A yearslong legal battle over the right to an emergency abortion in Idaho has been abruptly upended now that President Donald Trump has moved to drop the high-profile case.
Under the Biden administration, the Justice Department argued that emergency-room doctors treating pregnant women had to provide terminations if it was needed to save their lives or to avoid serious health consequences.
Yet a little more than a month after taking over the White House, Trump's decision to abandon the legal fight signals how the Republican administration plans on interpreting federal law designed to protect urgent care when up against states' abortion bans.
An attendee at Planned Parenthood's Bans Off Our Bodies rally for abortion rights holds a sign outside of the Idaho Statehouse on May 14, 2022, in downtown Boise, Idaho.
Here's what to know:
How did we get here?
In 2022, the U.S. Supreme Court overturned the constitutional right to an abortion. The ruling came down while President Joe Biden, a Democrat, was in office, but many of the justices who helped reverse Roe v. Wade were appointed under Trump.
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So in response, Biden warned that his administration considered abortion part of the stabilizing care that federal law requires facilities to provide to patients who show up at an emergency room. A month later, Biden sued Idaho, which had enacted an abortion ban that makes it a crime with a prison term of up to five years for anyone who performs or assists in an abortion.
The Biden administration argued that Idaho鈥檚 abortion ban prevented ER doctors from offering an abortion if a woman needed one in a medical emergency. But Idaho鈥檚 attorney general has pointed out that federal law also requires hospitals to consider the health of the 鈥渦nborn child鈥 in its treatment, too.
The lawsuit has twisted and turned in the legal system ever since. Last year, the Supreme Court agreed to step into the Idaho case, but it handed down a narrow ruling: Hospitals were allowed to make determinations about emergency pregnancy terminations, but the key legal question about what care hospitals should legally provide remains unresolved.
What does this federal law say?
Known as the Emergency Medical Treatment and Active Labor Act, or EMTALA, the 1986 law requires emergency rooms to offer a medical exam if you turn up at their facilities. The law applies to any ERs that accept Medicare funding 鈥 so nearly all of them.
Those ERs also are required to stabilize patients experiencing a medical emergency before discharging or transferring them. Notably, if the ER doesn't have the resources or staff to treat a patient, medical staffers must arrange a medical transfer to another hospital 鈥 they can't simply direct a patient to go elsewhere.
EMTALA is more scrutinized than ever since Roe was overturned. Multiple doctors and families have told The Associated Press about pregnant women with dangerous medical conditions showing up in hospitals and doctors' offices only to be denied the abortions that could help treat them. Some women described facing harmful delays.
Has Trump said why he's dropping the case?
Not yet. And the DOJ's three-page motion didn't explain why they wanted to abandon the lawsuit, either. However, since having a hand in revoking the constitutional right to abortion, Trump has repeatedly touted his support of leaving abortion regulations up to the states.
Meanwhile, ending the effort to use federal law to protect emergency abortions was a goal of Project 2025, the blueprint created by the Heritage Foundation for a second Trump term, which calls for reversing what it describes as 鈥渄istorted pro-abortion鈥 interpretations of federal law. Trump insisted during his 2024 presidential campaign that Project 2025 was not part of his agenda.
鈥淭heir move to drop this case against Idaho I think really shows what their true priorities are 鈥 and it is to push an anti-abortion political agenda rather than support the lives, health and well being of pregnant women and people, not just in Idaho but across the country because this case does have far-reaching impact,鈥 said Brittany Fonteno, president and CEO of the National Abortion Federation, an association of abortion providers.
What's going on elsewhere?
Trump鈥檚 decision to drop the Idaho case comes several months after the Supreme Court left a court ruling in place that found the federal government couldn鈥檛 require hospitals to provide pregnancy terminations when it would violate Texas鈥 abortion ban.
Texas had sued over the Biden administration's enforcement of EMTALA, and a lower federal court eventually sided with the state. But similar to the case in Idaho, the Supreme Court stopped short of deciding whether the federal law can supersede a state's abortion ban.
Meanwhile, concern has grown over whether Trump's decision in the Idaho case is a sign that his administration may also reverse course in a longstanding legal battle over telehealth access to mifepristone, the medication used in the nation's most common abortion method.
The Department of Justice under Biden sought to dismiss a complaint brought by a handful states seeking to roll back access to mifepristone. It's currently unclear how Trump plans to proceed.
These states already restrict abortion. Their legislatures could push it even further.
These states already restrict abortion. Their legislatures could push it even further.
Conservative state lawmakers are prepared to press for more abortion restrictions this year, regardless of any action President Donald Trump pursues in office. Many of the bills filed in state legislatures across the country focus on abortion pills, abortion access for minors, and, in at least one state, how to undo protections for the procedure, reports.
Legislators in Indiana, Missouri, Oklahoma, South Carolina, Texas, and Tennessee have filed bills that would further curb access. In states with near-total bans, lawmakers are looking to eliminate the workarounds residents have used to continue accessing abortions. In others, lawmakers will weigh whether to move from six-week abortion bans to almost completely outlawing the procedure. And in Missouri, where voters just amended the constitution to enshrine abortion rights, some legislators are pushing to reverse or weaken the new democratically established protection.
Because state legislatures often influence each other, more bills are almost certain to follow.聽
It's still unclear what appetite Trump has for federal abortion regulations. Anti-abortion organizations are still lobbying for the second Trump administration to restrict abortion rights, and several of the president's Cabinet members have made their opposition to abortion clear. Yet Trump himself has been inconsistent about how he would approach the issue. In his first term, he was a steadfast ally for abortion opponents. But on the 2024 campaign trail, he claimed he would veto any proposed national ban, even while taking credit for the fall of Roe v. Wade.聽
State lawmakers aren't waiting for the new president to clarify his approach, and many have taken Trump's election as validation to pursue new restrictions.
"It emboldened anti-abortion legislators," said Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange, which advocates for progressive policy in statehouses. "It pushed the limit."聽
In Texas, the largest state to ban abortion, the 2024 election eliminated the fear that pushing for new restrictions would result in political blowback, said John Seago, the head of Texas Right to Life, an influential anti-abortion organization. "It took the political excuses off the table," he said.
Medication Abortion
Bills filed so far suggest a focus on further limiting access to medication abortion, the two-drug regimen that can safely be taken from home with virtual medical oversight if needed. Pregnant people in states with bans 鈥攊n some cases prescribed and mailed by a health care provider in a state with abortion protections鈥攖o terminate their pregnancies.
The practice of having pills mailed to states with bans is medically safe but legally fraught. Health care providers typically are only protected when in their home states, and while abortion bans don't criminalize patients, those who receive medication can risk prosecution under other state laws. Still, it's created an effective enough workaround that abortion opponents are hunting for a way to end this virtual health care model.
"It's about the trafficking of abortion pills, whether that's through the mail, whether that's physicians bringing them over the border and distributing them鈥攖hose are really what we're focusing on," Seago said. "The fact that these trends have been going on for the past couple of years without accountability is something we seek to change this year."
Bills targeting abortion pills have been introduced in Texas and Tennessee, where abortion is illegal in almost all cases. They have also been introduced in Indiana, where abortion is illegal after six weeks.
Texas lawmakers have already introduced bills that would ban online; those who sell or distribute the medications through the Internet could be found guilty of a felony. Legislators in Indiana and Tennessee have also targeted distribution of these drugs; would outlaw possessing abortion medication or sending it to someone else, and a Tennessee bill . would also reclassify abortion pills as "controlled substances"鈥攁 classification that goes against medical evidence but takes a similar approach to a law enacted . A separate Texas bill would also classify those medications as controlled substances, which is typically designated for drugs with significant potential for abuse, such as narcotics, and can involve greater penalties for possession.
In Wyoming, where abortion is legal until fetal viability, a Republican-backed bill would require patients to receive an ultrasound before receiving abortion medication鈥攁 measure that is out of step with most major medical organizations' advice, but that would effectively outlaw providing medication through telehealth.聽
Such restrictions could have sweeping consequences for anyone who becomes pregnant. Mifepristone and misoprostol are also used to treat miscarriages, which typically require the same standard of care as an abortion.聽
It's not clear which specific bills will make it to their respective governors' desks鈥攊n Texas, Seago, said, his organization expects more medication-specific legislation to be filed in the state Senate, including the bills they will most actively champion鈥攂ut they signal a clear interest in medication and its particular role in helping people circumvent abortion bans.聽
That will also likely mean efforts to target the medical providers who have helped patients receive medication abortions. Many have relied on shield laws, or statutes saying their home state will not comply with another state's effort to prosecute them for providing abortion-related health care. The laws are still relatively new and have not yet been tested in court.
"We are going to see more attacks on shield laws," said Elisabeth Smith, the director of state policy and advocacy at the Center for Reproductive Rights, a legal advocacy group that has challenged state abortion laws in court. "We're going to see more attacks on providers."
That focus has already begun to take form outside of state capitols. Ken Paxton, Texas' attorney general, filed a lawsuit in December targeting a New York-based physician who allegedly prescribed and mailed abortion pills to a woman in Texas.聽
The case is a first test of whether existing state abortion bans can be leveraged to penalize people who live outside of their state lines, or if these bans will be thwarted by shield laws like New York's. More such lawsuits are likely, Seago said, a view other abortion law scholars and observers echoed. A successful case could halt or substantially undercut the practice of telehealth provision to people in states with abortion bans.
"This is a test case. They'll see how this goes, and I'm sure there will continue to be more challenges like this," said Greer Donley, a law professor at the University of Pittsburgh who studies medication abortion law.聽
New Barriers for Minors
While medication and its virtual prescription remain abortion opponents' top priority, legislators are also looking to other avenues that could further weaken access to or awareness of abortion, particularly for young people.聽
A bill in , where abortion is illegal in almost all cases, would prohibit acquiring abortion medication for a minor or transporting the minor out of the state for an abortion without the consent from the patient's parents or guardians. A where abortion is legal until 24 weeks of pregnancy, also targets young people by proposing to outlaw transportation of a minor for an abortion without their parents' or guardians' consent.
One would outlaw almost all abortions鈥攔ather than the six-week ban that currently exists鈥攂y removing exceptions for cases of rape and incest, and making it harder for minors specifically to get abortions. The bill would eliminate judicial bypass, which judges can grant to minors whose parents or guardians do not give consent to have an abortion.
Undoing Abortion Protections
Missouri's abortion rights measure passed in November, with If lawmakers can successfully weaken it鈥攕low-walking implementation, redefining it to offer less protection, or passing a new constitutional amendment that reverses it鈥攖hose efforts could offer a model for other anti-abortion states.聽
Lawmakers are seeking to reverse a decision by voters to enshrine abortion rights until fetal viability in the state constitution鈥攊ntroducing proposals to re-amend the state's constitution in , one to ban and another to of abortion medication.聽
Speaker of the House Jonathan Patterson has of redefining "fetal viability" to potentially earlier in pregnancy. Medically, a fetus is considered viable when it can live independently outside the uterus, typically around 23 to 25 weeks. But anti-abortion opponents have been trying to argue that the number falls earlier鈥攕ome suggesting around 15 weeks鈥攅ven though that has no medical basis. Patterson has not said when the legislature would seek to define viability.聽
The legality of some of those efforts is questionable, as is whether Missouri's state court system will allow these efforts to take effect.
Since Roe's overturn, reproductive rights supporters have relied on direct democracy, asking voters to amend their state constitutions to protect abortion, to undo prohibitions on the procedure. Those efforts have including Arizona, Michigan, Montana, Nevada, and Ohio, as well as in more reliably liberal states such as California, Colorado, Maryland, New York, and Vermont. In Florida, an abortion rights measure received 57%聽 of voter support鈥攁 share that would have been enough in other states, but shy of the 60% required to amend the state constitution. It was the first abortion rights measure to fail since the fall of Roe.
But many states do not allow for a citizen-initiated ballot measure process. Only four states that allow ballot measures鈥擜rkansas, Idaho, North Dakota, and Oklahoma鈥攈ave not yet had an abortion rights proposal before voters.
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