Trump Administration Drops High-Profile Emergency Abortion Case, Leaving Advocates ‘Devastated’

The Trump Administration dropped a high-profile lawsuit over the right to emergency abortions in Idaho on March 5—a stark reversal from the Biden Administration, and a move that reproductive rights advocates, providers, patients, and legislators have called “devastating” and “troubling.”

“Unfortunately, it was not a surprise at all. We have been nervous but ready for this decision to come down. I think the Trump Administration has abandoned pregnant women in medical crises by abandoning [this case],” says Idaho State Sen. Melissa Wintrow, a Democrat. “They dropped that case, which was only holding onto the sliver of protection in a crisis, and they can’t even allow that. Think about that: they can’t even allow a pregnant woman to go to the emergency room, and if her life and health are in jeopardy, to get medical treatment that could save it or preserve her health. That speaks volumes.”

On March 5, the U.S. Department of Justice (DOJ) filed a motion to dismiss the lawsuit, which had initially been brought by the Biden Administration. Doing so would have permitted Idaho to fully enforce its near-total ban on abortion, even in medical emergencies, but Idaho U.S. District Court Judge B. Lynn Winmill blocked that move by granting a temporary restraining order at the request of the state’s largest health care provider, St. Luke’s Health System, which had filed its own lawsuit on the issue in January, in anticipation of the Trump Administration dropping the case.

Read More: Women Denied Abortions in Idaho Take on the State’s Near-Total Ban

The initial case was one of the Biden Administration’s efforts to protect reproductive rights in the aftermath of the U.S. Supreme Court’s overturning of Roe v. Wade. At the heart of the lawsuit is a federal law known as the Emergency Medical Treatment and Labor Act (EMTALA), which requires emergency rooms receiving Medicare funding to stabilize patients experiencing medical emergencies before discharging or transferring them, regardless of the patients’ ability to pay. The Biden Administration argued that emergency abortion care is required under EMTALA, and that Idaho’s near-total ban on abortion prevents doctors from providing that care in medical emergencies. The state of Idaho has insisted that the state’s ban doesn’t conflict with federal law.

Idaho has one of the strictest restrictions on abortion in the country and has limited exceptions, such as if an abortion is necessary to prevent the pregnant person’s death, or for survivors of rape or incest, who have reported the crime to law enforcement and are in the first trimester of their pregnancy.

“EMTALA was never enough anyway, but it did add a little layer of a legal safeguard for necessary abortions and [health] care when it was a health emergency,” Wintrow says. “It was the last shred, the bare minimum protection for women in Idaho.”

The case filed by the Biden Administration eventually reached the U.S. Supreme Court, which ruled in June 2024 that Idaho hospitals receiving federal dollars were temporarily permitted to provide emergency abortions in situations where patients are facing serious health risks. But the court declined to rule on whether the state’s ban conflicts with EMTALA, throwing the case back down to lower court judges on procedural grounds.

Since Winmill granted St. Luke’s the temporary restraining order, doctors in Idaho are allowed to provide abortions in emergency situations for now, as the court reviews the case. The judge’s ruling prohibits the Idaho Attorney General’s Office from prosecuting doctors providing that care. The state Attorney General’s Office declined to comment on the pending litigation filed by St. Luke’s, but released a statement reacting to the news that the Trump Administration had dropped the lawsuit brought in during former President Joe Biden’s term. 

“It has been our position from the beginning that there is no conflict between EMTALA and Idaho’s Defense of Life Act,” Attorney General Raúl Labrador said in the press release. “We are grateful that meddlesome DOJ litigation on this issue will no longer be an obstacle to Idaho enforcing its laws.”

The Justice Department and White House did not respond to a request for comment on the decision to dismiss the case.

In a January press release (reviewed by TIME) announcing its own lawsuit, St. Luke’s chief physician executive Dr. Jim Souza said the conflict between the state’s near-total abortion ban and EMTALA “makes it impossible to provide the highest standard of care in some of the most heartbreaking situations.”

Read More: Here Are Trump’s Major Moves Affecting Access to Reproductive Healthcare

Carrie Flaxman, a senior legal advisor for the national legal organization Democracy Forward and a reproductive rights law expert, says that the Trump Administration’s decision to drop the lawsuit is in line with Project 2025, which claimed that “EMTALA requires no abortions” and encouraged the incoming presidential Administration to reverse what it called “distorted pro-abortion ‘interpretations’ added to” the federal law. (Trump distanced himself from Project 2025 during the 2024 election cycle, but some of his closest advisers were involved in drafting the handbook).

Flaxman says the change in the presidential Administration’s stance on the issue “is only going to sow confusion among doctors about how to comply with the law,” adding that “it is patients that end up suffering” amid such confusion. 

Doctors in Idaho have said that the full enforcement of the state’s near-total ban would prevent them from providing standard care in urgent situations. St. Luke’s lawyers said in their complaint that, when Idaho fully enforced its near-total ban on abortion for a few months in 2024, the health system was forced to airlift six patients experiencing medical emergencies out of the state to help them access care.

“The St. Luke’s medical providers treating these six patients when the law was fully in effect faced a terrible choice: they could either wait until the risks to the patient’s health became life-threatening or transfer the patient out of state,” St. Luke’s lawyers said in the complaint. “The first option was medically unsound and dangerous because these patients’ conditions could cause serious health complications if untreated, including systemic bleeding, liver hemorrhage and failure, kidney failure, stroke, seizure, and pulmonary edema. Moreover, watching a patient suffer and deteriorate until death is imminent is intolerable to most medical professionals.” At the same time, airlifting patients also puts patients at risk because it can lead to “significant delays in care,” St. Luke’s lawyers pointed out.

Read More: Medication Abortion Is Still the Most Common Type

Dr. Caitlin Gustafson—a family physician, abortion provider, and president of the Idaho Coalition for Safe Healthcare Foundation—says the state’s near-total ban leaves doctors struggling to parse through the laws when they’re trying to provide critical care to patients. When a patient experiences a medical emergency, delays in care can be dangerous and lead to other complications, Gustafson says. For instance, if a pregnant patient is hemorrhaging, and their health deteriorates, the patient’s condition could worsen to a point where their future fertility is at risk. 

“Without EMTALA, we are forced into a situation where we have to wait. ‘Are they sick enough?’ The law in Idaho says we may intervene with abortion care if it is to prevent the death. Well, that is a continuum, right? There is not a moment in which a patient holds up a sign and says, ‘Now is the moment where this is life-threatening,’” Gustafson says. (Gustafson is a St. Luke’s employee, but gave this interview as a representative of the Idaho Coalition for Safe Healthcare Foundation.)

Kayla Smith’s experience with Idaho’s near-total abortion ban was part of the reason she and her family moved out of Idaho to Washington State. In 2022, when Smith was around 18-19 weeks pregnant with her second baby, her ultrasound revealed that her baby had several serious fetal anomalies. Doctors said her baby likely wouldn’t survive birth. They were also concerned that continuing the pregnancy would be dangerous for Smith and put her at risk of developing preeclampsia, since she had experienced the condition while pregnant with her first child. But because Idaho’s near-total ban on abortion had just gone into effect, Smith was forced to travel out of state to Washington to receive abortion care.

Smith remembers asking her doctor a series of “what if” questions. What if she carried to term? What would that look like? What if she did develop preeclampsia? “The deciding point for me was during that appointment. I wanted to do the most humane thing for [my baby], but also [I realized] that my life was at risk because [the doctor] looked at me and was like, ‘I don’t know how sick you have to be with preeclampsia before we can induce you,’” Smith says.

Smith, who is a plaintiff in a separate lawsuit against Idaho requesting that the court clarify and expand the medical emergency exceptions under the state’s abortion ban, says she knows she was privileged to be able to travel out of state to obtain the care she needed, as that option is not available to others. For Smith—who has since become an advocate for the reproductive rights advocacy nonprofit Free & Just—the reality of the Trump Administration dropping the EMTALA lawsuit is “devastating.”

“I’m really afraid for women right now,” she says. “We don’t know what’s going to happen.”

Smith, Gustafson, and Wintrow say they are all grateful to St. Luke’s for taking over the case. Wintrow says “it took great courage to do so,” adding that the health system “saw the writing on the wall” with the new Administration and preemptively filed its lawsuit to try and protect pregnant people’s access to emergency abortion care in Idaho.

Smith says that if the courts side against St. Luke’s, “women are going to die.” She and Wintrow also say that the Trump Administration dropping the lawsuit has implications beyond Idaho, and fear that it might embolden other states to restrict emergency abortion care.

“This is not just going to affect Idaho,” Smith says. “I really feel like this has given the green light to those other red states who have abortion bans to also just dismiss EMTALA completely.”