Dive Brief:

• The Justice Department has dropped a Biden-era lawsuit that sought to require Idaho providers to offer emergency abortion care.
• Many watchdog groups see the move as abandoning pregnant people in a state that has a near-total ban on abortion. However, the DOJ’s decision to drop the case will not immediately change care access.
• St. Luke’s Health System, Idaho’s largest provider, separately challenged Idaho’s sweeping abortion ban in January. On Tuesday, St. Luke’s received notice the DOJ planned to drop its case and secured a temporary injunction against the state’s abortion ban, preserving access to emergency abortions for now. 

Dive Insight:

Abortion rights advocates have been bracing for the DOJ to drop its lawsuit against Idaho since Monday, when Special Counsel Daniel Schwei alerted St. Luke’s that the government would not be pursuing its claims under the Emergency Medical Treatment and Labor Act.

Nancy Northup, president and CEO of the Center for Reproductive Rights, called the decision to drop the lawsuit “indefensible” and “a dramatic change” to policy.

“President Trump talks about ‘protecting women’ in sports and in locker rooms, meanwhile he’d let them go septic in the ER,” she said in a statement.

During the time Idaho’s ban was in effect without EMTALA protections, Northrup said providers had resorted to airlifting hemorrhaging women out of the state to receive emergency abortion services. She warned, “With this action, the Trump administration is turning its back on pregnant people in the most dire of situations.” 

The DOJ first sued Idaho in 2022, after the state passed a near-total ban on abortion that allowed the procedure only when a mother’s life was at imminent risk. The state does not allow providers to perform abortion during other medical emergencies, even when the mother is at risk of organ failure.

The Biden administration argued that EMTALA requires providers to offer individuals in emergency rooms medical stabilizing treatments, which could include abortions. Idaho has said there is no conflict between its ban and EMTALA, noting that providers can perform abortions when mothers’ lives are directly at risk.

However, in court filings, providers said determinations aren’t always so simple. And, in some cases, providers were afraid to make a medical judgment about whether the mother’s life was at imminent risk because performing an abortion in Idaho outside of life-saving circumstances carries a penalty of jail time.

The case worked its way through the courts before landing in front of the U.S. Supreme Court last summer.

The high court kicked the question back to an appellate court, declining to offer firm guidance on how state and federal law interact. While abortion rights advocates were pleased the court allowed emergency abortions to continue as litigation proceeded, most agreed the court missed an opportunity to provide crucial clarity for providers.

At the time, two of the court’s liberal justices, Justices Ketanji Brown Jackson and Elena Kagan, said the court’s reluctance to provide a firm answer on how EMTALA interacted with state abortion laws was misguided. 

“While this court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires,” Kagan wrote in a partial dissent. 

Now, the new presidential administration appears to have a different read on EMTALA, despite having waffled previously on abortion policy.

During Robert F. Kennedy’s confirmation hearings for his post as HHS secretary, Kennedy flip-flopped as to whether federal law ought to protect emergency abortion care. In a hearing before the Senate Finance Committee, he said he didn’t know whether the law applied. The next day, appearing before the Senate Committee on Health, Education, Labor and Pensions, Kennedy said EMTALA would cover abortion access in life-threatening scenarios.

On the campaign trail, President Trump made often contradictory remarks about abortion policy in the U.S., at times calling some state-level bans too restrictive and at other times seeming permissive about the possibility of prosecuting patients who violate restrictive bans.

However, architects of Project 2025, a plan written for Trump by the Heritage Foundation, a conservative think tank, clearly called for Trump to drop EMTALA lawsuits and rescind HHS guidance stating EMTALA covers emergency abortions.

Trump said on the campaign trail that Project 2025 was not part of his agenda, but he has already implemented many of their ideas during his first days in office.

Idaho Attorney General Raul Labrador said in a statement that his office was “grateful that meddlesome DOJ litigation on this issue will no longer be an obstacle to Idaho enforcing its laws.”

Still, abortion rights advocates remain hopeful they will prevail in court, even without the support of the DOJ.

“Despite this decision, EMTALA remains federal law. Idaho’s largest health care provider, St. Luke’s, has filed its own lawsuit to continue the fight that the administration dangerously abandoned today,” said Fatima Goss Graves, CEO and president of the National Women’s Law Center. “No one should have to wait until they are at death’s door to receive the emergency care they need.”