Officials testify on the Ongoing Investigation into the collapse of Baltimores Francis scott key bridge. Watch the House Infrastructure Committee live at 10 a. M. Eastern on cspan, our mobile video apps or online at c span. Org. Cspan is your unfiltered view of government. We are funded by the celebrate companies and more. The u. S. Supreme court heard oral arguments in a se on whether federal law preempts in idaho ban on nearly all abortions. That near van was initiated in august of 2022 ter the u. S. Supreme court overturning of roe versus wade. The Biden Administration filed suit against ido, arguing that that law can conflicts with the 1986 federal statute that requires Emergency Care including abortions at hospits participating in medicare. The justices have through june to issue a ruling. The oral argument is just under two hours. We will hear argument this morng case 23 726. The consolidating case. Mr. Turner. Thank you,. Chief justice. When congre amended the medicare act in 1986, itput on a Century Foundation of state law. States have always been responsible for licensing daca source doctors. Works preciselbeuse the states regulate the practice of mecine and nothing requires doctors to igno e scope of their license and offer medica treatments that violate state law. Three statutory provisions make this clear. First, section 1395, the medicare ox opening provision. Forbids the federal ment from controlling the practice of medicine that is the role of safety relation. Sectn,subdivision f. Third, the stabilization prisn is limited tolable treatments which depes the scope of the hospital staff medical license. Legal treatments are not available treatments. Atth court on prevention of state regulations, combined that with the need for clear and spending clause conditions and the administrations reading becomes. The administrations misreading also lacks any limiting prinpl if e. R. Doctors can perform whatever treatmt ey determine its appropriate, then doctors can ignore not onlye abortion laws for state regulations and opioid use. Inrmed consent requirement. That turns that presumption on its head and leaves Emergency Rooms unregulated under ate law. It is unsurprising that no court has endorsed such an expansive view. Everyone understands that licensing laws limit medical practice. That is why a nurse is t available to perform open heart surgery no matter the need, no matterr knowledge. The answer does not change just because we are talking about abortion. The court should reject the administrations unlimited reading and reverse the judgment. I welcome, of course, questions. Normally when we have preemption case, there is some relationshipbeeen the parties. Is the state regulated by the federal government or is the state engaged in some contractual relationship . Yes, your honor. In this case, idaho, fo example has no state hospitals that participate with emergency oms. There is not even a part of that relationship. The paiebeing regulated here are hospitals and door i think your question is tting at the armstrong issue. We think that is a significant question. It was not part of the question preste we think the brief raises significant questions and deals with that argument well but the questi esented here is one of direct conflict between idahos law and on that question, we do not think it is hard at all. Going at direct conflict, if you consider the express limitation within the state of availability before we do thatcan i step and get your understanding ofthe ate . You made some representations as to w you see it working. Let me tellu what i think and you can tellme whether you agree, disagree, or otherwise. I think thatthere are two things that are plain on the face of this statute. One is at it is about th present provision of stabilizing ca for people who are experiencinggency medical conditions. That is one thing i think the e is doing. I also think it is operating to displace the prerogatives of hospitals or stor whomever wi respect to that narrow slice of the unerse. One very minor part or small part of the overall healthcare provision. Wh at means is that whena hospital wants to only prov stabilizing care in emergencies for who can pay for it, for example. Says no, i am sorry. You have to ste anyone who is periencing an emergency medical condition. When a hospital wants to provide treatments to people who are experiencing only certain kinds of emergency conditions. They say no, heres the list of conditions in you have to provide stabilizing care for thospele. Similarly, the state says look, it is job to govern of healthcare in our state and we say that only certain kinds of healthcare can be given to people who are experiencing emergency medical coitns. We do not want whatever treatment we will only certain kinds of treatmen they say no. We are directing that as a tter of federal law, when someone presentswi an emergency condition, they have assessed and the hospital stdo whatever is in its capacity to stabilize em is that your understanding of the statut partially, your honor. We agree that doesimpose a federal stabilization ement but the question is what is the content of that stabilization requirement . You have to reference state law. I thk at you decide is important because when you can see that imposes a stabilization requirement, it is the statute, the federal government interfering, if you will in the steshealthcare choices. A statute that says it is not all the states way. Ere are federal requirements here. There is a requirento stabilize emergency patients. And you agrewi that. Purpose was narrowed to bridge this gap that existed. Just because it is state and healthcare, the federal government has nothing to say about it the federal government has plenty to say about in the statute. You arrit. Now there is a question of what is the content of this stabiliziorequirement and as far as i understood your opening remarks, this is le to the states but if i am just lookinatthe statute, tells you what the content of the stabilization requirement is. It is ovide such medica treatment to assure within asable probability that no material deterioration is likely to occur if the person were transferred or didnt get care. It tells you very clearly it is an object of standard. Is it is a standard that early has reference to medical preference. Here is the ntt of the standard. You have tostilize. What is that mean . It means tovide the treatment necessary to assure what is in reasonable medical probability that no deterioration occurs. Let me respond in two ways. First, the objective standard that you set forth inthat others understanding is contrary. They say it is a totally objective stda and atever treatment the doctor determines i think thats not true. I think that you guys can argue about this yourself and as i understand the solicito generals brief and we will see what says, its not up to every individual doctor. This is stdard that is objective, and corporate medical standards of ca. The more fundamental point is the definition that you quoted of stabilizing care. In the operativprovision, also sexually anexpensively qualified by that icis within the staffi cilities available at a hospital. That is right. It says within the staffing facilities available at the hospital. If yolo at that language, it is absolutely clear at that is not a reference to what state law involves. The staff and facilities available. If you dont vestaff available to provide the medil re than i guess you cannot provide the medical care. If you dont have the cities available to provide the medical care, you cannot provide the medical care or transferhato take place for the good of the tient. The availability it is the availability of staff an facilities. Do you have the right doctors . Do you have enough doctors . Do you have the right facilities . Is iter r the patient to transfer them to the hospital a few miles away . You are exactly right. You have the right doctors . How do you swer that question without licensing laws . You cant do that. That is the initl point that i was trying to make isthat the federal mandate is to ove stabilizing care for emergency conditions regardless of any otr directive that the state has or e hospital has. We prevent that care from beg provided. That is the work of the statute. That is not even hhss conclusion. In the state Operations Manual which on page 36 of the brief, it definedenes what makes a staff person available unr the statute. Does it say that they e not available if state law does not allow this procedure . Gets as they are available to the extent they aroffering to the extent of their medical license. That is our argument. They want to draw it far more rr. We agree, that is the component. There is also a legal component. Counsel,thproblem we are having right now is u are putting prmpon on its head. The purpose of prmpon is to say that if the state passes a law that violates federal w, the state law is no longer effective. There is no state linsg law that would permit the state to say dot eat diabetics with insulin. Eat them only with pills. The doctor lookata juvenile diabetic and says without insulin, they are going to get seriouy l and eight likelihood, and i do not know what that means under idaho law, we will get that shortly. We believe this is a better treatment. Federal law would say we cannot do that. Medically deceptive standards re require the treatment of diabetics with insun. Medically accepted obligation of doctors when they have women withceain conditions that may not result in death but more than likely will result in very serious medical conditions, including blindness for some. The loss of organs, chronic chronic blood stkes. Idaho is saying unless a door can say in good faith that this peon is likely as opposed to serious illness, they cannot perform the abortion. I do not know your arment about state licensing law becae is is what this law does. It tells states your licensing laws cannot take out objective medical conditions that could save a person from seriou injury or death. I think there artwo crucial responses to your point. Let me begin with the preemption point. Bdivision f and 1395 are telling hhs, the federal government, and courts just the opposite. Know. It is saying atyou cannot preempt him if there is direct conflict. If objected medical care requires you to treat women who present the potential of serious medical complications. The abortion is the only thing that can prevent that, you have to do it. Idaho lasa the doctor has to determinnobut there is a serious medicacondition but that the person will di that is a hu difference. We agree that there is daylight between how the administrati reading and tala and what idahos life permits. We agree that there is a controversy. There is more than a controversy. What you are sangto us is that if it does not ve preemptive force, not just idaho. Has a saving condition r abortions when it threatens a womans life. What you are saying is that state in the nation, and there are some right now at dont even have that as an exception to their abortion laws. What you are saying is that there is no federal law on the from saying even if a womaate will die, you cannot perform an abortion. I know of no state that does not include a lifesaving exception. Some of been debating it. Your theory of this case leads to that conclusion. I think our point is that. Could hear your answer . And e administrations reliance on a standard like best article evidence or a national norm, i think that is ve fraud. What it really is sangis the text, itself does not addresd what stabilizing treatment is required. You go outside the text to professional stanthat are flowing out there that might day today and that boils down to a question between conflict of what says and what idaho law says. Actually, can you clarify becae am not sure i understand. Looking at isfrom a broader perspective, it emto me that it says you must provide whatever treatment you have the capacity, meaning stf and facility, to provide and stabilize patients whar experiencing emergency medical conditions. Idaho law seems to say that you cannot pridthat treatment unless doing so is necessary to prevent a patients death. Why is that not a direct conflict . U ve must in a ceain situation, that is what the federal government is saying. You cannot if it involves abortion, says idaho. I think that exame really highlights why. A nurse might be ailable. The nurse might even think she knows how and under the provision, the administrations reading would sa her into action, put her into the operating room and open open the patient up. Idaho would say no. That is still a conflict. Les y the administrations position is that nurse can do it. Are you suggestingth federal law would not preempt state la that says no, she cant. Whether federal law could do that is different question of whether does do that. I think the answer is clear that it esnt. Its like the organ case with the controlled substances act, this cot noted that the provisions theyre rely upon and assume a medical profession being regulated by state police powers. A fourpage statute. For every conceivable medical treatment. It did leave that the medical community. What congress was not going to addrs ery treatment for every condition but it said you dowh is needed to ensure non deterioration. I guess the question here is do you concedth with respect to certain medical conditions, and aboronis the standard of care . The standard of care i shouldsain idaho, there is a feaving exception for certain abortions and that is the standard of care. The stanrdof care is necessarily set and determined by. I think you have to coed with respect to certain medical nditions, abortion is the standard of care because your own statute as interpreted by yo n courts acknowledges that when a condition gets d enough such that e womans life is in peril, the doctors are supposed to give abortions. The reason that that is true is that respect to certain, rare and important conditions and rcumstances, abortion is the accepted medical standard of care. Is that not right . Yes. That was my point that eris a lifesaving exception under idaho law. The question is that also, the accepted standard of care, rather than the womans life being. The Womans Health is in peril. Lets take all these cases being rare but within these rare cases, there is a significant number erthe woman, her life is not t shes going to lose her reproductive organs. Shes going to lose the ability to have children in the future unss an abortion takes place. That is the category of cases in which emtala says my gosh, of course the abortion is necessary sure that no material deterioration occurs. Idaho says sorry, no abortion here and the result is that these patients are now helicoptered out of ate. It is a very difficult situation. These situations, nobody is arguing that they dont raise tough dil questions that implicate theological and moral questions. Idaho, like 22 other states and Even Congress and emtala nice th there are two patients to considering thciumstances. The two patient scenario is tough when you have the competing interests. That would be a good response if federal law did not ta position on what you characterize as toh question. Federal law does take a position on the question. Ys that you do not have to wait until the person is on the verge of death. If the woman is going to lose is enough to trigger thisduty on part of the hospital to stabilize the patient and th way to stabilize patients in these circumstances, all doagree. Idaho law does not require that doctors wait until the patient is on the verge of death. There is no medical certainty requirement. Im sorry, answer the following question. These are hypotheticals that are true. Hold on one second. U can tell me whether idahos exception and this will go ck to the point that even if ahlaw fully mpes with federal law. You have a pregnant woman who is early into her send trimester at 16 weeks. Goes to the e. R. Because she felt gush of fluid leave her body. She was diagnosed with. The doctors believe that a medical intervention to terminate her nancy is needed to reduce the real medical ssibility of experiencing sepsis, and uncontrolled hemorrhage from the broken sack. This story of a real woman. E was discharged in florida because the fetus still had fetal. The hospalsaid she is not likely to die but there are going to be serious medical competitions. The doctors refused to treat her because eycould not say that she would die. She was horrified, went home. The nextda she bled, she passed out, painfully taken to the hospital. There she received an abortion because she was about to die. What you are telling us is that a case in which idaho, the day before would have said is okay to have an abortion . Idaho idahos lifesaving exception, a doctor could in odfaith medical jume determine i am asking you. The florida doctor said i nnot say that she is going to die. If you are doctor says cannot without a medical certainty say that shes going to die but i do know that shes going to lead to death if we dont have an abortion but shes not leavinyeso i am not sure. The doctor does not need to have medical certainty. Answer yes or no. He cannot say that eris likely to. He can say there is likely to be a very serious medical condition like a hysterectomy. Let megoto another one. Imagine a patient who es to the e. R. At 14 eks. Again, abortion is. She was in and out of th hospital up to 27 weeks. This particular patient,ey had to deliver her baby. The baby died. Shhad a hysterectomy and she can no longer have children. All right. You are telling me that the doct uld not have done the abortion earlier . Again, it goes back to whether a doct n in good faith medical judgment that its a life for the doctor to risk when idaho law changed to make the issue whether she is going to die or not or whether she have a serious medicacondition. Correct . It is very casebycase. I am kind of shocked. I thought your own expert had said below that these kinds of cases were d and you are now saying that they e not . I am not saying that. She is asking with this be covered or not. I know it was my understanding that the legislators witnesses said that these would be covered. Those doctors said if they were exercising their medical judgment, theyd in good faith determine that life saving lifesaving ca s necessary. That is my point. Some doctors could not. Some doctors might reach a contrary conclusion is what shes asking you. If he reached the conclusion that the leslures doctors did, would they be prosecuted under idaho law . No. If they reached the conclusion that dr. Reynolds, dr. Whit what if the prosecutor thought differently . What if the prosecutor but i dont think any can draw that conclusion, im going to put on my expert. That is the nature of discretion and it may reltin a case has idaho put out any kind of guidance . What is covered by the and what is not . The e regulations but i think the guiding star isthe planned parenthood versus austin case which is a lengthy treatment by the idaho suprem court of this law. It made clear, the court made clear that there is no medical certainty requirement. You do no to wait for the mother to cing death. Thank