The Trump administration sowed confusion and fear among physicians with its move this past week to rescind Biden-era guidelines to hospitals that provide life-saving abortions.
While the move doesn’t change the law, doctors and reproductive-rights advocates fear it will have a chilling effect on health care workers in states with abortion bans, ultimately harming pregnant women.
Earlier this past week, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced they would rescind guidance issued during the Biden administration, which reinforced to hospitals that under the Emergency Medical Treatment and Labor Act (EMTALA,) abortions qualify as stabilizing care in medical emergencies.
Emergency rooms in states with abortion bans have been struggling since the 2022 overturning of Roe v. Wade to understand when they can legally provide emergency abortions.
After President Trump pulled the Biden-era guidance seeking to clarify that question, emergency room doctors will experience “more confusion” and “more fear,” according to health and legal experts who spoke with The Hill.
“Clinicians are scared to provide basic medical care, and this care is clearly in line with medical ethics … medical standards of care, and they’re being put in this situation where they can’t win,” said Payal Shah, director of research, legal and advocacy at Physicians for Human Rights.
Since the Supreme Court overturned Roe v. Wade in 2022, at least 13 states have enacted near-total abortion bans, according to data from the Guttmacher Institute.
There are exceptions in these states when continuing a pregnancy poses a threat to the health or life of the mother. However, most of the language in state laws is unclear on how that determination is made, resulting in instances of emergency rooms denying care.
Doctors in states like Idaho, Texas and Tennessee have filed lawsuits requesting that lawmakers clarify when an abortion is allowed to save the life of a pregnant person. The doctors and patients involved in the lawsuits argue that state laws do not adequately protect pregnant patients in emergencies.
Many of these states have severe punishments for doctors who violate abortion bans, like steep fines and prison time.
“For clinicians, there is actually no safe way to navigate this in this moment, and ultimately, that’s how these laws are designed,” Shah said. “They’re designed to cause chaos and confusion. They’re often written in ways that don’t use medical terminology.”
Without clear guidance, pregnant women suffer and sometimes die, as ProPublica has reported. One striking example of this is the 2023 case of Kyleigh Thurman, a Texas woman who was repeatedly denied care for a nonviable pregnancy after days of experiencing bleeding and pain.
Health care workers discovered that she had an ectopic pregnancy, which is when a fertilized egg implants and begins to grow outside of the uterus, usually in a fallopian tube. Ectopic pregnancies are never viable and are life-threatening if not treated properly.
It wasn’t until her OB/GYN “pleaded to hospital staff that she be given care,” that the hospital administered a shot ending her pregnancy, according to a complaint filed by the Center for Reproductive Rights on behalf of Thurman.
The shot came too late, and the ectopic pregnancy ruptured Thurman’s right fallopian tube, which was then removed.
“If a patient is actively hemorrhaging or experiencing an ectopic pregnancy which is also life-threatening, doctors need that clear guidance that yes, EMTALA applied,” said Autumn Katz, associate director of U.S. litigation at the Center for Reproductive Rights.
A federal investigation into Thurman’s case found that the Texas hospital violated EMTALA, according to a recent letter from the CMS.
“I finally got some justice,” Thurman said in a statement. “I hope this decision will do some good in encouraging hospitals to help women in situations like mine.”
Hospitals that violate EMTALA are subject to heavy fines and, in some extreme cases, risk losing a portion of their Medicare and Medicaid hospital funding, according to the National Institutes of Health.
Former President Biden leaned on the law to preserve access to emergency abortion across the country, leading to a legal fight with Idaho, which has a strict abortion ban. The Supreme Court last year dismissed the case, declining to rule on the merits of a politically charged case.
The rescinding of these guidelines also means hospitals that violate the law will likely not be investigated as often as they were under previous administrations, according to Shah. That lack of punitive risk means that hospitals could be incentivized to deny life-saving care for patients.
“The standard of EMTALA is pretty high,” said Katherine Hempstead, senior policy adviser at Robert Wood Johnson Foundation. “This kind of takes that layer of reassurance away, and it will make a lot of providers feel very vulnerable.”
