Moyle v. United States: Ruling, Split, and Idaho Impact

In Moyle v. United States, the Supreme Court was asked whether the federal Emergency Medical Treatment and Labor Act (EMTALA) requires Idaho hospitals to perform abortions needed to stabilize a patient’s health, even though Idaho’s near-total abortion ban criminalizes the procedure outside of life-threatening circumstances. On June 27, 2024, the Court sidestepped the question. In a brief, unsigned opinion, it dismissed the case as “improvidently granted” and sent it back to the lower courts, leaving the underlying conflict between federal emergency care law and state abortion law unresolved.¹

The Conflict That Produced the Case

EMTALA requires every hospital that accepts Medicare and runs an emergency department to screen patients who arrive seeking care and, if an emergency medical condition exists, to provide stabilizing treatment. The statute defines that condition broadly: symptoms serious enough that, without immediate attention, a reasonable person would expect the patient’s health to be placed in serious jeopardy or expect serious impairment to bodily functions or serious dysfunction of any organ.²

Idaho’s Defense of Life Act, Idaho Code § 18-622, makes performing an abortion a felony punishable by two to five years in prison, with license suspension on a first offense and permanent revocation on a second. The only medical exception is for abortions a physician believes in good faith are necessary to prevent the patient’s death. The exception operates as an affirmative defense, meaning the charged physician must prove it applies.³

The two laws leave a dangerous gap. EMTALA covers patients whose health is in serious jeopardy. Idaho permits abortion only when the patient will otherwise die. Conditions like severe preeclampsia, premature rupture of membranes, sepsis, placental abruption, and severe heart failure can threaten devastating health consequences short of immediate death.¹ A physician who intervenes to stabilize such a patient may violate state criminal law; a physician who waits may violate federal law.

The Department of Justice sued Idaho, arguing EMTALA preempts the state ban in these emergencies under the Supremacy Clause. EMTALA contains a limited preemption clause that displaces state laws only where they “directly conflict” with its requirements.² Idaho responded that EMTALA is a screening and transfer statute, not a treatment mandate, and that its references to “unborn children” show Congress never meant it to compel abortions. A federal district court sided with the government and issued a preliminary injunction blocking Idaho from enforcing its ban in EMTALA-covered emergencies.

What the Supreme Court Did on June 27, 2024

Idaho appealed directly to the Supreme Court, and the Court agreed to hear the case before the Ninth Circuit ruled. This expedited review, called certiorari before judgment, is unusual and typically signals that the Court sees an urgent need to decide. The urgency did not survive argument. The Court issued a brief per curiam opinion dismissing the case as improvidently granted, concluding it should not have taken the case at this stage.¹

At the same time, the Court vacated a stay it had entered in January 2024. That stay had allowed Idaho to enforce its abortion ban in all circumstances while the case was pending. Lifting it reinstated the district court’s preliminary injunction, so Idaho once again could not prosecute physicians who performed emergency abortions to protect a patient’s health.¹

The dismissal is procedural. It creates no precedent, decides no legal question, and binds no court. The case went back to the Ninth Circuit to proceed through normal appellate review. Idaho physicians got temporary relief; the fundamental legal conflict got no answer.

How the Justices Split

Although the Court declined to rule, the separate opinions revealed how divided the justices are on the merits. The breakdown was 3-3-3.

Justice Kagan, joined by Justice Sotomayor, wrote that the conflict was straightforward: EMTALA requires stabilizing treatment for serious health emergencies, Idaho criminalizes that treatment, and federal law prevails under the Supremacy Clause. Justice Jackson agreed with that conclusion and argued the Court should have decided the case on the merits rather than ducking it, calling the dismissal a delay that left doctors in the dark and patients at risk.¹

Justice Barrett, joined by Chief Justice Roberts and Justice Kavanaugh, provided the votes to dismiss. Her concurrence argued the dispute had narrowed during litigation. Idaho’s attorneys had represented that the state’s law already permitted emergency abortions for conditions like preeclampsia, placental abruption, and sepsis, while the federal government had backed away from claims that EMTALA requires abortions for mental health conditions. With both sides moving toward common ground, Barrett concluded the case was not ripe for a sweeping ruling on whether federal spending power can preempt state criminal law.

Justice Alito, joined by Justice Thomas, dissented sharply. He argued the Court should have reached the merits and held that EMTALA does not require hospitals to perform abortions. His reasoning leaned on the statute’s references to the “unborn child” as a patient whose emergency condition the hospital must also address, reading the law as imposing a dual obligation that cuts against treating it as an abortion mandate.

Three justices saw clear federal preemption. Three wanted to deny preemption entirely. Three thought the question was premature. That split virtually guarantees the issue returns to the Court.

What Has Changed Since the Ruling

Two developments have reshaped the legal landscape since June 2024, and both pull against the preemption theory the Justice Department advanced.

The Fifth Circuit Reached the Opposite Conclusion

In Texas, the same legal question produced a contrary result. In Texas v. Becerra, the Fifth Circuit Court of Appeals ruled that EMTALA does not require hospitals to perform emergency abortions and that the federal guidance saying otherwise exceeded the government’s statutory authority.⁴ The court emphasized EMTALA’s obligations regarding the unborn child alongside the mother, said the law does not create a national standard of care, and noted that the practice of medicine is governed by states. The Supreme Court declined to review the decision.

The Fifth Circuit’s permanent injunction blocks the federal government from enforcing its abortion-related EMTALA interpretation anywhere in Texas, and also blocks enforcement against individual members of the American Association of Pro-Life Obstetricians and Gynecologists and the Christian Medical and Dental Associations wherever those physicians practice.⁴ This is the kind of circuit split the Supreme Court usually resolves. Moyle delayed that resolution indefinitely.

CMS Rescinded the Guidance Underlying the Lawsuit

The enforcement picture shifted again in 2025. In July 2022, during the Biden administration, CMS had issued guidance telling hospitals that EMTALA required stabilizing treatment, including abortions, when a pregnant patient presented with an emergency. That guidance was the basis for the enforcement actions in both the Idaho and Texas lawsuits. On May 29, 2025, CMS formally rescinded it.⁵

CMS said it would keep enforcing EMTALA generally, including protections for pregnant patients and their unborn children in emergencies. But the specific interpretation that EMTALA requires emergency abortions when state law forbids them is no longer the federal government’s official position. The text of EMTALA has not changed, and the Idaho district court injunction remains a separate court order. What has disappeared is the federal enforcement pressure that made the preemption argument matter in practice.

Where Emergency Abortion Access in Idaho Stands Now

As of mid-2025, the district court’s preliminary injunction remains in effect. Idaho cannot enforce its abortion ban against physicians who perform emergency abortions to prevent serious health harm as defined by EMTALA.¹ The case is before the Ninth Circuit for a merits hearing, and that court’s ruling will determine whether the injunction becomes permanent or is overturned.

Several factors continue to create uncertainty for Idaho physicians despite the injunction. It is a preliminary order that could be modified or reversed at any stage. The federal government that originally sued to establish the preemption theory has since rescinded the guidance underlying it. And Idaho’s affirmative-defense structure means that even a prosecution that ultimately fails still forces the physician to defend against a felony charge. Doctors have described the environment as one where it is impossible to know at what point they can safely intervene without risking prison or their license.

The split decision in Moyle, the opposing ruling in the Fifth Circuit, and the federal government’s reversal all point in the same direction: the question the Supreme Court declined to answer in June 2024 is still open, and the next case to reach the Court is likely to be decided on the merits.

1
Supreme Court of the United States. Moyle v United States
2
Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
3
Idaho State Legislature. Idaho Code 18-622 – Defense of Life Act
4
United States Court of Appeals for the Fifth Circuit. State of Texas v Xavier Becerra
5
Centers for Medicare & Medicaid Services. Rescinded Reinforcement of EMTALA Obligations Specific to Patients Who Are Pregnant or Are Experiencing Pregnancy Loss