When the U.S. Supreme Court overturned Roe v. Wade in its Dobbs v. Jackson Women’s Health Organization decision, it returned the issue of abortion to the people and their elected lawmakers—once again allowing states to enact strong pro-life policies for the first time in nearly 50 years.
Now, the Biden administration is attempting to undermine that ruling by misinterpreting federal law to unilaterally create a new abortion mandate within hospital settings. Thankfully, the states of Texas and Idaho, along with two pro-life physician organizations, are standing up to this abuse of power.
What is the Emergency Medical Treatment and Labor Act?
The U.S. Congress passed the Emergency Medical Treatment and Labor Act (EMTALA) in 1986. It requires all hospitals that participate in Medicare to provide medical screening and stabilizing treatment for emergency medical conditions, even if the patient is not able to pay.
The primary purpose of EMTALA was to prevent “patient dumping,” the practice of refusing to treat patients who are unable to pay. It ensured that hospitals could not turn away patients who required immediate medical assistance but might not be insured.
EMTALA explicitly states that hospitals are required to provide treatment to stabilize emergency medical conditions for both a pregnant mother and her “unborn child.” The act clearly outlines the need to protect unborn children, not harm them.
But following the Supreme Court’s decision to overturn Roe, the Biden administration is attempting to misuse EMTALA to mandate the performance of abortions.
In July 2022, the Centers for Medicare and Medicaid Services issued guidance purporting to remind states about their duties under EMTALA. In reality, the guidance created new requirements that have never existed in federal law.
Instead of requiring a doctor to provide treatment for both mothers and unborn children, this new guidance said doctors must perform abortions if “abortion is the stabilizing treatment necessary to resolve [an emergency medical condition].” And it did not limit the definition of an “emergency medical condition” to cases where the mother’s life is in danger but rather included “incomplete medical abortions” and undefined “health” conditions.
The federal government has previously defined “health” conditions for pregnant women to include social and emotional health, and the term “incomplete medical abortions” refers to chemical abortions that could have been initiated elsewhere. In other words, this new guidance effectively forces doctors to perform elective abortions in a variety of circumstances, even when both the mother and the unborn child could be saved.
Under this newfound interpretation of EMTALA, the Biden administration is attempting to override states’ life-saving laws, which protect women and their unborn children in the emergency room.
But states like Texas and Idaho are standing up against this unlawful federal power grab to ensure life-saving care is given to women and their children.
Currently, Texas law protects every person’s life, including the unborn, allowing abortion only to save the life of the mother.
According to the state’s Human Life Protection Act, which went into effect following the overturning of Roe, “[a] person may not knowingly perform, induce, or attempt an abortion.” Texas also has several laws predating Roe that prohibit anyone in the state from causing an abortion or acting as an accomplice to an abortion or attempted abortion.
All these laws include exceptions in cases where the life of the mother is at risk. And doctors in Texas, as in every other state, can and do treat women’s ectopic pregnancies and other life-threatening conditions in the emergency room.
In State of Texas v. Becerra, Alliance Defending Freedom attorneys are representing the state of Texas alongside doctors who are members of two pro-life organizations—the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) and the Christian Medical and Dental Associations (CMDA).
The state of Texas, AAPLOG, and CMDA filed a lawsuit in July 2022 seeking to have the unconstitutional abortion mandate struck down. Less than a month later, a federal district court in Texas granted our request to temporarily halt the mandate while the lawsuit proceeds, and the 5th Circuit upheld this decision in January 2024.
In a similar but separate case, the Idaho Attorney General’s Office, ADF, and Cooper & Kirk are representing the state of Idaho in State of Idaho v. United States of America. This case seeks to defend Idaho’s Defense of Life Act against the Biden administration’s attempt to force doctors to deny life-saving protections for women and their unborn children.
Idaho enacted the Defense of Life Act in 2020 to safeguard the lives of women and their children, ensuring doctors do not perform abortions except when necessary to preserve the life of the mother. Since the law was passed while Roe was in effect, the law stated that it would be triggered in the event the Supreme Court “restores to the states their authority to prohibit abortion.” This is exactly what happened after the Supreme Court overturned Roe in the Dobbs decision.
But just like in Texas, the Biden administration sought to misuse EMTALA to force Idaho emergency room doctors to harm women and take the lives of their unborn children in violation of state law.
Unfortunately, a federal district court upheld the Biden administration’s novel interpretation of EMTALA and temporarily blocked Idaho’s life-saving law. A three-judge panel of the U.S. Court of Appeals for the 9th Circuit agreed to let Idaho’s law remain in place. But a larger en banc panel of the appeals court overturned that decision and restored the district court’s ruling in November 2023.
Idaho Attorney General Raúl Labrador, together with attorneys from ADF and Cooper & Kirk, filed an emergency application for stay pending appeal with the U.S. Supreme Court to allow Idaho to continue to enforce its law and prioritize women’s health and well-being while the case proceeds.
What’s at stake?
EMTALA and Idaho’s law share the same goal: save every person’s life. In fact, EMTALA requires that emergency rooms provide life-saving care to everyone, including pregnant women and their unborn children, regardless of whether the patient has insurance. But the Biden administration is abusing federal law to force doctors to put women and their children at risk by performing abortions illegal under Idaho law. Women deserve to know that emergency room physicians will do everything possible to save their lives and their children’s lives, but the administration’s unlawful actions threaten their access to life-saving care.
If hospitals do not comply with the Biden administration’s abortion rule, the administration threatens to revoke all federal health funding from them and sue to block the states’ life-saving laws in the meantime. At the same time, since the Texas and Idaho laws prioritize the lives and health of both women and their children, the hospitals could face criminal penalties under state law if they perform the elective abortions that the Biden administration is attempting to mandate.
Furthermore, the Biden abortion rule violates the rights of AAPLOG members, CMDA members, and other doctors who have ethical and medical objections to elective abortions. In addition to their own ethical concerns, doctors would likewise be forced to choose between violating the federal abortion mandate and being kicked out of federally funded care or violating state law. Either choice comes with the threat of significant penalties.
Women and their children deserve to know emergency room physicians will do everything possible to preserve their lives. The federal government has no authority to override Texas or Idaho’s laws prioritizing people’s health and well-being. The Biden administration should never force health-care providers to harm their patients or take vulnerable lives.
- State of Texas v. Becerra
- July 2022: After the Biden administration issued guidance declaring that EMTALA mandates the performance of some elective abortions, the state of Texas, AAPLOG, and CMDA filed a lawsuit seeking to have the Biden administration’s unconstitutional abortion mandate struck down.
- August 2022: A federal district court in Texas granted ADF’s request to temporarily halt enforcement of the mandate while the lawsuit proceeds. The Biden administration appealed the decision.
- November 2023: Oral arguments were heard at the U.S. Court of Appeals for the 5th Circuit.
- January 2024: The 5th Circuit ruled that the Biden administration cannot use EMTALA to force emergency room doctors to perform abortions.
- State of Idaho v. United States of America
- August 2022: A federal district court temporarily enjoined Idaho’s Defense of Life Act in emergency rooms.
- May 2023: The district court denied Idaho’s motion for reconsideration.
- October 2023: A panel of the U.S Court of Appeals for the 9th Circuit unanimously agreed to allow Idaho to enforce its life-saving law.
- November 2023: An en banc 9th Circuit panel reversed the three-judge panel’s decision and restored the district court’s ruling preventing Idaho from ensuring life-saving care to women and their children in emergency rooms. The Idaho Attorney General’s Office, together with ADF and Cooper & Kirk, filed an emergency application for stay pending appeal with the U.S. Supreme Court to allow Idaho to continue to enforce its law prioritizing women and children’s lives while the case proceeds.