83 F.4th 1130
9th Cir.2023Background
- Idaho enacted §18-622 (2020), a near-total abortion ban that would take effect after a U.S. Supreme Court decision restoring states’ authority over abortion; Dobbs triggered the law.
- §18-622 criminalized most abortions but included a “life of the mother” exception measured by a physician’s good-faith medical judgment; Idaho later amended the statute and the Idaho Supreme Court interpreted the exception broadly.
- The federal government sued, arguing EMTALA (42 U.S.C. §1395dd) preempts Idaho’s law because EMTALA requires hospitals to stabilize emergency conditions, which the government contends can require abortions.
- The district court granted a preliminary injunction preventing enforcement of §18-622; Idaho and the Idaho Legislature (as intervenor) appealed and the Legislature moved for a stay pending appeal.
- The Ninth Circuit granted the stay, holding EMTALA does not preempt §18-622 and that the stay factors (likelihood of success, irreparable harm, balance of equities, public interest) favor the Legislature.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether EMTALA directly preempts Idaho §18-622 (impossibility) | EMTALA’s stabilization duty can require abortions as stabilizing treatment | EMTALA does not mandate specific treatments; Idaho’s exception covers life‑saving abortions | EMTALA does not preempt §18-622; no physical impossibility of dual compliance |
| Whether §18-622 is obstacle to EMTALA’s purpose (obstacle preemption) | The ban could obstruct EMTALA’s goal of ensuring emergency care for pregnant patients | EMTALA aims to prevent hospital dumping, not dictate methods of care; states set standards | §18-622 does not frustrate EMTALA’s purpose; no obstacle preemption |
| Whether the Legislature shows irreparable harm without a stay | (Govt.) Injunctive relief prevents protection of patients; delay undermines claims of state harm | (Legislature) Being enjoined from enforcing duly enacted statutes injures state sovereignty | Legislature suffers irreparable harm from injunction; stay appropriate |
| Whether equities and public interest warrant a stay | Continued enforcement risks patient health and burdens neighboring hospitals | Public interest favors state self-governance and enforcing enacted laws; Idaho law contemplates emergency care | Balance and public interest favor preserving the law during appeal |
Key Cases Cited
- Dobbs v. Jackson Women’s Health Org., 142 S. Ct. 2228 (2022) (returned abortion policy to states)
- Nken v. Holder, 556 U.S. 418 (2009) (four-factor stay test)
- Cipollone v. Liggett Grp., Inc., 505 U.S. 504 (1992) (express non‑preemption language controls analysis)
- Draper v. Chiapuzio, 9 F.3d 1391 (9th Cir. 1993) (EMTALA direct‑conflict framework)
- Hines v. Davidowitz, 312 U.S. 52 (1941) (obstacle preemption principle)
- Fla. Lime & Avocado Growers, Inc. v. Paul, 373 U.S. 132 (1963) (physical impossibility preemption standard)
- Medtronic, Inc. v. Lohr, 518 U.S. 470 (1996) (narrow construction of federal preemption over state police powers)
- Baker v. Adventist Health, Inc., 260 F.3d 987 (9th Cir. 2001) (EMTALA’s non‑preemption interpretation)
- Planned Parenthood Great Northwest v. Idaho, 522 P.3d 1132 (Idaho 2023) (Idaho Supreme Court’s authoritative interpretation of §18‑622 exception)
- Maryland v. King, 567 U.S. 1301 (2012) (state sovereignty and irreparable harm from enjoining statutes)