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23-726 6jgm
23-726 6jgm
____ (2024) 1
Per Curiam
IDAHO, PETITIONER
23–727 v.
UNITED STATES
ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE NINTH CIRCUIT
[June 27, 2024]
PER CURIAM.
The writs of certiorari before judgment are dismissed as
improvidently granted, and the stays entered by the Court
on January 5, 2024, are vacated.
It is so ordered.
Cite as: 603 U. S. ____ (2024) 1
IDAHO, PETITIONER
23–727 v.
UNITED STATES
ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE NINTH CIRCUIT
[June 27, 2024]
After the Idaho Supreme Court construed the law, the Dis-
trict Court revisited its findings, and reaffirmed its entry of
the injunction. See 2023 WL 3284977, *1, *5 (May 4, 2023).
In line with standard practice, that decision now can go to
the Court of Appeals, and the District Court can afterward
consider further evidence and arguments for the purpose of
final judgment. Idaho is not entitled to anything more. It
mainly argues that EMTALA never requires a hospital to
“offer medical treatments that violate state law,” even when
they are needed to prevent substantial health harms. Tr.
of Oral Arg. 4. In my view, that understanding of EMTALA
is not “likely to succeed on the merits,” and so cannot sup-
port a stay of the injunction. Nken v. Holder, 556 U. S. 418,
434 (2009). Neither does the State’s argument provide any
basis for this Court to short-circuit the proceedings below.
Today’s ruling thus puts the case back where it belongs, and
with the preliminary injunction in place.
II
JUSTICE ALITO’s dissenting opinion requires a brief re-
sponse. His primary argument is that although EMTALA
generally obligates hospitals to provide emergency medical
care, it never demands that they offer an abortion—no mat-
ter how much that procedure is needed to prevent grave
physical harm, or even death. See post, at 4–15. That view
has no basis in the statute.
EMTALA unambiguously requires that a Medicare-
funded hospital provide whatever medical treatment is nec-
essary to stabilize a health emergency—and an abortion, in
rare situations, is such a treatment. The statutory obliga-
tion kicks in when an individual arrives at a hospital with
an “emergency medical condition,” which is one involving
serious jeopardy to health. §1395dd(e)(1)(A). The hospital
must then “stabilize” the condition. §1395dd(b)(1)(A). That
means offering the medical treatment necessary to ensure
that “no material deterioration of the condition” is likely to
Cite as: 603 U. S. ____ (2024) 5
——————
*The amendment’s history confirms that understanding. As originally
enacted, EMTALA did not obligate hospitals to provide medical care
when a woman’s fetus, but not the woman herself, was in peril. See Tr.
of Oral Arg. 105 (Solicitor General describing “well-publicized cases”
where women’s “own health and life were not in danger, but the fetus
was in grave distress and hospitals weren’t treating them”). To fix that
problem, very large bipartisan majorities in both the House and the Sen-
ate elected to broaden the provision, entitling a woman to demand care
for her unborn child as well as herself. See 103 Stat. 2248; 135 Cong.
Rec. 31431 (1989); id., at 31127; id., at 24605; id., at 23393. The amend-
ment would likely have sparked far more opposition if it somehow tacitly
withdrew EMTALA’s requirement that hospitals treat women who need
an abortion to prevent death or serious harm.
Cite as: 603 U. S. ____ (2024) 1
IDAHO, PETITIONER
23–727 v.
UNITED STATES
ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE NINTH CIRCUIT
[June 27, 2024]
——————
*The United States also clarified that if pregnancy seriously jeopard-
izes the woman’s health postviability, EMTALA requires delivery, not
abortion. Brief for United States 10; Tr. of Oral Arg. 75. And it empha-
sized that EMTALA requires abortion only in an “emergency acute med-
ical situation,” where a woman’s health is in jeopardy if she does not re-
ceive an abortion “then and there.” Tr. of Oral Arg. 79–80. These two
temporal points also narrow the scope of EMTALA’s potential conflict
with Idaho’s Act.
6 MOYLE v. UNITED STATES
Tr. of Oral Arg. 23. The same is true for the conditions iden-
tified by the Government’s witnesses (severe heart failure
and sepsis). Reply Brief in No. 23–727, pp. 8–9.
A grant of certiorari before judgment presumes that fur-
ther proceedings below are unnecessary to the Court’s res-
olution of the question presented. That was a miscalcula-
tion in these cases, because the parties’ positions are still
evolving. The United States has clarified that EMTALA’s
reach is far more modest than it appeared when we granted
certiorari and a stay. Idaho law has materially changed
since the District Court entered the preliminary injunction,
and, based on the parties’ arguments before us, it seems
that the framing of these cases has not had sufficient op-
portunity to catch up. Cf. The Monrosa v. Carbon Black
Export, Inc., 359 U. S. 180, 184 (1959) (“Examination of a
case on the merits, on oral argument, may bring into ‘proper
focus’ a consideration which, though present in the record
at the time of granting the writ, only later indicates that
the grant was improvident”).
On top of that, petitioners have raised a difficult and con-
sequential argument, which they did not discuss in their
stay applications, about whether Congress, in reliance on
the Spending Clause, can obligate recipients of federal
funds to violate state criminal law. Brief for Petitioners in
No. 23–726, pp. 48–51; Reply Brief in No. 23–727, pp. 3–4;
see also Brief for Prolife Center at the University of
St. Thomas as Amicus Curiae. The District Court did not
address this issue below—nor did the Ninth Circuit, which
we bypassed. We should not jump ahead of the lower
courts, particularly on an issue of such importance. Cutter
v. Wilkinson, 544 U. S. 709, 718, n. 7 (2005) (“[W]e are a
court of review, not of first view”); New York v. Uplinger,
467 U. S. 246, 251 (1984) (Stevens, J., concurring) (dismiss-
ing as improvidently granted where “constitutional ques-
tions” would otherwise be considered “premature[ly]”). The
lower courts should address the Spending Clause issue in
the first instance.
Cite as: 603 U. S. ____ (2024) 7
Opinion of JACKSON, J.
IDAHO, PETITIONER
23–727 v.
UNITED STATES
ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE NINTH CIRCUIT
[June 27, 2024]
Opinion of JACKSON, J.
Opinion of JACKSON, J.
Opinion of JACKSON, J.
Opinion of JACKSON, J.
——————
*See Brief for Idaho Coalition for Safe Healthcare, Inc., as Amicus Cu-
riae 7–13 (providing examples in Idaho where doctors’ lack of certainty
prevented them from providing medically necessary abortions); see also
Brief for St. Luke’s Health System as Amicus Curiae 14–16 (same); Brief
6 MOYLE v. UNITED STATES
Opinion of JACKSON, J.
Opinion of JACKSON, J.
Opinion of JACKSON, J.
IDAHO, PETITIONER
23–727 v.
UNITED STATES
ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE NINTH CIRCUIT
[June 27, 2024]
that 96% of hospitals have at least 50% of their inpatient days paid by
Medicare and Medicaid. AHA, Fact Sheet: Majority of Hospital Pay-
ments Dependent on Medicare or Medicaid (Mar. 2024).
Cite as: 603 U. S. ____ (2024) 3
ever will be. Apparently, the Court has simply lost the will
to decide the easy but emotional and highly politicized ques-
tion that the case presents. That is regrettable.
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 espe-
cially so because the Court’s decision to reexamine the stay
issued in January makes it necessary to reassess whether
Idaho showed a likelihood of success on the merits, a ques-
tion that is closely related to the question whether Idaho or
the Government has correctly interpreted EMTALA. I will
therefore proceed to analyze what EMTALA means.
I
A
The text of EMTALA shows clearly that it does not re-
quire hospitals to perform abortions in violation of Idaho
law. To the contrary, EMTALA obligates Medicare-funded
hospitals to treat, not abort, an “unborn child.”
EMTALA imposes two main obligations on covered hos-
pitals. First, a hospital must, within its “capabilit[ies],”
“screen” “any individual” arriving at the emergency room
without regard to the individual’s ability to pay.
§§1395dd(a), (h). The purpose of this screening is to deter-
mine whether the individual has an “emergency medical
condition,” which EMTALA defines as follows:
“a medical condition manifesting itself by acute
symptoms of sufficient severity (including severe pain)
such that the absence of immediate medical attention
could reasonably be expected to result in—
“(i) placing the health of the individual (or, with re-
spect to a pregnant woman, the health of the woman or
her unborn child) in serious jeopardy,
“(ii) serious impairment to bodily functions, or
“(iii) serious dysfunction of any bodily organ or
Cite as: 603 U. S. ____ (2024) 5
——————
2 At oral argument, the Solicitor General stated that, in the Govern-
member of the species homo sapiens who is born alive at any stage of
development.” 1 U. S. C. §8(a). But it goes on to provide that this defi-
nition is not to “be construed to . . . deny . . . any legal status or legal
right applicable to any member of the species homo sapiens at any point
prior to being ‘born alive.’ ” §8(c). Thus, the Act itself provides no support
for the Government’s position.
4 §1395dd(a).
5 §1395dd(c)(1)(A)(i).
6 §1395dd(b)(2).
7 §1395dd(d)(2)(A).
8 §§1395dd(b)(3), (c), (e)(4).
Cite as: 603 U. S. ____ (2024) 7
——————
9 §1395dd(e)(1)(A)(i).
10 §§1395dd(c)(1)(A)(ii) and (2)(A), (e)(1)(A)(i).
8 MOYLE v. UNITED STATES
B
For those who find it appropriate to look beyond the stat-
utory text, the context in which EMTALA was enacted re-
inforces what the text makes clear. Congress designed
EMTALA to solve a particular problem—preventing private
hospitals from turning away patients who are unable to pay
for medical care. H. R. Rep. No. 99–241(I), pt. 1, p. 27
(1985); K. Treiger, Preventing Patient Dumping: Sharpen-
ing the COBRA’s Fangs, 61 N. Y. U. L. Rev. 1186, 1188
(1986). And none of many briefs submitted in this suit has
found any suggestion in the proceedings leading up to
EMTALA’s passage that the Act might also use the carrot
of federal funds to entice hospitals to perform abortions. To
the contrary, EMTALA garnered broad support in both
Houses of Congress, including the support of Members such
as Representative Henry Hyde who adamantly opposed the
use of federal funds to abet abortion.11
It is also telling that the Congress that initially enacted
EMTALA in 1986 and the one that amended it in 1989 also
passed appropriations riders under what is now known as
the Hyde Amendment (named after Representative Hyde)
to prevent federal funds from facilitating abortions, except
in limited circumstances. See Harris v. McRae, 448 U. S.
297, 302 (1980). Between 1981 and 1993—the very period
when EMTALA was enacted and amended—the Hyde
Amendment contained only one exception: for abortions
necessary to save the life of the pregnant woman. Congres-
sional Research Service, E. Liu & W. Shen, The Hyde
Amendment: An Overview 1 (2022); see §204, 99 Stat. 1119
(1986 Hyde Amendment). The Hyde Amendment thus pro-
hibited federal funds from paying for the health-related
——————
11 See House Vote #499 in 1986 (99th Cong.), GovTrack.US (Mar. 20,
——————
12 Additionally, it is doubtful that Idaho law would have prevented an
abortion in this suit. The woman was diagnosed with “[i]nevitable abor-
tion.” Centers for Medicare and Medicaid Services, Hospital Surveys
With 2567 Statement of Deficiencies—2024Q1 (2010–2016 file) Row
16,961. But Idaho law does not apply to “non-viable pregnancies . . .
where the unborn child is no longer developing.” Planned Parenthood
Great Northwest v. State, 171 Idaho 374, 445, 522 P. 3d 1132, 1203
(2023); see also Idaho Code Ann. §§18–604(1), (11).
Cite as: 603 U. S. ____ (2024) 11
——————
14 Only one state psychiatric hospital accepts Medicare funds, and it
III
Even if the Court is unwilling to decide the statutory in-
terpretation question, there is no excuse for vacating the
stay of the preliminary injunction. In order to obtain that
injunction, the Government was required to make a strong
showing that it was likely to prevail on the merits. See
Munaf v. Geren, 553 U. S. 674, 690 (2008). And as I have
explained, its argument was almost certain to lose. That in
itself is sufficient to preclude continuation of the prelimi-
nary injunction.
Why then have six Justices voted to vacate the stay? The
per curiam itself provides no explanation. In separate opin-
ions, three of the six agree with the Government’s interpre-
tation of EMTALA, see supra, at 15, n. 17, and that at least
is an explanation that would make sense if the premise (the
correctness of the Government’s interpretation) were
sound. As for the remaining three, their only explanation
is that “the injunction will not stop Idaho from enforcing its
law in the vast majority of circumstances” and that there-
fore Idaho cannot show that it will be irreparably harmed
by allowing the injunction to remain in place during the
pendency of the appeal. Ante, at 7 (BARRETT, J., joined by
ROBERTS, C. J., and KAVANAUGH, J., concurring). That jus-
tification is patently unsound. “ ‘[A]ny time a State is en-
joined by a court from effectuating statutes enacted by rep-
resentatives of its people, it suffers a form of irreparable
injury.’ ” Maryland v. King, 567 U. S. 1301, 1303 (2012)
(ROBERTS, C. J., in chambers). And in this case, Idaho’s in-
jury is not abstract. As I will explain, it is very likely that
——————
apply to Spending Clause measures or how Idaho can be bound by con-
ditions to which it has never agreed.
JUSTICE JACKSON’s opinion adds nothing to JUSTICE KAGAN’s legal anal-
ysis, but she reads my opinion to suggest “that States have free rein to
nullify federal law.” Ante, at 7 (opinion concurring in part and dissenting
in part). Anyone who reads my opinion can see that it makes no such
suggestion but simply explains what the federal law in question means.
Cite as: 603 U. S. ____ (2024) 17
any latitude, it said, “ ‘operates for the benefit, not the dis-
advantage, of the pregnant woman.’ ” Id., at 445–446, 522
P. 3d, at 1203–1204. Even so, Idaho’s law is focused on
“death,” and a doctor must be able to say in “good faith” that
he or she was acting to preserve the woman’s life, not
simply her health. Idaho Code Ann. §18–622(2)(a)(i).
These different considerations—health versus life—may
lead to different outcomes. For instance, consider the situ-
ation of a woman who experiences a condition that was dis-
cussed in the briefs and at argument: preterm prelabor rup-
ture of membranes (PPROM), which occurs when a
woman’s amniotic sac breaks before the 37th week of preg-
nancy. 1 App. 295. The Members of this Court are not phy-
sicians and should therefore be wary about expressing con-
clusions about medical issues. But guidance provided by
prominent medical institutions is sufficient to show how
Idaho law and EMTALA, as interpreted by the Govern-
ment, may conflict in such cases.
If a woman experiences PPROM between the 34th and
37th week of pregnancy and does not go into labor, her phy-
sician is likely to recommend that labor be induced.18 In
that situation, it does not appear that the risk of conflict is
high.
On the other hand, when PPROM occurs earlier than
that, the chances of conflict are greatly increased. If
PPROM occurs before the 34th week and the woman’s preg-
nancy continues, she may experience conditions such as an
infection of the amniotic fluid, inflammation of the uterine
lining, hemorrhage, or sepsis.19 However, life-threatening
——————
18 See, e.g., 1 App. 306; Mount Sinai, Premature Rupture of Membranes,
https://www.mountsinai.org/health-library/special-topic/premature-
rupture-of-membranes#:~:text=Sometimes%20the%20membranes%
20break%20before,rupture%20of%20membranes%20 (June 21, 2024).
19 One study found that 14% of women with PPROM before the point
——————
Wade, 82 Yale L. J. 920, 921, and n. 19 (1973); J. Dellapenna, Dispelling
the Myths of Abortion History 695 (2006) (“Blackmun’s definition of a
woman’s ‘health’ in Doe as encompassing anything affecting her ‘well-
being’ virtually precluded any possible regulation of abortion during the
entire months of pregnancy”); R. Ponnuru, The Party of Death 10 (2006)
(“Roe required that any ban on late-term abortion include an exception
allowing abortion to protect a woman’s health; Doe defined that excep-
tion so broadly that it swallowed up any possibility of a ban”).
Cite as: 603 U. S. ____ (2024) 25
* * *
Today’s decision is puzzling. Having taken the unusual
step of granting certiorari before Idaho’s appeal could be
heard by the Ninth Circuit, the Court decides it does not
want to tackle this case after all and thus returns the ap-
peal to the Ninth Circuit, which will have to decide the is-
sue that this Court now ducks. What is more, the Court
vacates the stay it issued earlier this year even though the
majority fails to provide any facially plausible explanation
for doing so.
I cannot endorse this turn of events and therefore re-
spectfully dissent.