WASHINGTON — Conservative Supreme Court justices voiced skepticism Wednesday that state abortion bans enacted after the overturning of Roe v. Wade violate federal health care law, though some also questioned the effects on emergency care for pregnant patients.

The case marks the first time the Supreme Court has considered the implications of a state ban since overturning the nationwide right to abortion. It comes from Idaho, which is among 14 states that now ban abortion at all stages of pregnancy with very limited exceptions.

The high court has already allowed the state ban to go into effect, even in medical emergencies, and it was unclear whether members of the conservative majority were swayed by the Biden administration’s argument that federal law overrides the state in rare emergency cases where a pregnant patient’s health is at serious risk.

The closely watched case tests how open the court is to carving out limited exceptions to state abortion bans. Their ruling, expected by late June, will also affect a similar case in Texas and could have wide implications amid a spike in complaints that pregnant women have been turned away from emergency rooms care since Roe was overturned.

At issue is the 1986 Emergency Medical Treatment and Labor Act, which requires hospitals receiving federal funds to provide urgent care for all patients, regardless of their ability to pay. The Biden administration invoked the statute known as EMTALA after the Supreme Court eliminated the nationwide right to abortion in 2022.

The administration sued Idaho in August 2022, saying that the state’s restrictions are preempted by the federal law and that strict state bans have confused health workers, confounded patients and led to delays in lifesaving care for pregnant people.

A federal judge initially sided with the administration and ruled that abortions were legal in medical emergencies. After the state appealed, the Supreme Court allowed the law to go fully into effect in January.

The Biden administration says abortion care must be allowed in those cases under a law that requires hospitals accepting Medicare to provide emergency care regardless of patients’ ability to pay.

Justice Samuel Alito, who wrote the decision overturning Roe v. Wade, was doubtful. “How can you impose restrictions on what Idaho can criminalize, simply because hospitals in Idaho have chosen to participate in Medicare?” Alito said.

Justice Neil Gorsuch expressed concern about the scope of the federal government’s assertion and asked whether it could effectively transform “the regulation of medicine into a federal function” by attaching certain conditions to its funding of hospitals nationwide. Both Gorsuch and Alito drew attention to the fact that the EMTALA statute does not mention abortion but includes the term “unborn child” when defining what constitutes a patient.

“Isn’t that an odd phrase to put in a statute that imposes a mandate to perform abortions? Have you ever seen an abortion statute that uses the phrase ‘unborn child?'” Alito asked Solicitor General Elizabeth Prelogar. “It seems the plain meaning is that the hospital must try to eliminate any immediate threat to the child.”

Prelogar said Congress added the language to expand protections for pregnant individuals to include treating conditions that specifically threaten the health and well-being of the unborn child — not to exclude protecting the pregnant person.

Idaho contends its ban does have exceptions for life-saving abortions, and the administration wants to wrongly expand the times when it’s allowed to turn hospitals into “abortion enclaves.”

But liberal justices detailed cases of pregnant women hemorrhaging or having to undergo hysterectomies after abortion care was denied or delayed in states with bans.

“Within these rare cases, there’s a significant number where the woman’s life is not in peril, but she’s going to lose her reproductive organs. She’s going to lose the ability to have children in the future unless an abortion takes place,” said Justice Elena Kagan.

Kagan noted that pregnant people in need of emergency abortion care in Idaho were being transferred out of state for treatment.

At one point, Justice Amy Coney Barrett expressed frustration with Idaho’s attorney, Joshua Turner, suggesting he was “hedging” when he asserted that state law allows doctors to use their medical judgment and in “good faith” to determine whether a lifesaving abortion is permitted.

Barrett suggested the Idaho attorney’s answers to Justice Sonia Sotomayor’s hypotheticals, which were about whether state law would allow an abortion to address certain threatening conditions short of death, were at odds with representations in his written filings.

“I’m kind of shocked, actually, because I thought your own expert had said below that these kinds of cases were covered — and you’re now saying they’re not?” Barrett asked, referring to the examples of threats to a pregnant individual’s health.

Attorney Joshua Turner responded that doctors can use their “good faith” medical judgment under Idaho’s life-saving exception, but Barrett continued to press: “What if the prosecutor thinks differently?”

Turner acknowledged that a doctor could face a criminal case in that situation. Performing an abortion outside of limited exceptions in Idaho is a felony punishable by up to five years in prison.

Most Republican-controlled states have started enforcing new bans or restrictions since Roe was overturned, and Turner said those laws all have narrower exceptions than the federal law.

“This isn’t going to end with Idaho. This question is going to come up in state after state,” he said.

Turner later emphasized that state law “does not require that doctors wait until a patient is on the verge of death” to provide care.

But Barrett and Chief Justice John Roberts pressed the state’s lawyer about whether prosecutors or other state officials could second-guess a doctor’s determination.

“What happens if a dispute arises with respect to whether or not the doctor was within the confines of Idaho law or wasn’t? Exactly how is that evaluated?” Roberts asked. Turner said that doctors are overseen by medical boards officials and that prosecutors have discretion when deciding to take action.

CARE IN IDAHO AFFECTED

Doctors have said Idaho’s abortion ban has already affected emergency care. More women whose conditions are typically treated with abortions must now be flown out of state for care, since doctors must wait until they are close to death to provide terminations within the bounds of state law.

Abortion opponents say doctors have mishandled maternal emergency cases, and argue the Biden administration overstates health care woes to undermine state abortion laws.

The justices also heard another abortion case this term seeking to restrict access to abortion medication. It remains pending, though the justices overall seemed skeptical of the push.

Prelogar emphasized the distinction between the state law that permits abortion only when a person is at risk of death and the care federal law requires when a pregnant individual has a serious medical condition.

“In Idaho, doctors have to shut their eyes to everything except death,” Prelogar said. “Whereas under EMTALA, you’re supposed to be thinking about things like, ‘Is she about to lose her fertility? Is her uterus going to become incredibly scarred because of the bleeding? Is she about to undergo the possibility of kidney failure?'”

Conservatives counter that the White House is stretching a law that makes no mention of the procedure so it can justify abortion access. The text of the statute requires hospitals to offer “any individual” with an emergency medical condition “such treatment as may be required to stabilize the medical condition.”

Turner, Idaho’s acting solicitor general, said the federal statute does not permit emergency room doctors to ignore state abortion restrictions. Just as individual states have different rules for dispensing opioids to manage pain, he said, doctors are required to abide by state medical regulations.

Since Roe was overturned, dozens of stories have emerged of people with high-risk pregnancy complications being turned away from hospitals in states with abortion bans. While all of the bans include some kind of medical exception for the life or health of the pregnant individual, the language is often vague, leaving doctors unsure of whether they can legally provide an abortion. Six other states have restrictions similar to those in Idaho’s law and do not include a health exception, Prelogar told the court Wednesday.

In 2022, officials at the Centers for Medicare and Medicaid Services issued guidance to hospitals receiving Medicare funds that emergency room doctors must terminate pregnancies in some circumstances, even if a state’s law bars the procedure. Hospitals that do not comply face penalties of up to $120,000 per violation.

The audience was sparse inside the court, with several benches empty or sparingly used. But outside, dueling protesters gathered with signs such as “Abortion saves lives,” and “Emergency rooms are not abortion clinics.”

Information for this article was contributed by Lindsay Whitehurst, Gary Fields and Mark Sherman of The Associated Press and by Ann E. Marimow, Caroline Kitchener, Kim Bellware, Dan Diamond and Perry Stein of The Washington Post.

    Anti-Abortion activists rally outside the Supreme Court, Wednesday, April 24, 2024, in Washington. (AP Photo/Jose Luis Magana)
  

    Anti-Abortion and Abortion-rights activists rally outside the Supreme Court, Wednesday, April 24, 2024, in Washington. (AP Photo/Jose Luis Magana)
  

    Abortion rights activists, covered in blankets with red paint, lie down as they rally outside the Supreme Court, Wednesday, April 24, 2024, in Washington. (AP Photo/Jose Luis Magana)
  

    Abortion-rights activists rally outside the Supreme Court on Wednesday, April 24, 2024, in Washington. (AP Photo/Mariam Zuhaib)