After the Biden administration attempted to apply federal statute to supersede an Idaho law protecting unborn life, the Supreme Court chose to dismiss Idaho’s challenge to the combined cases in question and allow emergency abortions to take place in the state.

While proponents on both sides of the abortion debate have voiced their opinions on the matter, the decision of the court not to rule is concerning for reasons other than the ethical dilemma of abortion. The court had another serious question before it: Does the federal government have the ability to intervene in state law in this situation?

Nearly two years ago, a lower court issued a preemptive ban on Idaho’s Defense of Life Act as it pertained to allowing emergency procedures under the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospital emergency rooms to accept patients even if they don’t have insurance. The Supreme Court lifted the ban in January as it took up the cases, but with their most recent decision to dismiss, the ban is back in effect and emergency abortions in Idaho are allowed while lower courts continue proceedings.

While federal law typically preempts state law, the question as to whether or not it does in this instance is an important one. Several of the justices appeared to agree that this question was worth considering, even when they disagreed with one another on the ultimate decision to dismiss.

Justice Samuel Alito dissented in the dismissal of the case and in his opinion, joined by Justice Clarence Thomas and, in part, Justice Neil Gorsuch, pointed out the concern over states’ rights. He noted, “…it is not necessary to decide whether the Legislature’s theory is correct. At a minimum, however, it provides yet another reason to be wary about interpreting EMTALA to displace the core powers of a nonconsenting State without unmistakable clarity regarding the meaning of the federal law.”

Alito wrote that Congress already addressed the problem of the federal government intervening in state affairs in the Medicare Act, as well as the very wording of the EMTALA. Indeed, the preemption clause of the EMTALA states, “The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section. [sic]” This shows, he argued, that EMTALA was meant to exist alongside state law.

Justice Amy Coney Barrett came down on the opposite side, but still acknowledged the need for clarity about the federal government’s power. In her concurring opinion in favor of dismissing the cases, she was joined by Chief Justice John Roberts and Justice Brett Kavanaugh. She wrote that there is a disagreement between the parties as to whether hospitals are required to administer abortions “or any other treatment forbidden by state law” under the federal statute of EMTALA. Notably, she added that they “also disagree about whether EMTALA, as a statute enacted under Congress’s spending power and that operates on private parties, can preempt state law [sic],” adding that this issue has been brought up now for the first time in the Supreme Court. Barrett wrote this is not the time to “answer these important questions” and “would be imprudent” to do so for various reasons.

She also noted that the Idaho parties are concerned about the role Congress is allowed to play in state governance. The question over whether “Congress, in reliance on the Spending Clause, can obligate recipients of federal funds to violate state criminal law” was not addressed by the lower courts. She wrote that the lower courts should consider and decide on this before the Supreme Court supersedes the typical judicial order. In stating the importance of this issue of federal power versus state autonomy, it appears that Barrett and the justices joining her opinion agree there is a new concern that has been raised in bringing the cases, but still they decide not to act.

Citizens depend on their local elected leaders to pass laws that reflect their own personal beliefs, and they should be able to rely on the courts to keep the federal government in check if it seeks to broaden its power. As Alito pointed out, the “gap between the Idaho law and the Government’s interpretation of EMTALA matters.” Idaho has always allowed abortions to save the life of the mother, he wrote, “but it has not allowed abortions for other non-life-threatening medical conditions.” This differentiation is not meaningless. It is exemplary of how the citizens of Idaho feel about the topic of abortion, he argued – and forcing hospitals to go against this and administer emergency abortions “thwarts the will of the people of Idaho as expressed in law by their elected representatives.”

If states are made to change their laws based on the whims of those currently leading at the federal level, the peoples’ rights will suffer. A nation is only as strong as its foundational structure, and it is the duty of the courts to uphold it.

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