Ban. Yeah, absolutely. Allows abortions if situations where patients are failing not close enough to say that its necessary to prevent death. And that means that these patients are left in that gap. Meghan mentioned. And i mean, just ask the obvious question here. This world did not exist before roe was overturned. Absolutely. Right. Part of the challenges, the meaning of the statute, this federal statute that protects people in emergencies. And idaho is trying to say that this is a new problem that the federal government is is creating the rules. But in fact, this has always been the treatment for abortions or sometimes the treatment for these kinds of conditions. Its just that it wasnt banned before. Dobbs has changed the landscape. Its not that emtala has changed. Its that emtala plays out differently. Now the dobbs allows abortions to be bound with very strict are no exceptions for health. Ryan follow dobbs who was supposed to the intent of dobbs of send it back to the states. And that was going be the end of it. States would deal with it and so on. But that has not been the case by a long shot. We i mean, within the last couple of months, we heard the case regarding mifepristone. And this is yet another aspect of the postroe world that were all living in now that the justices are going to have to sort through yes. Sending it back to the states easier said than done, which is why youre getting all these cases coming back up to the court seeking clarity. Now, weve seen two of these major abortion cases this year. You mentioned the other one a few weeks ago that was litigated about mifepristones one of the two drugs commonly used in medication, abortion and these decisions are significant not only because they impact the women who may need these procedures, you need this medication. Also quiz it could have an enormous impact on the election historically, weve seen that abortion is an issue that has always galvanized. Many were certain block of republican voters. But since the overturn of roe v wade, its actually something that is really begun to galvanize democratic voters. These decisions not expected until late june, early july, thats going to be at the peak of the president ial campaign season. So there is much more at stake here, potentially depending on what these decisions end up being, than just the actual decisions themselves. And to help our viewers out mega one word were going to be hearing a lot is emtala. Were going here that a lot during the arguments we need to explain that to our viewers are just a law passed in the 1980s that was supposed to tell Emergency Rooms that are receiving what federal funding that you cannot deny access. You cannot deny care to people. And one of the based on the research i was doing, im one of the cases that i got some Media Attention back then that led to this law being passed, was a woman with a stillborn so there were cases back then with women with devastating pregnancies who were at issue in all of this . Yeah. So its its the emergency medical treatment and labor act is what emtala stands for. It was enacted in 1986. And if you read some of the coverage of why this went into place, its almost sort of mindboggling because we lived for almost 40 years with this in place, this was put in place after there were a lot of reports of whats known as patient dumping, essentially, a lot of patients, many of whom who didnt have insurance, who were moved before they were even known if they were stabilized from a private hospital . When a Public Hospital for financial reasons and this could include pregnant women. And if youre in an Emergency Situation and you havent been screened and stabilized before the transfer data showed that there were poor outcomes patients even may have died because of this. So this was really an important statute, i think was really interesting is some of the arguments we may here today you hear from idaho is will they didnt call out abortion specifically in emtala and therefore, its a government overreach. And so were going to hear like, should everything be called out in emtala, every kind of emergency medical situation, i think itll be interesting to hear these arguments assignee mean that is i mean, its another reminder of some of these issues playing out while roe was still the Law Of The Land and and yet laws like emtala were put into place. How do you expect some of the arguments to play out backandforth as we listen to this, because obviously, were going to hear both sides of this very potent political issue that raises a whole lot of emotions for a lot of folks out yeah. I think one big issue is going to be what exactly does emtala requires. So the federal government says it requires the patients not be dumped if they cant afford to pay, but also the stabilizing care provided a guarantee of Emergency Medical Care. And idahos seems to be saying in some parts of the brief that its really just about making sure patients, patients can equal treatment and its not providing any kind of National Standard of care. I think thats gonna be a big part of the debate. It doesnt mention the word abortion, but it also doesnt mention all sorts of other treatments that would be required to stabilize medical care. So rogers, he cares Emergency Care . Exactly. And so you have to in some level, leave it to the Health Care Professional to decide what is the appropriate treatment stabilize a patient and you cant list everything because theres so many conditions that could arise and paula i mean, not to try to predict what were going to hear when these justices get going here. But it sounds as though where were going to hear from justices like sam alito and so on, is familiar arguments that weve heard. And actually before i have you answered that question, i apologize. Were gonna go right to the arguments. Heres chief justice john roberts. It put emtala on a centuriesold foundation, a state law. States have always been responsible for licensing doctors and setting the scope of their professional practice, indeed, and tala works precisely because states regulate the practice of medicine nothing in emtala requires doctors to ignore the scope of their license and offer medical treatments that violate state law. Three statutory provisions make this clear. First, section 13, 95, the medicare acts opening provision forbids the federal government from controlling the practice of medicine thats the role of state regulation. Second, subdivision, f, in Emtala Codifies A Statutory Presumption against preemption of state medical regulations and third, and Tala Stabilization Provision is limited to available treatments, which depends on the scope of the Hospital Staffs medical license illegal treatments are not available. Treatments at in this courts own presumption against preemption of State Regulations. Combine that with the need for clear and unambiguous spending clause conditions. And the administrations reading becomes holy untenable the administrations misreading also lacks any limiting principle. If er doctors can perform whatever treatment and they determined is appropriate, then doctors can ignore not only state abortion laws, but also State Regulations on opioid use and informed consent requirements that turns the presumption against preemption on its head in leaves Emergency Rooms and regulated under state law. Its unsurprising that no court has endorsed such an expansive view of emtala. And until dobbs nor had hhs everyone understands that Licensing Laws limit medical practice. Thats why a nurse isnt available to perform openheart surgery. No matter the need no matter hur knowledge . The answer doesnt change just because were talking about abortion the court should reject the administrations unlimited reading of emtala and reversed the discourse judgment. I welcome the courts questions. The normally, when we have a preemption case, theres some relationship between the parties is the state being regulated by the federal government under emtala or is a state and engaged then some sort of kweisi contractual relationship yes, your honor. In this case, the state idaho, for example, has no State Hospitals that participate with the Emergency Rooms in emtala. And so in this case, 30 isnt even a clause that relationship the parties being regulated by emtala. Here are hospitals and doctors. I think your question is getting at the armstrong issue and we think that is a significant question. It wasnt part of the question presented. We think the Indiana Amicus Brief raises significant questions and deals with that argument. Well but the question presented here is one up direct conflict between idahos law and emtala. And on that a question, we dont think theres hard at all youre going to that direct conflict. I think if you consider the express limitation within the statue of availability well, before we do that, can i just step back and get your understanding of the statute you made some representations as to how you see it working. And so let me tell you what i think and then you can tell me whether you agree, disagree, or otherwise so i think that there are two things that are clean, pretty plain on the face of this statute. One is that emtala is about the provision of stabilizing care for people who are experiencing emergency medical conditions. And one thing i think the statute is doing. I also think that it is operating to displace the prerogatives of hospitals or states, or whomever with respect to that fairly narrow slice of the health universe, this idea of Emergency Medical Services is like one very minor part or small part of the Overall HealthCare Provision of health care. So what that means is that when a hospital once to only provide stabilizing care in emergencies for people who can pay for it. For example emtala says, no, im sorry, you have to stabilize anyone whos experiencing an emergency medical condition or when a hospital wants to provide stabilizing treatments to people who are are experiencing only certain kinds of Emergency Conditions. And tala says, no, heres the list of conditions and you have to provide stabilizing care for those people similarly, if the state says, look, its our job to govern all of healthcare in our state and we say that only certain kinds of health care can be given to people who are experienced Thank Emergency medical conditions. We dont want whatever treatment we want only certain kinds of treatment and says, no. We are directing that as a matter of federal law, when someone presents with an emergency condition, they have to be assessed and the hospital must do what is ever is in its capacity to stabilize them. Is that your understanding of the statue partially, your honore, we agree that emtala does impose a federal Stabilization Requirement, but the question here is, what is the content of that Stabilization Requirement for that . You have to reference state law. Okay. Well what you just said is important because when you concede that emtala imposes a Stabilization Requirement, it is this statute, the federal government interfering, if you will, in a States Health care choices. So emtala is on its face, a statute that says its not all the states way. There are federal requirements here. There is a requirement to stabilize Emergency Patients and you agree with that . Yeah. Justice kagan, we agree that and house purpose was narrowed to bridge this gap that existed in some. Okay. So we can just take off the table this idea that just because its a state and the healthcare the federal government has nothing to say about it. The federal government has plenty to say about it in this statue. Now, youre right. Now. Theres a question of whats the content of this Stabilization Requirement and as far as i understood your opening remarks, you say, well this is left to the states but if im just looking at the statute, the statute tells you what the content of the Stabilization Requirement is. Its to provide such medical treatment it may be necessary sorry, to assure within reasonable probability that no Material Deterioration of the condition is likely to occur if the person were transferred or didnt get care. So it tells you very clearly its an objective standard its basically its a standard that clearly has referenced to accepted medical practice, not just whatever one doctor happens to think, but its here the treatment necessary to assure within reasonable medical probability that no Material Deterioration occurs let me respond in two ways. First, the objective standard that you set forth, baer and that understanding thank is contrary to the administrations view. They see it as a totally subjective standard and whatever treatment a doctor determines as propriate. But thats t true. I mean, i think u guys can argue about this yourself, but as i understand, the Solicitor Generals brief, and well see what the Solicitor General says. But the Solicitor Generals as its not up to every individual doctor, this is a standard that is objective, tt incorporates acpted medical standards of care. Ell, in the Re Fundamental Point is the definition that you quoted have care in the operative position provision in b1 is also texturally explicitly qualified by that which is within the staff and facilities available at rate thats what facilities available at the hospital and if you just look at that language, i mean, its absolutely clear that thats not a reference to what state law involves the staff and facilities available if you dont have staff available to provide the medical care, then i guess you cant provide the medical care if you dont have the facilities available to provide the medical care, then you cant provide the medical care at transfer has to take place for the good of the patient. This is a really important, is this the availability here . Because its the availability of staff and facilities . Its do you have the right doctors . Do you have enough doctors . Do you have the right facilities or is it better for the patient to transfer them to the hospital . A few miles away, youre exactly right. Do you have the right doctors . How do you answer that question, except by reference to State Licensing Law, but you absolutely cant do that. I mean, thats the the point that i was trying to make, which is that the federal mandate is to provide stabilizing care for Emergency Conditions regardless of any other directive that the state has or the hospital has that would prevent that care from being provided. Thats thats the war work of the statute. Justice jackson. Thats not even hhs is conclusion in the state operations manual, which they proffered on page 36 of the brief it defines what makes a staff person available under the statute and they say it has to it doesnt say that theyre not available of state law, doesnt doesnt allow this procedure. It says they are available to the extent they are operating within the scope of their medical license. And that is our argument. They want to now draw it far more narrow and look only at physical availability. We agree thats the component, but theres also a legal Availability Component here. So the problem were having right now is that youre sort of putting preemption on its head the whole purpose of preemption is to say that if the state passes a law that violates federal law, the state law is no longer effective. So there is no State Licensing Law that would permit you permit the state to say dont treat diabetics with Insulin Treat them only with pills. Metaphor, and a doctor looks at a juvenile diabetic and says, without insulin, theyre going to get seriously ill. And the likelihood. And i dont know what that means under idaho law, well get to that shortly. Because i dont know this. We believe this is a better treatment federal law would say, you cant do that Medically Accepted, objective, medically success. That standards of care require the treatment of diabetics with insulin the Medically Accepted obligation of doctors when they put have women with certain conditions that may not result in death but more than likely will result in very serious medical conditions, including blindness or some for others, the loss of organs for some chronic blood strokes idaho is saying, unless the doctor can say in good faith that this persons death is likely as opposed to serious illness. They cant perform the abortion so i dont know your argument about State Licensing Law because this is what this law does. It tells states your Licensing Laws can take out objective middle medical conditions that could save a person from serious injury or death yeah i think there are two crucial responses to your point and let me begin with the Preemption Point Subdivision Af and section 13, 95. Ive actually are telling Hhs The Federal Government and courts just the opposite that you know, its saying, you can preempt unless theres a direct conflict if objective medical care requires you to treat women who are who present the potential of serious medic