The federal guidance that the Trump administration says is intended to provide clarity is that instead it further confuses healthcare providers whether they can provide abortions in emergencies, particularly in states with strict abortion laws.
This month, the Trump administration rescinded federal guidance for 2022 that specified that under the Emergency Medical Care and Labor Act (EMTALA) that even states with laws that restrict such procedures should be able to obtain an abortion if a medical emergency becomes necessary. The HHS and the Centers for Medicare and Medicaid Services said they would continue to enforce federal laws, specifying that the policy includes emergency medical conditions that put the health of pregnant women or fetal women at serious risk.
Later in a letter to healthcare providers last week, US Health and Human Services Director Robert F. Kennedy Jr. under EMTALA, stressed that stabilizing care should be provided to people pregnant and suffering from medical emergencies, but did not specify what that care will include.
In a letter on June 13th, Kennedy says it is a 2022 memo, “caused confusion, but that’s not much better.”
Some doctors ask for something different.
Some doctors say that the reconstruction of previous guidance is unclear exactly what was intended for emergency care, especially in states where abortion laws are highly restricted. The latest letter does not mention abortion at all. The lack of details creates more uncertainty.
“I think this is just trying to help clinicians deal with all the disruptions they have to deal with, just trying to care for the patient before a patient, and try to navigate state law and federal guidance to provide patient care,” U.S. practitioners. “That’s not something you want to make a mistake, because the outcome is very serious and you find it very scary.”
Verma is grateful that even after the administration retracted the 2022 guidance, a new letter from Kennedy makes it clear that Emtala is still a land law. But without specific mention of abortion, she said the national law patchwork makes it difficult for doctors to navigate emergencies. Some of these state laws can even send doctors to prison if an emergency makes the wrong decision about when abortion is required.
“It was not helpful to specify that abortions were covered by EMTALA,” Verma said. “I think it would be helpful to have that language, especially in this really scary, cold environment.”
Alison Haddock, an emergency room doctor and president of Dr. American College of Emergynice, said he was pleased that Kennedy’s letter confirmed that pregnant patients need to receive care and includes examples of common problems such as miscarriage, ectopic pregnancy, and early rupture of the membrane.
“These are some of the situations that are truly challenging for our doctors. It’s good to see that they represent the obstetric emergency that EMTALA applies to,” Haddock said.
But she added that the Trump administration’s leadership won’t wipe out everything.
“I think doctors are still struggling with the conflicting state laws that remain in a grey area of uncertainty about how to stick to Emtala and comply with state law.
Traveling to the emergency room is common among pregnant people, studies show. The majority of emergency health providers say that pregnant patients treat pregnant patients and, in some circumstances, treatments that protect the health and life of pregnant people may require abortion, according to the American university of obstetricians and gynecologists.
Haddock said pregnancy emergency doesn’t always occur during standard working hours. “The ability to convene the ethics committee at 2am is very limited and could be a lot of layers of passing in the hospital.”
Haddock said her association had written to members and encouraged them to advocate for clearer guidance from their hospitals.
“To make this even more clear is really important to ensure that doctors feel they have the protection they need to provide life-saving care,” she added.
When it comes to Emtala, details are important. When it became federal law in 1986, some hospitals refused to care for uninsured working women, so in 1989, pregnant people who had contractions had to seek emergency medical care even if they were unable to pay for it.
In 2021, guidance from the Biden administration added more detail, saying it is the physician’s duty to provide stabilizing treatments that “preempt any direct state law or mandate that could ban or prevent such treatment.”
However, it did not describe the 2022 guidance that abortions had to be provided when necessary.
The Biden administration’s guidance was intended to eliminate confusion in states with anti-abortion laws that do not include exceptions regarding the lives and health of pregnant people., He said federal law preceded state law in such cases.
The memo was Roev by the US Supreme Court. It was published a few weeks after overturning Wade. The 1973 ruling granted pregnant people the constitutional right to abortion.
The previous court case last year made clear whether federal law requires medical services to provide access to emergency care in all states, regardless of abortion law, but the High Court sent it back to the lower court. In March, the Trump administration dropped the lawsuit. Some legal experts interpreted it as a signal that the administration would not enforce EMTALA.
Even with the 2022 guidance in place, provider investigations in the states where criminal abortions were found to be running in “confusion and confusion,” said Payal Shah, head of research, law and advocacy for human rights for medical and human rights organizations who received the Nobel Peace Prize. Providers had a hard time deciding whether Emtala would actually protect them if they had to do an abortion, even in an emergency.
“Criminalization causes fear and clinicians feel paralyzed,” Shah said. “They don’t feel they have the authority to make decisions about medical judgment and medical ethics, reproductive health care in line with the preferences of pregnant patients. Instead, it becomes a legal decision.”
After the DOBBS decision removed federal rights to abortion in 2022, some women died after doctors said it was a “criminal” to intervene in a miscarriage or that they had no access to timely medical care. Idaho’s strict abortion law has led some doctors to tell pregnant patients that local hospitals should consider purchasing “lifeflight insurance” in case they don’t take care of pregnancy complications.
Rescising the 2022 guidance would probably make such a story more common, several experts said.
“Retracting this guidance serves no purpose other than to intensify or deepen that confusion,” Shah said. “This is an attempt to gas-lit Americans and say that the criminalization of abortion is working. Criminalization is not working. That’s what the evidence really shows.”
Alexa Kolbi-Molinas, assistant director of ACLU’s Reproductive Freedom Project, interprets the new HHS letter to mean that it requires emergency abortion care, but she He added that the administration’s actions on the issue were “reckless at best, and at worst, completely dangerous.”
“The Trump administration is in a hurry to completely disrupt its own work,” Corbi Molinas said in an email. “The law was clear for 40 years. Pregnant patients who go to hospitals during a medical crisis must receive health and life-saving care regardless of state law. If the administration did not revoke previous guidance earlier this month to reaffirm the hospital’s obligation to provide this care, they would not have to issue a letter on Friday.”
HHS did not respond directly to what “stabilizing care” means and whether its EMTALA interpretation included abortion as stabilizing care. Instead, the agency spokesman sent a link to the June 4th message from Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services.
“Don’t believe in the spin and fear of fake news,” the post said. “The Biden administration has caused confusion, but Emtala is clear and the law has not changed. Women will be cared for miscarriage, ectopic pregnancy and medical emergency in all 50 states. This remains the same in the Trump administration.”
Doctors and patients’ burdens
“For me, this question remains. If they truly believe that abortion is part of the emergency care of pregnant people, why don’t they use the term “abortion”? “We are pleased to announce that we are committed to providing a range of services and services to delivering the most innovative and important aspects of our services,” said Rebecca Hart Holder, president of Reproductive Equity Now.
“If the Trump administration or Secretary Kennedy really intended to reassure healthcare providers that abortions are protected under Emtala in the event of a medical emergency, they would have explicitly used those terms as eligible examples of emergency care,” Hart Holder added. “I think it’s a fair assumption to have more people die when they’re in an emergency.”
In the wake of DOBBS, Kennedy’s letter presents another potential issue, said reproductive law expert Loronda Donelson.
“In the letter, he states that Emtala needs to care for pregnant women and their fetus. That may have been less meaningful, but with the increasing fetal personality of the national abortion ban, it raises questions about whether these emergency department providers are fulfilling their duties to the fetus. Huber Reproductive Health Equity Legal Fellow Partnership for Women and Family.
“This guidance does not provide clarification. It will increase the confusion among patients, providers and everyone regarding whether they can enter the emergency department if they are undergoing abortion as a necessary stabilizing care.”
In March, concerns about even more clarity, 88 lawmakers reintroduced a resolution confirming that EMTALA would protect access to emergency abortion care. But even if such a bill would go through Congress, it is unclear whether Trump will sign it.
Legal experts say that in the absence of additional laws, confusion continues to place an unfair burden on doctors and patients.
“It’s unrealistic that there are doctors who should save their lives, test all the important things about them and become lawyers and policy advocates at The Nitty’s The The The The The The The The Of The Tears at The Nitty should do,” Donelson said.
However, it is important for patients to know that if they are experiencing a medical emergency, they should go to the emergency room.
“The last thing I want is a kindergartener who has no access to care in the hospital, can’t go, and then has a medical emergency to think something bad will happen.”
