Federal health officials rescinded guidance Tuesday issued by former President Joe Biden’s administration that said Medicare-funded hospitals must provide life-saving abortion care, regardless of state bans. (Photo by Otto Kitsinger/ Idaho Capital Sun)
The U.S. Department of Health and Human Services has rescinded guidance issued in July 2022 that emphasized hospitals are responsible for providing emergency abortion care despite state bans, saying it does not reflect the Trump administration’s policy.
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law requiring hospitals that accept Medicare funding to provide stabilizing treatment to anyone who comes to an emergency room seeking care. After the Dobbs decision in June 2022 that allowed states to regulate abortion access and more than a dozen states implemented total abortion bans, the Health and Human Services Department under former Democratic President Joe Biden’s administration issued guidance reinforcing hospitals’ obligations to patients under EMTALA, regardless of state policy. Abortion is a form of stabilizing care in certain situations, such as when a pregnant patient’s water breaks prematurely and the fetus is not yet viable.
“(Centers for Medicare and Medicaid Services) will continue to enforce EMTALA, which protects all individuals who present to a hospital emergency department seeking examination or treatment, including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy,” the Tuesday announcement said. “CMS will work to rectify any perceived legal confusion and instability created by the former administration’s actions.”
The statement did not elaborate further on what that will mean in cases where the EMTALA mandate conflicts with state abortion bans. In court, Idaho’s attorneys arguing on behalf of the state have said EMTALA never requires an abortion to be performed as part of stabilizing care — an argument also made by U.S. Supreme Court Justice Samuel Alito when the court heard Idaho’s case last year. The justices sent the case back to the circuit court for further consideration, but the Trump administration dropped the Biden-era lawsuit against Idaho in early March.
Abortion-rights advocacy organizations said the move sends a clear message that the administration is siding with anti-abortion foes.
“Stripping away federal guidance affirming what the law requires will put lives at risk,” said Fatima Goss Graves, president and CEO of the National Women’s Law Center, in a statement. “To be clear: this action doesn’t change hospitals’ legal obligations, but it does add to the fear, confusion, and dangerous delays patients and providers have faced since the fall of Roe v. Wade.”
Doctors in places like Idaho, where the Biden administration sued over the state’s near-total abortion ban as it relates to EMTALA, have said the ban is what created confusion. Court injunctions have been in place off and on through litigation over the past three years, and when it wasn’t in place for a four-month period in 2024, staff at the state’s largest hospital airlifted six patients to other states because there was uncertainty about whether they could be prosecuted under the state law. Patients can also file complaints under the EMTALA law, and if the hospital is found to be in violation, it could lose its status and funding as a Medicare provider.
St. Luke’s, the state’s largest hospital system, filed a new lawsuit as the plaintiff in January, anticipating that the Trump Department of Justice would drop it. The federal judge in that case issued a new injunction protecting St. Luke’s doctors from prosecution under the state ban, but other Idaho doctors outside of that health system are not protected by it.
The federal health agency also rescinded a letter written by Biden’s former HHS secretary, Xavier Becerra, that told U.S. health care providers the federal statute protected their clinical judgment and the actions they take to provide stabilizing treatment, regardless of the state where they practice.
There have been several lawsuits over EMTALA since 2022 besides in Idaho, including one in Tennessee filed in January by the Catholic Medical Association that specifically challenged the July 2022 guidance. The Association said the Biden-era memo and accompanying letter were issued without conducting proper administrative procedure, and alleged that it violated the religious freedom of doctors.
On Tuesday, when DHHS rescinded the guidance, the Association dropped the lawsuit.
Regina Davis Moss, president and CEO of a reproductive health and sexuality advocacy organization called In Our Own Voice, is a former HHS employee and longtime advocate for better reproductive health outcomes for Black women and girls and nonbinary people. Moss said Black women are already two to three times more likely to die during pregnancy than white women, and this policy change on EMTALA will only serve to make those statistics worse.
“We’re changing the whole scope and spirit of why we had to have EMTALA in the first place,” Moss said. “It’s leading to delays in care, and it’s putting pregnant people’s lives at risk.”
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