The US Supreme Court rejected the Biden administration’s appeal to review a lower court decision that bars emergency abortions violating Texas’ strict abortion ban on Monday, leaving in place restrictions on emergency abortion care in the state. The Supreme Court’s decision not to intervene in the case contrasts with its earlier action in the Idaho case, where it allowed emergency abortions to continue.
The case stemmed from guidance issued by the Biden administration in July 2022, which reminded hospitals of their obligations under the Emergency Medical Treatment and Labor Act (EMTALA), a 1986 federal law which requires Medicare-participating hospitals to perform abortions and provide stabilizing treatment to patients in emergencies even in states where the procedure is otherwise banned. This resulted in access to emergency abortion care nationwide, regardless of state-level restrictions. In response, Texas, along with two anti-abortion medical organizations, the American Association of Pro-Life Obstetricians & Gynecologists and the Christian Medical & Dental Associations, had sued to block enforcement of the guidance, arguing it improperly sought to compel healthcare providers to perform abortions beyond what Texas law permits.
In August 2022, US District Judge James Wesley Hendrix issued a preliminary injunction blocking enforcement of the guidance in Texas, on the basis that the administration’s interpretation of EMTALA was likely unlawful and would permit abortions beyond Texas’ legal exceptions. The Fifth Circuit Court of Appeals upheld this ruling in January 2024.
Abortion rights advocates and doctors have expressed concerns that the ruling will lead to confusion among healthcare providers and potentially endanger patients’ lives, arguing that the lack of clarity on exceptions to abortion bans in various states has already resulted in pregnant women being turned away from emergency rooms, even in cases of serious medical distress.
Conversely, anti-abortion groups and Texas officials have hailed the decision as a victory for state sovereignty and the protection of foetal life, maintaining that Texas law already includes sufficient exceptions for medical emergencies and that the federal guidance was an overreach of executive authority.
This case is part of a larger national debate over abortion access following the Dobbs decision. As states have enacted varying degrees of abortion restrictions, conflicts between state and federal law have emerged, particularly concerning emergency medical care. In May, the Texas Supreme Court rejected a challenge to the state’s abortion laws. Additionally, a report by Amnesty International in June found that the right to abortion remains a threat across the US. Further, the US Supreme Court unanimously rejected a challenge to the abortion pill Mifepristone in June.
