Document ID: ./input/supremecourt_opinions/opinions/23pdf/23-726_6jgm.pdf
Page Number: 35

12 

MOYLE v. UNITED STATES 

ALITO, J., dissenting 

Clause] provisions . . . is in no way mandatory”).  “[T]he ‘le-
gitimacy of Congress’ power’ ” to enforce conditions tied to 
federal funds depends on whether the parties who accepted
federal  funds  also  “ ‘voluntarily  and  knowingly’ ”  accepted 
the  conditions.  Cummings  v.  Premier  Rehab  Keller,  596 
U. S. 212, 219 (2022) (quoting Barnes v. Gorman, 536 U. S. 
181, 186 (2002)).

Because the enforcement of conditions attached to the re-
ceipt of federal money depends on a recipient’s knowing and
voluntary  consent,  “the conditions must be set  out  ‘unam-
biguously.’ ”  Arlington Central, 548 U. S., at 296 (quoting 
Pennhurst, 451 U. S., at 17).  And recipients must be given 
a  “legitimate  choice  whether  to  accept  the  federal  condi-
tions.”  National  Federation  of  Independent  Business  v. 
Sebelius,  567  U. S.  519,  578  (2012)  (opinion  of  ROBERTS, 
C. J.); accord, Steward Machine Co. v. Davis, 301 U. S. 548, 
590  (1937).  The  Government’s  interpretation  founders  at 
both points.

First, consider the requirement that EMTALA speak un-
ambiguously.  Even if it were possible to read EMTALA as
requiring  abortions  prohibited  by  Idaho  law,  it  is  beyond
dispute  that  such  a  requirement  is  not  unambiguously 
clear.  The statute does not mention abortion, let alone ex-
pressly bind hospitals to perform abortions contrary to state
law. 

The  need  for  clear  statutory  language  is  especially  im-
portant  in  this  suit  because  the  Government’s  interpreta-
tion would intrude on an area traditionally left to state con-
trol, namely, the practice of medicine.  We typically expect
Congress to “ ‘make its intention “clear and manifest” if it 
intends  to  pre-empt  the  historic  powers  of  the  States.’ ”  
Gregory v. Ashcroft, 501 U. S. 452, 461 (1991) (quoting Rice 
v. Santa Fe Elevator Corp., 331 U. S. 218, 230 (1947)); see 
also Gonzales v. Oregon, 546 U. S. 243, 274 (2006) (“[T]he 
background principles of our federal system also belie the 
notion  that  Congress  would  use  such  an  obscure  grant  of