WASHINGTON (AP) 鈥� The U.S. Supreme Court on Wednesday of state bans that have been enacted since the court upended the Roe v. Wade constitutional right to abortion. While the current case involves an Idaho abortion ban, the court鈥檚 ruling could have implications beyond that state.
Idaho lawmakers have banned abortion except when a mother鈥檚 life is at risk. The Biden administration says the state law conflicts with a federal law requiring emergency room doctors to stabilize patients, no matter what, even if that means an abortion.
How the court will rule is uncertain. The justices could make a major ruling 鈥� or they could rule narrowly on how Idaho鈥檚 state law interacts with the federal law, the the Emergency Medical Treatment and Active Labor Act ( ).
A look at the key points in Wednesday鈥檚 arguments.
POTENTIALLY FAR-REACHING IMPACT
Attorneys for both sides warned that the justices鈥� ruling could affect women and doctors far beyond Idaho, changing how emergency rooms treat patients in many other states.
鈥淭here are 22 states with abortion laws on the books,鈥� said Attorney Joshua N. Turner, who represented Idaho. 鈥淭his isn鈥檛 going to end with Idaho. 鈥� This question is going to come up in state after state.鈥�
Solicitor General Elizabeth Prelogar, arguing for the Biden administration, cautioned that other states could pass laws limiting how emergency rooms offer other services, which could mean trouble for more patients when they go to a hospital.
鈥淭his effectively allows states to take any particular treatment they don鈥檛 want their hospitals to provide and dump those patients out of state,鈥� she warned. 鈥淎nd you can imagine what would happen if every state started to take this approach.鈥�
MEDICAL HYPOTHETICALS
Medical 鈥渨hat-ifs鈥� peppered the arguments, sometimes turning personal: What if a woman鈥檚 water breaks early in her pregnancy, exposing her to serious infection risk at a point when the fetus can鈥檛 survive outside the womb? What if continuing the pregnancy would subject a pregnant person to organ failure, or cause permanent infertility?
Idaho's Turner told the court that those would be 鈥渧ery case by case鈥� situations 鈥� a response that left Justice Amy Coney Barrett 鈥渟hocked.鈥�
Barrett, one of the conservatives who voted to overturn Roe v. Wade, pressed Turner on when a prosecutor might bring charges against a doctor for providing an abortion. Experts whom Turner had cited, Barrett said, had told the court that doctors who performed abortions in those cases would be protected.
Turner agreed and said that doctors in Idaho could use their 鈥済ood faith,鈥� medical judgment but Barrett pressed him further.
鈥淲hat if the prosecutor thought differently?鈥� Barrett asked. 鈥淲hat if the prosecutor thought, well, I don鈥檛 think any good faith doctor could draw that conclusion.鈥�
Justice Sonia , part of the court鈥檚 liberal minority, asked Turner to consider how the federal law requires hospitals to treat patients for more common medical emergencies, like the that she has had since childhood.
What if, she said, the state banned treating diabetes with insulin?
鈥淔ederal law would say you can鈥檛 do that,鈥欌�� said Sotomayor. 鈥淥bjective medically accepted standards of care require the treatment of diabetics with insulin. Idaho is saying unless the doctor can say that this person鈥檚 death is likely, as opposed to serious illness, they can鈥檛 perform abortion.鈥�
ABORTION FOR SUICIDAL PATIENTS?
Conservative Justice Samuel Alito was particularly alarmed by Idaho鈥檚 argument that emergency rooms could be forced to provide abortions if a pregnant patient in mental distress demanded one. The state has only raised this as a hypothetical, and not provided an actual example of a doctor being in this position.
鈥淒oes health mean only physical health or does it also mean mental health?鈥� Alito asked Prelogar, noting that he was trying to get her on the record about it if future incidents arise.
Prelogar said it鈥檚 not the administration鈥檚 view that an abortion would be provided as emergency medical care if a woman was suicidal or depressed. She said that the hospital would be required to treat such patients in other ways, dealing with their mental health episode.
鈥淭hat could never lead to pregnancy termination because that is not the accepted standard of practice to treat any mental health emergency,鈥� Prelogar said.
THE LAW鈥橲 INTENT
Congress passed its federal law mandating that emergency rooms stabilize or treat patients in 1986, after reports that private hospitals were offloading patients 鈥� many of them without health insurance and in bad condition 鈥� on public hospitals.
Nearly 40 years later, the attorneys and justices spent some of Wednesday diving into why Congress crafted the law.
Justice Brett pressed Prelogar on why the law was initially created. Idaho鈥檚 officials have argued that the law was supposed to ensure patients without health insurance were treated, and should not be used as a way for the federal government to police whether doctors perform abortions in an emergency.
鈥淭he text of the statute which says in no uncertain terms, here is the fundamental guarantee: If you have an emergency medical condition and you go to an ER in this country, they have to stabilize you,鈥� Prelogar said.
But Turner raised another conundrum for the court about Congress鈥� intent: Why would doctors be required to perform abortions when the text of the law calls on them to treat 鈥渦nborn children.鈥�
鈥淚t would be a strange thing for Congress to have regard for the unborn child and yet also be mandating termination of unborn children,鈥� he told the court.
AN UNCLEAR RESOLUTION
It鈥檚 unclear exactly where the Supreme Court will land, but the court had earlier allowed Idaho鈥檚 abortion ban to be fully enforced while litigation continues.
That means at least five members of the court voted to put on hold a lower court鈥檚 ruling that the federal law overrides Idaho鈥檚 abortion ban in medical emergencies. So the Biden administration was facing a tough road in persuading the court to uphold that ruling.
Six conservative justices all have cast votes to limit abortion access, including five who voted less than two years ago to overturn Roe v. Wade.
Justices Neil Gorsuch, Clarence Thomas and Alito seemed most likely to side with Idaho on Wednesday. The liberal justices, Ketanji Brown Jackson, Kagan and Sotomayor were most favorable to the administration.
The outcome likely turns on the votes of the other three members of the court 鈥� Chief Justice John Roberts and Barrett and Kavanaugh.
Barrett and Kavanaugh voted to overturn Roe.
鈥斺赌�
Boone reported from Boise, Idaho.
Amanda Seitz, Rebecca Boone And Mark Sherman, The Associated Press
