A case that will test the balance of power between the Biden administration and state governments in the wake of the overturning of Roe v. Wade is heading to the Supreme Court this week. 

At issue is whether Idaho’s Defense of Life Act is preempted by a federal law, the Emergency Medical Treatment and Active Labor Act, requiring doctors to provide medically necessary procedures.

As arguments approach on April 24, Idaho has maintained that abortion regulation is now in the hands of the states, while the Justice Department argues that a nearly-40-year-old law mandates that hospitals provide emergency treatment, including abortion, for the health of the mother. 

The case arrives before the court as state abortion ballot initiatives are ramping up across the country and abortion is a top issue for voters in the upcoming presidential election.

In March, the Supreme Court heard arguments for the first major abortion case since the overturn of Roe v. Wade, about whether the Food and Drug Administration put women’s health at risk when it removed safeguards from a drug used in chemical abortion procedures. 

Idaho’s Defense of Life Act — a trigger law that went into effect after the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization — criminalizes performing an abortion except when a physician determines “in his good faith medical judgment” that the “abortion was necessary to prevent the death of the pregnant woman,” or when a woman has reported to law enforcement that she is pregnant as a result of incest or rape.

The Justice Department sued Idaho in 2022, arguing that the state law prevents hospitals from following the requirements laid out in the federal emergency medicine statute. 

“In the days since the Dobbs decision, there have been widespread reports of delays and denials of treatment to pregnant women experiencing medical emergencies,” Attorney General Merrick Garland said in a statement.

Idaho’s governor, Brad Little, fired back that abortion was in the hands of states following Dobbs.

“The U.S. Justice Department’s interference with Idaho’s pro-life law is another example of Biden overreaching yet again while he continues to ignore issues that really should demand his attention – like crushing inflation and the open border with Mexico,” he said in a statement. 

In January, the Supreme Court issued an order allowing Idaho to enforce its abortion ban until the justices make a decision in the case — overturning a lower court ruling that blocked Idaho from enforcement. 

When reached by the Sun, the Justice Department declined to comment, citing pending litigation. In a brief, the Biden administration argues that only allowing abortion to prevent the death of the mother — and not in cases that could otherwise harm the woman’s health — is a violation of federal law. 

“EMTALA’s promise is limited but profound: No one who comes to an emergency room in need of emergency medical care should be denied the treatment required to stabilize her condition,” the brief reads. “For some pregnant women suffering tragic emergency complications, the only care that can prevent grave harm to their health is termination of the pregnancy.”

Federal law requires hospitals that participate in Medicaid to offer those services, the department argues. 

“Many pregnancy complications do not pose a threat to the woman’s life when she arrives at the emergency room — but delaying care until necessary to prevent her death could allow her condition to deteriorate, placing her at risk of acute and long-term complications,” the filing notes. When the mother’s health is threatened, the mother deserves care that “any other person with any other condition would seek and receive in a hospital emergency room.” 

Idaho argues in its brief that the Biden administration reinterpreted the EMTALA — 40 years after President Reagan signed into law — to “create a nationwide abortion mandate in hospital emergency rooms that accept Medicare funding.”

The Biden Administration and the press are falsely portraying the law, Idaho’s attorney general’s office tells the Sun, adding that both the federal and state law are meant to protect “everyone’s life.”

“Idaho law is perfectly consistent with EMTALA, which provides explicit protections for ‘unborn children’ in four separate places,” a representative of the office says. “The notion that EMTALA requires doctors to perform abortions is absurd. We are asking the Supreme Court to end the administration’s unlawful overreach and to respect the people of Idaho’s decision to protect life.”

The state’s brief cites a recent Fifth Circuit Court ruling on similar issues arising out of Texas — there, the court held that the federal law doesn’t mandate any specific types of treatment, including abortion. 

Nearly two dozen Republican-led states are backing Idaho’s law, writing in an amicus brief that if the court accepts the Biden administration’s position, it would “permit the Executive Branch to seek decrees overriding all manner of state laws and fundamentally transform the relationships among citizens, their States, and the United States.” The states are urging the court to “preserve the federalist structure” and the states’ “power to regulate for the welfare of their citizens.” 

“President Biden did not wait for Congress to enact pro-abortion legislation,” Idaho argues in its brief. “Instead, three days after issuing the executive order, the administration discovered a national abortion mandate in the silence of EMTALA, where it had evidently lain dormant for 36 years.”