The U.S. Supreme Court declined on Monday to hear a bid by President Joe Biden’s administration to enforce in Texas federal guidance requiring hospitals to perform abortions if needed to stabilize a patient’s emergency medical condition.

The justices turned away the Justice Department’s appeal of a lower court’s decision that halted enforcement of the guidance in Texas, where a Republican-backed near-total ban on abortion is in effect, and against members of two anti-abortion medical associations.

The Biden administration issued the guidance in July 2022 to protect access to abortion after the Supreme Court’s conservative majority the previous month overturned the landmark 1973 Roe v. Wade ruling that had legalized abortion nationwide.

The guidance reminded healthcare providers across the country of their obligations under a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA) to ensure Medicare-participating hospitals offer emergency care stabilizing patients regardless of their ability to pay. Medicare is the government healthcare program for the elderly. Hospitals that violate EMTALA risk losing Medicare funding.

The guidance made clear that under that law physicians must provide a woman an abortion if needed to resolve a medical emergency and stabilize the patient even in states where the procedure is banned, and that the measure preempts state bans that offer no exceptions for medical emergencies or with exceptions that are too narrow.

Texas law prohibits abortions unless the pregnancy places the woman at risk of death or “substantial impairment of a major bodily function.”

Republican-governed Texas and two anti-abortion medical associations – the American Association of Pro-Life Obstetricians & Gynecologists and the Christian Medical & Dental Associations, sued the administration, arguing that the guidance unlawfully purports to compel healthcare providers to perform abortions.

U.S. District Judge James Wesley Hendrix in 2022 blocked enforcement of the guidance, finding that it is an unlawful interpretation of the EMTALA statute, and would allow abortions beyond what is permitted by Texas law.

The New Orleans-based 5th U.S. Circuit Court of Appeals on Jan. 2 upheld Hendrix’s decision, ruling that “EMTALA does not mandate any specific type of medical treatment, let alone abortion.” The 5th Circuit’s decision came a month after the top court in Texas ruled against a woman who was seeking an emergency abortion of her non-viable pregnancy.

Abortion rights advocates have challenged the scope of abortion ban exceptions in several states due to uncertainty, including among physicians, about what medical emergencies during pregnancy would permit health providers to perform the procedure.

In a similar case in June, the Supreme Court permitted, for the time being, abortions to be performed in Idaho when pregnant women are facing medical emergencies.

The Supreme Court’s 6-3 ruling in the Idaho case revived a federal judge’s decision that EMTALA takes precedence over Idaho’s Republican-backed near-total abortion ban when the two conflict. While the justices lifted a block they had placed on the judge’s ruling in the case, they did not resolve the dispute on its merits, opting instead to dismiss it as “improvidently granted.”