states where abortion is legal, and some providers are leaving states with laws that could take away their licenses or prosecute them for administering emergency abortions, for instance.