Idaho v. United States, the federal challenge to Idaho’s near-total abortion ban under the Emergency Medical Treatment and Labor Act (EMTALA), ended without a ruling on the merits. The Supreme Court dismissed the case in June 2024 as improvidently granted, the Trump administration’s Department of Justice voluntarily dismissed the underlying lawsuit in March 2025, and the Centers for Medicare and Medicaid Services rescinded the guidance memo that had driven the federal government’s legal theory. Idaho’s Defense of Life Act is now fully enforceable in emergency rooms, and no active federal case is challenging it.
The Conflict the Lawsuit Was Built On
Idaho Code § 18-622, the Defense of Life Act, makes performing an abortion a felony carrying two to five years in prison, along with license suspension or permanent revocation for healthcare professionals.1Idaho State Legislature. Idaho Code 18-622 – Defense of Life Act The statute allows a physician to terminate a pregnancy only when, in good-faith medical judgment, the procedure is necessary to prevent the woman’s death. That exception is structured as an affirmative defense, meaning the physician must prove the procedure was justified rather than the state having to prove it was not.2Idaho State Legislature. Idaho Code 18-622 – Defense of Life Act
EMTALA, codified at 42 U.S.C. § 1395dd, requires every Medicare-participating hospital with an emergency department to screen patients and provide stabilizing treatment for emergency medical conditions. The statutory definition of “emergency medical condition” reaches acute symptoms where the absence of immediate care could seriously jeopardize the patient’s health, cause serious impairment to bodily functions, or lead to serious dysfunction of any organ.3Office of the Law Revision Counsel. 42 U.S. Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
The gap between the two standards is the entire dispute. EMTALA covers serious health harms short of death; Idaho’s exception applies only when death is on the table. A patient with severe preeclampsia or a dangerous intrauterine infection may face permanent kidney failure or sepsis without being close enough to dying to satisfy Idaho’s exception, yet EMTALA’s federal standard would treat her condition as an emergency requiring stabilization.
In 2022, the Biden Justice Department sued Idaho shortly before the Defense of Life Act took effect, arguing under the Supremacy Clause that EMTALA preempts state law inside emergency rooms. Idaho countered that EMTALA is a screening and transfer statute that never mentions abortion and cannot be read to require one. A federal district court in Idaho issued a preliminary injunction blocking enforcement of the ban in emergency situations while the case proceeded.
The Supreme Court’s 2024 Dismissal
The Supreme Court granted certiorari before judgment, pulling the case from the Ninth Circuit before that court had ruled. The consolidated cases were docketed as Moyle v. United States (No. 23-726) and Idaho v. United States (No. 23-727). In January 2024, the Court stayed the district court’s injunction, briefly allowing Idaho to enforce its ban in emergency rooms while briefing continued.4Supreme Court of the United States. Moyle v. United States – Per Curiam Opinion
On June 27, 2024, the Court issued a per curiam opinion dismissing the writs as “improvidently granted” and vacating its January stays.4Supreme Court of the United States. Moyle v. United States – Per Curiam Opinion A dismissal as improvidently granted, sometimes shortened to “DIG,” means the Court concluded it should not have taken the case at that stage. It is not a decision on the merits. No majority opinion addressed whether EMTALA actually preempts Idaho’s criminal statute.
Justice Kagan’s concurrence explained the practical effect: with the stay dissolved, the district court’s preliminary injunction snapped back into force, preventing Idaho from enforcing its ban when a pregnancy termination was needed to prevent serious health harm.4Supreme Court of the United States. Moyle v. United States – Per Curiam Opinion Justice Barrett, also concurring, agreed the case should return to the lower courts to proceed in the regular course so both sides could build fuller records.
How the Case Actually Ended
The reinstated injunction did not last. On March 5, 2025, the Trump administration’s Justice Department filed a motion to dismiss the lawsuit it had inherited from its predecessor. Idaho Attorney General Raúl Labrador publicly maintained there had never been a genuine conflict between EMTALA and the Defense of Life Act. With the federal government no longer pressing the case, the basis for the injunction dissolved.
The Centers for Medicare and Medicaid Services then formally rescinded the July 2022 guidance memo that had directed hospitals to treat EMTALA as requiring emergency abortions in certain circumstances. That memo, QSO-21-22-Hospitals, was rescinded effective May 29, 2025.5Centers for Medicare & Medicaid Services. Rescinded Reinforcement of EMTALA Obligations Specific to Patients Who Are Pregnant or Are Experiencing Pregnancy Loss The federal agency that oversees EMTALA enforcement no longer interprets the statute as requiring abortion as stabilizing care, and it no longer treats the statute as preempting state abortion laws.
Together, the dismissal and the rescission mean the federal government is not challenging Idaho’s Defense of Life Act and is not directing hospitals in the state to override it. Idaho physicians in emergency rooms operate under the state law’s “prevent death” standard without a competing federal directive.
What Idaho Physicians and Patients Face Now
The Defense of Life Act applies in emergency rooms the same way it applies anywhere else in Idaho. A physician may terminate a pregnancy only when the procedure is necessary, in the physician’s good-faith medical judgment, to prevent the patient’s death. Serious but non-fatal harm, such as significant organ damage or an infection that has not yet become life-threatening, sits in a gray zone where clinical judgment runs directly into criminal liability.
Emergency medicine rarely offers clean lines between a serious health risk and imminent death. Physicians in Idaho have reported that legal uncertainty causes delays as hospital legal teams evaluate whether a patient’s condition has deteriorated enough to satisfy the statutory exception. During the period when the law’s application was in flux, several Idaho hospitals transferred pregnant patients to out-of-state facilities, and the incentive to transfer remains whenever a case feels legally ambiguous.
EMTALA itself has not gone away. Every Medicare-participating hospital in Idaho still must screen emergency patients and provide stabilizing treatment. What has changed is the federal position on whether stabilizing treatment can include abortion when a patient’s health, but not her life, is at risk. Without federal enforcement of that reading, the state criminal statute operates without a federal counterweight.
The Circuit Split That Could Revive the Question
The Idaho lawsuit is over, but the underlying legal question is not. Two federal appeals courts have reached opposite conclusions about whether EMTALA preempts state abortion bans.
The Fifth Circuit sided with Texas in a challenge to the same 2022 HHS guidance, holding that EMTALA “does not mandate any specific type of medical treatment, let alone abortion” and that HHS had exceeded its authority by interpreting the statute to require one.6United States Court of Appeals for the Fifth Circuit. State of Texas v. Xavier Becerra The court blocked the guidance from being enforced against Texas and against members of two national medical organizations. CMS acknowledges on its own website that it is prohibited from enforcing the EMTALA abortion interpretation within Texas and against members of those organizations.7Centers for Medicare & Medicaid Services. Emergency Medical Treatment and Labor Act (EMTALA)
The Idaho district court’s injunction rested on the opposite reasoning, that federal funding obligations override state criminal penalties in emergency rooms when stabilizing treatment requires a pregnancy termination. The Ninth Circuit never issued a merits ruling because the Supreme Court pulled the case up and the DOJ later dismissed it, but the district court’s approach pointed the other direction from the Fifth Circuit’s.
Circuit splits are typically how the Supreme Court decides a question is ripe for a national answer. For now, the legal picture depends on geography. Hospitals in Fifth Circuit states operate under a ruling that EMTALA does not require abortions. Hospitals elsewhere face uncertainty about how a court in their circuit might rule if the question returns. If a future administration revives the Biden-era legal theory, or if the split prompts the Supreme Court to take the preemption question on its merits, the balance in Idaho could shift again.