Document ID: ./input/supremecourt_opinions/opinions/23pdf/23-726_6jgm.pdf
Page Number: 36.0

Cite as:  603 U. S. ____ (2024) 

13 

ALITO, J., dissenting 

authority to regulate areas traditionally supervised by the
States’ police power”).

Second, consider the requirement that parties be given a
choice before being bound by Spending Clause conditions. 
The Government’s interpretation purports to limit Idaho’s
choices about what conduct to criminalize.  But Idaho never 
“agree[d]” to be bound by EMTALA,14 Cummings, 596 U. S., 
at 219, let alone to surrender its historic power to regulate
the  practice  of  medicine  or  the  performance  of  abortions
within its borders. 

The  Idaho  Legislature  takes  its  argument  against 
preemption even further.  It contends that EMTALA cannot 
preempt the State’s abortion regulations because Idaho is 
not a party to the agreement between the Federal Govern-
ment and the hospitals that take Medicare funds.  See Brief 
for  Petitioners  in  No.  23–726,  pp.  50–51.  As  it  explains,
States cannot be bound by terms that they never accepted,
so it is hard to see how a third party’s agreement with the
Federal  Government  can  deprive  a  State  of  the  ability  to
enforce  its  criminal  laws.    Accord,  Talevski,  599  U. S.,  at 
212  (THOMAS,  J.,  dissenting)  (“[E]ven  those  who  held  the 
broadest conception of the spending power recognized that 
it was only a power to spend, not a power to impose binding 
requirements with the force of federal law”).

The potential implications of permitting preemption here 
are far-reaching.  Under the Government’s view, Congress
could apparently pay doctors to perform not only emergency 
abortions but also third-trimester elective abortions or eu-
genic abortions.  It could condition Medicare funds on hos-
pitals’ offering assisted suicide even in the vast majority of 
States that ban the practice.  It could authorize the practice
of medicine by any doctor who accepts Medicare payments 

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14 Only  one  state  psychiatric  hospital  accepts  Medicare  funds,  and  it 

does not have an emergency room.  2 App. 531.