Amicus Brief: Moyle v. United States, Idaho v. United States

The Manhattan Institute filed a brief today to defend federalism in the context of state authority to define locally appropriate medical practice. The federal Emergency Medical Treatment and Labor Act (EMTALA) requires that hospitals accepting Medicare funds provide stabilizing care to all ER patients, regardless of their ability to pay. Fair enough, but the Biden Administration is trying to use EMTALA to nationalize standards of care and thus large swaths of state regulatory structures.

In 2020, Idaho passed the Defense of Life Act, banning all abortions in the state except where necessary to protect the life of the mother. The Act officially went into effect two years later, after the Supreme Court’s overturned Roe v. Wade and thus sent abortion regulation back to the states. Shortly thereafter, the federal government reinterpreted EMTALA to require the provision of abortions in any hospital that accepts Medicare funding and sued to block Idaho’s law.

The district court granted a preliminary injunction, finding that EMTALA largely preempts the Defense of Life Act. A unanimous Ninth Circuit panel stayed that judgment, holding that EMTALA does not preempt Idaho’s law because there’s no conflict between the two and the state law in no way frustrates the federal law’s purpose. The panel reasoned that EMTALA doesn’t establish national care standards but simply mandates equal treatment for indigent patients. Without explanation, the en banc Ninth Circuit vacated the panel’s opinion and granted rehearing, at which point the Supreme Court granted Idaho’s request for review (and MI filed an amicus brief)—but then ultimately dismissed the petition as improvidently granted, sending the case back to the Ninth Circuit.

These consolidated cases present a critical opportunity to limit the federal government’s authority over state law concerning the practice of medicine. If the government’s position stands, future administrations will be able to ban or mandate gender-affirming care, euthanasia, or right-to-try uses of experimental medicines. Our brief explains the history and purpose of EMTALA and the dire implications of federal overreach and a nationalization of medical practice.

Medical standards of care are the historic domain of state regulation, so any federal mandate in this area must enjoy an especially strong statutory basis. That’s not the case here. The federal government’s novel interpretation of EMTALA has no basis in the law’s text, structure, history, or even purpose. EMTALA was meant to solve a particular problem left unaddressed by previous healthcare legislation: the increasing and widespread trend of “patient dumping,” wherein hospitals would deny emergency care and refer out patients based on their ability to pay. EMTALA imposes a threefold obligation on hospitals. First, hospitals must provide an appropriate medical-screening examination to any individual who comes to the ER and requests one. Second, the hospital must provide either stabilizing treatment or transfer to another medical facility if the individual is found to have an emergency medical condition. Third, the hospital may transfer individuals with emergency medical conditions only in select circumstances.

The Ninth Circuit should affirm the consensus of federal circuit courts across the country: that EMTALA is an equal-treatment statute, not a standard-of-care statute. This longstanding consensus is consistent with established principles of federalism, and is a more faithful reading of EMTALA. As Justice Scalia wrote for the Court in 2001, Congress does not “hide elephants in mouseholes.” Nor does it smuggle nationalized standards of care under the beneficent language of equal treatment.

Ilya Shapiro is a senior fellow and director of Constitutional Studies at the Manhattan Institute. Follow him on Twitter here.

Tim Rosenberger is a legal fellow at the Manhattan Institute.

Special thanks to law school associate Steven Arthur.

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