What Does the Trump Administration’s Dismissal of EMTALA Litigation Mean for Emergency Abortion Care?

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Earlier this month, the Trump administration dismissed the legal challenge initially brought by the Biden administration against Idaho, claiming that the state’s abortion ban violates the Emergency Medical Treatment and Active Labor Act (EMTALA) because it lacks a health exception. EMTALA is the federal law that requires hospitals to provide stabilizing treatment to patients who present to their emergency rooms. This dismissal signals an imminent reversal of the guidance issued by the Biden administration, which clarified that hospitals and physicians are obligated to provide stabilizing care, including abortion, if that is the necessary treatment. The Trump administration’s dismissal of this lawsuit means there will be no federal enforcement of EMTALA when hospitals do not provide the abortion care necessary to stabilize a patient’s health.

The dismissal of the case, however, is not the last word on whether Idaho can fully enforce its abortion ban. There is pending litigation brought by St. Luke’s Health System Ltd., the largest Idaho-based not-for-profit health system. Like the Biden administration, St. Luke’s claims that EMTALA requires a health exception. Last week, the federal district court issued a temporary restraining order blocking Idaho from enforcing its ban when abortion care is necessary to preserve the health of pregnant patients at St. Luke hospitals. This order is limited to St. Luke’s hospitals and its providers; the order does not apply to other hospitals in the state.

In their defense, Idaho maintains that there is no conflict between the state and federal law since EMTALA requires physicians to do everything in their power to preserve the life of both the pregnant person AND the fetus. They cite the specific language in the law that calls out stabilizing an “unborn child” and argue that the law treats an “unborn child” or fetus as a patient and expressly requires that the fetus of a pregnant woman in labor be delivered. The provisions about pregnant women and the unborn child were added to the Act in 1989 in response to reports of hospital refusals to treat uninsured pregnant women presenting in emergency rooms while in active labor.

Six states, including Idaho, representing 9.3 million women of reproductive age, ban abortion with an exception to save the life of the pregnant person, but no exception for preserving health.  If the litigation brought by St. Luke’s is unsuccessful, women in those states will continue to be unable to access abortion care in their states when they have a pregnancy-related emergency that puts their health at risk. The absence of a federally recognized health exception to abortion bans has direct implications for a pregnant person’s ability to make decisions about how to preserve their own health and clinicians’ autonomy to manage pregnancy-related medical emergencies based on broadly accepted standards of care.