Supreme Court declines Biden administration appeal in Texas emergency abortion case

WASHINGTON — A court order that says hospitals cannot federally be required to provide pregnancy terminations when they violate a Texas abortion ban will stay for now, the Supreme Court said Monday.

The decision is another setback for opponents of Texas’ abortion ban, which for two years has withstood multiple legal challenges, including from women who had serious pregnancy complications and have been turned away by doctors.

It left Texas as the only state where the Biden administration is unable to enforce its interpretation of a federal law in an effort to ensure women still have access to emergency abortions when their health or life is at risk.

The justices did not detail their reasoning for keeping in place a lower court order, and there were no publicly noted dissents. Texas had asked the justices to leave the order in place while the Biden administration had asked the justices to throw it out.

Texas Attorney General Ken Paxton called the decision “a major victory.”

The Biden administration argues that a federal law, called the Emergency Medical Treatment and Labor Act, or EMTALA, requires emergency rooms to provide abortions if a pregnant patient’s health or life is at serious risk, even in states where the procedure is banned. The law only applies to emergency rooms that receive Medicare funding, which most hospitals do.

The Supreme Court decision comes weeks before a presidential election in which Democratic nominee Kamala Harris has put abortion at the center of her campaign, attacking Republican challenger Donald Trump for appointing judges to the high court who overturned nationwide abortion rights in 2022.

“I will never stop fighting for a woman’s right to emergency medical care — and to restore the protections of Roe v. Wade so that women in every state have access to the care they need,” Harris said on social media Monday evening.

Texas' abortion ban has also been a centerpiece of Democratic U.S. Rep. Colin Allred ’s challenge against Republican U.S. Sen. Ted Cuz for his seat.

At a campaign event over the weekend in Fort Worth, Texas, hundreds of Allred’s supporters broke out in raucous applause when he vowed to protect a woman’s right to an abortion. “When I’m in the Senate, we’re going to restore Roe v. Wade," Allred said.

At a separate event the same day, in a nearby suburb, Cruz outlined a litany of criticisms against Allred, but didn’t bring up the abortion law.

Katie Glenn Daniel, the state policy director of SBA Pro-Life America, applauded the Supreme Court decision and pointed to data showing Texas doctors have been able to provide an average of about five abortions per month to save a patient's life or health.

Still, complaints of pregnant women in medical distress being turned away from emergency rooms in Texas and elsewhere have spiked as hospitals grapple with whether standard care could violate strict state laws against abortion. Several Texas women have lodged complaints against hospitals for not terminating their failing and dangerous pregnancies because of the state's ban. In some cases, women lost reproductive organs.

In asking the Supreme Court to toss out the lower court decision, the administration pointed to a similar case from Idaho earlier this year in which the justices narrowly allowed emergency abortions to resume while a lawsuit continues. At the time the Idaho case began, the state had an exception for the life, but not the health, of a woman.

Texas said its case is different, however, because the law provides some exceptions if a pregnant patient's health is at risk.

Texas pointed to a state Supreme Court ruling that said doctors do not have to wait until a woman’s life is in immediate danger to provide an abortion legally. Doctors, though, have said the Texas law is dangerously vague, and a medical board has refused to list all the conditions that qualify for an exception.

Marc Hearron, an attorney for the Center for Reproductive Rights, said doctors in Texas got no clarity from the Supreme Court on Monday.

“The health care crisis is ongoing,” Hearron said. “Patients are going to continue to suffer.”

Mary Ziegler, a law professor at the University of California at Davis who has written extensively about abortion, said there remains much uncertainty for doctors in Texas, who could risk life in prison for performing abortions.

“I think we’re going to continue to see physicians turning away patients, even patients who could qualify under the state’s exceptions, because the consequences of guessing wrong are so severe and the laws are not that clear,” Ziegler said.

The Texas case started after the Supreme Court overturned Roe v. Wade in 2022, leading to abortion restrictions in many Republican-controlled states. The Biden administration issued guidance saying hospitals still needed to provide abortions in emergency situations under a health care law that requires most hospitals to treat any patients in medical distress.

Texas sued over that guidance, arguing that hospitals cannot be required to provide abortions that would violate its ban. The 5th U.S. Circuit Court of Appeals sided with the state, ruling in January that the administration had overstepped its authority.

Health and Human Services Secretary Xavier Becerra said in a post on X, “Reproductive rights are under assault in this country and women’s health and lives remain in danger from the chaos and confusion caused by overturning Roe.”

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Stengle contributed to this report from Dallas. AP reporters Amanda Seitz in Winston-Salem, North Carolina, Sean Murphy in Oklahoma City and Aamer Madhani in Washington also contributed to this report.