On April 24, the U.S. Supreme Court will hear Idaho v. United States. This case will determine whether a narrow but powerful nationwide guarantee of access to emergency hospital care protects pregnant women whose medical emergencies require an abortion as stabilizing care to prevent death or severe and long-lasting injury to health.
Since 1986, the Emergency Treatment and Labor Act (EMTALA) has applied to all Medicare-participating hospitals with emergency departments. In the aftermath of Dobbs v Jackson Women’s Health Organization, which ended the constitutional right to abortion but did not alter EMTALA’s special emergency care protections, the question of whether Dobbs affects this unique American law has loomed. Furthermore, the implications of the case extend beyond pregnancy-related emergencies; if the Supreme Court rules in Idaho’s favor, states effectively would be able to override EMTALA protections for disfavored populations, conditions and treatments more generally.
“The High Court’s decision could leave pregnant women who experience a health crisis without basic care to stabilize their emergency,” said Lynn R. Goldman, dean of the George Washington University Milken Institute School of Public Health and one of the amici. “Many serious problems can occur in a pregnancy that require immediate treatment. Without emergency medical care, including an abortion if needed, women are at risk for serious, lifelong health consequences.”
EMTALA assures a national approach to patients presenting to emergency departments that assures they are screened and stabilized for life or health—threatening conditions including reproductive emergencies. Congress made EMTALA a condition of hospital Medicare participation as a safeguard for patients. This protection was needed because of a significant prior history of patient dumping, including discharge of unstable patients, and neglect. For 40 years, this guarantee, whose scope and purpose are clear, has protected all patients seeking emergency care. By its express terms, EMTALA preempts state laws that contravene its requirements.
The public health amicus brief argues that if the Supreme Court allows Idaho to proceed despite the clear scope and sweep of EMTALA, states could bar their hospitals from intervening in other health emergencies including any type of emergency involving pregnant women where pregnancy loss might be a consequence of emergency intervention.
"Every individual deserves access to vital emergency care and EMTALA embodies our nation’s collective commitment to this principle of safeguarding life and health. Any limitation on these emergency care protections would leave countless people at risk and erode the very foundation of compassion in our healthcare system,” said Georges C. Benjamin, executive director of the American Public Health Association.
The brief is signed by the American Public Health Association, the Robert Wood Johnson Foundation, the American Medical Women’s Association and the Network for Public Health Law as well as 133 deans and scholars in public health, health professions and health law and policy.
The brief argues that EMTALA preempts state laws that conflict with the emergency care obligations it imposes on the nearly 6,000 U.S. hospitals that participate in Medicare. Idaho’s state law criminalizes the provision of abortion care in all but life-endangering situations, putting the law at direct odds with EMTALA’s universal protections.
If the Supreme Court rules in favor of Idaho, the public health brief argues, the impact would go far beyond abortion and would allow states to ban treatment for disfavored emergency conditions—a move that would threaten other kinds of emergency care in other situations.
The brief can be accessed online here. You can also view all the briefs in the case here.
The deans and scholars who signed the brief did so in their individual capacities. The views expressed are their own and do not represent their affiliated institutions, organizations or employers.
