Subscriber Benefit
As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe Now
Reproductive rights advocates have sounded the alarm over a recent decision by President Donald Trump’s administration to rescind Biden-era guidelines to the Emergency Medical Treatment and Labor Act.
The act, which is overseen by the Centers for Medicare & Medicaid Services under the United States Department of Health and Human Services, establishes required care procedures for hospitals treating patients with an emergency medical condition.
In particular, the act has been viewed as crucial to guiding hospitals in their ability to provide emergency abortions following the overturning of Roe v. Wade in 2022.
“Whenever we have narrow exceptions, like we have here in Indiana, what should be a medical decision becomes a medical legal decision and complicates things dramatically, so that’s why guidance is helpful,” said Chris Daley, executive director for the Indiana chapter of the American Civil Liberties Union.
Advocates for the act and its standards for emergency abortions say Trump’s decision is detrimental to the ability of health care providers to determine when they can perform these abortions lawfully.
“The Trump administration’s decision to withdraw EMTALA guidance guaranteeing pregnant people medical care in emergency situations will sow confusion for providers and endanger the lives and health of pregnant people,” Skye Perryman, president and CEO for the organization Democracy Forward, told the ACLU in a June press release about the recission.
But some hospitals and hospital organizations in Indiana say they’re carrying on with business as usual.
About the law
The Emergency Medical Treatment and Labor Act—often referred to using the acronym EMTALA—was enacted by Congress in 1986 to ensure access to emergency medical services, regardless of one’s ability to pay for the services. The act is codified in the Social Security Act.
Under the act, Medicare-participating hospitals must provide stabilizing treatment for patients who arrive at their facility with an emergency condition. If they cannot stabilize the patient themselves, they must initiate the patient’s transfer to another medical facility.
Language within the act can be interpreted to allow emergency abortions as stabilizing medical treatment, some say.
After Roe v. Wade was overturned in 2022, former President Joe Biden’s administration issued guidance reinforcing the obligations health care providers have under EMTALA.
Specifically, the administration stated that “a physician’s professional and legal duty to provide stabilizing medical treatment to a patient who presents to the emergency department and is found to have an emergency medical condition preempts any directly conflicting state law or mandate that might otherwise prohibit such treatment.”
Under the act, stabilizing treatment must prevent material deterioration and compel hospitals to act before the patient’s condition declines, according to the Biden administration.
The administration further stated that EMTALA’s preemption of state law can be enforced by individual physicians in several scenarios, including as a defense to state enforcement and in a federal suit that seeks to enjoin threatened enforcement.
While the current administration’s decision does not impact the law, it could impact how it’s interpreted.
Challenges to the act
President Trump’s decision is not the first time EMTALA has been challenged within the context of emergency abortion access.
Shortly after the Biden administration released guidance on the act in 2022, the Texas Attorney General filed a lawsuit against the Health and Human Services Department, alleging that EMTALA does not authorize the federal government to “compel health care providers to perform abortions.”
Texas officials suggested that EMTALA “contemplates that an emergency medical condition is one that threatens the life of an unborn child. It is obvious that abortion does not preserve the life or health of an unborn child.”
Further, the state argued that the Social Security Act does not grant EMTALA the ability to authorize federal employees to exert control over the practice of medicine or how medical services are provided.
The U.S. District Court in Northern Texas sided with the state, determining in January 2023 that the department could not enforce the guidance that Texas abortion laws are preempted by EMTALA.
The department appealed to the Fifth Circuit Court of Appeals in March 2023. The appellate court affirmed the district court’s decision the following February. In Oct. 2024, the United States Supreme Court denied the department’s writ of certiorari.
This March, a federal district judge in Idaho granted a preliminary injunction preventing the state’s attorney general from enforcing the Idaho Defense of Life Act, which criminalizes abortion in most circumstances, against the St. Luke’s Health System Ltd., “as applied to medical care required by the Emergency Medical Treatment and Labor Act.”
The decision stems from a lawsuit filed in January by St. Luke’s against Idaho Attorney General Raúl Labrador, which argues that Idaho’s abortion law is preempted by EMTALA.
St. Luke’s lawsuit was built off another lawsuit filed by the Biden administration to protect reproductive rights after Roe v. Wade’s overturning, according to Time.
In March, the U.S. Department of Justice filed a motion to dismiss the lawsuit, allowing the state to enforce its abortion ban even during emergency situations, the Associated Press reported.
The impact on Indiana
Right now, the preliminary injunction to allow emergency abortions is still in place pending a longer-term injunction, the Idaho Capital Sun reported.
In Indiana, it’s yet to be determined how far-reaching the Trump administration’s recent decision over EMTALA is in relation to providing emergency abortions.
Indiana’s near-total abortion ban outlaws the procedure except in cases of fatal fetal anomaly and in the event of a serious health risk to the mother. The state also permits abortion in cases of rape or incest, up to 10 weeks after fertilization.
Several health systems across the state did not respond to The Indiana Lawyer’s request for comment when inquiring whether the recission of the federal guidance impacts their practice.
A representative for Eskenazi Health said the recission does not change the health system’s practice.
The Indiana Hospital Association offered the following statement to The Lawyer:
“Indiana hospitals have and will continue to adhere to all state and federal laws related to the limited circumstances when an abortion can be provided in Indiana including when necessary to prevent any serious health risk to the pregnant woman or to save the pregnant woman’s life.”
Right to Life Indiana did not respond to a request for comment.
The ACLU of Indiana concludes that the recission has more dire implications for smaller health care systems and providers without the robust legal framework that larger systems have.
“The concern is those hospitals without that same kind of infrastructure who were looking at the [EMTALA] guidance as a way to just simplify what can they do,” said Daley. “And now that the guidance has been revoked, they have to go back to the underlying law, do some interpretation of it.”•
Please enable JavaScript to view this content.