Supreme Court won't decide Texas dispute over emergency abortions

Washington — The Supreme Court on Monday turned away a clash between a federal emergency care law and Texas' near-total ban on abortion, declining to provide clarity over whether physicians in states with the most restrictive laws must provide abortion care in certain emergency circumstances.

The court's rejection of the Biden administration's appeal leaves in place a lower court decision that blocked the federal government from enforcing guidance it issued to hospitals notifying them that they must provide emergency abortions if the health of the mother is at risk. The Department of Health and Human Services told health care providers in a July 2022 letter that when a state abortion law does not include an exception for the life and health of the mother, that measure is preempted by the federal emergency care law. 

The order comes months after the high court dismissed a similar appeal from Idaho, which put back in place a lower court order that blocked the state from enforcing its near-total abortion ban when the procedure is needed to preserve the health of the mother.

The cases have pitted two of the nation's most severe abortion measures against a federal law that requires Medicare-funded hospitals to offer abortions when needed to stabilize a patient's emergency medical condition. In Texas, abortion is banned except when the life of the mother is at risk.

In the Idaho case, the Supreme Court's decision indicated that the majority believed the court intervened too early. The justices did not address the underlying question of whether the federal law, the Emergency Medical Treatment and Labor Act, trumps near-total bans in certain circumstances.

The Texas dispute provided the high court with another opportunity to answer that question, though it declined to do so.

The case began after Health and Human Services Secretary Xavier Becerra told hospitals more than two years ago that federal law requires them to provide pregnant patients experiencing emergency medical conditions with stabilizing treatment, including abortions, regardless of state restrictions.

His guidance came just two months after the Supreme Court overturned Roe v. Wade, which opened the door for states to enact their own abortion laws. Nearly two dozen states have passed measures that have curtailed access to the procedure, and 14 of those states have bans with some exceptions.

Texas sued the Biden administration to block its mandate requiring hospitals to provide emergency abortions, alleging that the secretary exceeded his authority when issuing the guidance.

A federal district court sided with Texas and blocked the guidance, finding that hospitals cannot be forced to provide abortions in certain medical emergencies when it would violate the state's ban.

The U.S. Court of Appeals for the 5th Circuit upheld that order, ruling that EMTALA "does not govern the practice of medicine" or mandate physicians to terminate pregnancies when it is the necessary stabilizing treatment for a medical emergency. The 5th Circuit said the practice of medicine is governed by the states, and physicians must comply with state law.

The Biden administration had urged the Supreme Court to throw out that decision and order additional proceedings in light of its ruling in the Idaho case in June. It also pointed to a recent decision from the Texas Supreme Court that found state law doesn't require the mother's death to be imminent or that she suffer physical impairment in order in order to perform an abortion.

State officials had argued in the wake of that decision that there is no conflict between its abortion ban and EMTALA, since Texas allows abortion where the mother is at risk of death or faces a serious risk of "substantial impairment of a major bodily function."

They urged the Supreme Court to leave the lower court's decision in place, writing in a filing that in Texas, a health care provider can comply with both EMTALA and state law by offering stabilizing treatment without violating its ban. In limited circumstances, they said, that can include providing an abortion when it is necessary to prevent the "substantial impairment of a major bodily function."