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Texas abortion bans upheld in federal court


The extremely strict abortion bans in Texas won again in the federal courts yesterday. The federal Fifth Circuit Court of Appeals sided with the state of Texas and its attorney general, Ken Paxton. It said that the Biden administration cannot enforce a law governing emergency medicine to make sure patients get abortions in cases where their lives are threatened by a pregnancy. Julie Rovner of KFF Health News is here to help us unpack this ruling. Hi, Julie.

JULIE ROVNER: Hi. How are you?

SUMMERS: I'm well. So Julie, what is the emergency medicine law that is at the center of this case, and what did the Biden administration do to spark this challenge from the state of Texas?

ROVNER: Well, the law is called EMTALA, which stands for the Emergency Medical Treatment and Active Labor Act. It was passed in 1986, and it requires hospitals that take Medicare, which is almost all of them, to, at very least, examine any patient who comes to their emergency department regardless of the patient's ability to pay. Those who are found to have emergency medical conditions - in that case, the ER must provide, at very least, enough care to stabilize the patient. The law's original intent was to prevent hospitals from turning away patients without health insurance.

Now, after the Supreme Court overruled Roe in 2022, the Biden administration reminded hospitals that if that emergency stabilizing treatment requires an abortion, that federal law overrides any state ban to the contrary. Texas and a couple of anti-abortion medical groups objected to that, saying it was an overreach by the Biden administration to require every emergency room physician basically to perform abortions, and they filed this lawsuit.

SUMMERS: OK. And, Julie, this ruling - what exactly does it say?

ROVNER: Well, basically, the three-judge panel - two judges appointed by President Trump and the third by President George W. Bush - said that Texas was right and federal government was wrong, that EMTALA does not require any specific forms of medical care and that the administration's guidance amounted to an expansion of the law. Now, the ruling could put doctors in Texas in a very difficult spot where providing an emergency abortion could be a violation of state law but where not providing it could be a violation of federal law.

SUMMERS: I mean, there are a lot of states in the mix here, but I understand that this has an interesting comparison to something happening in Idaho.

ROVNER: That's right - very similar situation. That case hasn't been fully argued yet. But the Ninth Circuit Court of Appeals has put Idaho's abortion ban on hold to the extent that it conflicts with EMTALA, which is a win for the Biden Justice Department for the moment and the opposite of the Texas ruling.

SUMMERS: And what is likely to happen next now that we have these conflicting decisions?

ROVNER: Well, Idaho's attorney general has already asked the Supreme Court to step in and allow Idaho to enforce its ban while the case works its way through the rest of the Court of Appeals. So in a way, this case is already at the Supreme Court. Now, the justices don't have to act on that request. The emergency petition was sent in November. We still haven't heard back. But if the Fifth Circuit ends up saying that states don't have to abide by the federal EMTALA law and the Ninth Circuit says the opposite, then the Supreme Court will have to step in to settle the situation. That would be ironic, of course, because in the Dobbs ruling overturning Roe, Justice Alito said he hoped that the court wouldn't have to keep adjudicating abortion cases. That's apparently not how things are turning out.

SUMMERS: Julie Rovner of KFF Health News, thank you.

ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.

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Julie Rovner