Abortion Policy Politics & Gov Public Health Federal law on emergency abortion care under scrutiny, could have ripple effects in Ohio
Administration guidance around a lesser-known 1980s-era federal law regarding emergency abortion care has been rescinded by President Donald Trump’s administration, and could impact emergency room patients in Ohio.
The Emergency Medical Treatment and Labor Act (EMTALA) was enacted in 1986, with the aim to give peace of mind to patients entering emergency departments by making it law that patients must be treated and stabilized, or transferred to a hospital that can, regardless of income or insurance level. Hospitals risk Medicare and Medicaid funding if they don’t follow the law.
Ohio hospitals
The assurances held in the act include abortion services and care in the event of an emergency, which is why, when Roe v. Wade was overturned by the U.S. Supreme Court in 2022, guidance was released by the U.S. Health and Human Services leader on how to continue under the federal law.
The letter from former Secretary Xavier Becerra emphasized the protections in the act around “clinical judgment” and the the legal duty for physicians or other providers to “provide stabilizing medical treatment” to an emergency room patient above any “directly conflicting” state law.
“Thus, if a physician believes that a pregnant patient presenting at an emergency department, including certain labor and delivery departments, is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment,” Becerra wrote.
Earlier this month, however, the Trump administration rescinded the guidance, along with Becerra’s letter explaining it, saying the documents “do not reflect the policy of this administration.”
A statement from the Centers for Medicare & Medicaid Services said the federal law would still be enforced, despite the removal of guidance.
But Jessie Hill, professor and director of the Reproductive Rights Law Initiative at Case Western Reserve University, said the action by the Trump administration will have impacts in states were abortion isn’t legal or is more restricted, and it “creates confusion for physicians who want to provide abortions in emergency situations because it’s not longer clear whether EMTALA permits that.”
“That said, even in states like Ohio where abortion is protected, it could have some effect,” Hill said. “In particular some hospitals – especially Catholic hospitals – will decline to provide emergency abortions except in the most extreme circumstances. This would be forbidden by the prior administration’s interpretation of EMTALA, but may be permitted by the current one.”
Local hospitals contacted by the Capital Journal said they are adhering to laws and providing care accordingly. Ohio also has a constitutional amendment that includes abortion care as one of the rights held in the state’s founding document.
“In terms of EMTALA, our legal landscape has been stable in Ohio,” a spokesperson for University Hospitals said. “Our approach at University Hospitals has not changed, and we provide appropriate clinical care.”
OhioHealth representatives said the system “will continue to offer care to our patients within the confines of any new regulatory landscape and always within the best practice standards of care.”
“If termination is medically necessary, OhioHealth health care professionals will take all measures to ensure the safety of the mother’s life, baby’s life or both,” a statement read.
The Ohio State University Wexner Medical Center said it follows both state and federal laws, noting state law that restricts “abortions done in state institutions to those that are necessary for life-threatening maternal health conditions and pregnancies that are a result of rape or incest, which have been reported to police,” according to spokesperson Marti Leitch.
A request for comment from Mount Carmel Health System was not returned as of Thursday.
‘Real-life effect’
The federal law further entered the national conversation via an Idaho court case that ended up rising to the U.S. Supreme Court last year.
The nation’s highest court, however, didn’t rule on the merits of the federal law, instead sending the case back to a lower court for further litigation. Because of that, a lower court ruling was allowed to continue, temporarily allowing abortions in emergency situations.
But it was the story of Ohioan Brittany Watts’ treatment that spurred U.S. House Rep. Emilia Sykes, D-Ohio, to fight to reinforce the rights under EMTALA.
“What was important for me was to highlight the real-life effect of what happens when there is confusion and uncertainty around the law,” Sykes told the Capital Journal, “that this does not become commonplace where women are seeking health care thinking they can’t receive it.”
Watts was criminally charged after suffering a miscarriage at home, accused of abuse of a corpse. Watts had gone to St. Joseph Warren Hospital and was diagnosed with a condition that “endangered her pregnancy.” But after waiting for hours, she left and came back the next day. She waited several more hours, then returned home, where the miscarriage occurred, according to her attorneys.
A grand jury declined to return an indictment, and Watts has since sued the city of Warren, law enforcement officers and the hospital, claiming constitutional violations and violations of EMTALA.
The resolution introduced by Sykes and New Jersey Rep. Mikie Sherrill looks to “reaffirm” that the emergency medical law protects access to emergency abortion care in every state.
Sykes acknowledged the uphill battle her resolution faces toward passage with Republican majority in the U.S. House and “a pretty dysfunctional Congress that does not particularly lend itself to the health care of women and the health care of people.”
In the language of the resolution, the sponsors say bans and restrictions on reproductive health care “put the health and lives of pregnant people at risk.”
They say state laws with bans or restrictions in emergency circumstances that “force medical providers to decide between withholding necessary, stabilizing medical care from a patient experiencing a medical emergency or face criminal prosecution” also risk the health of pregnant individuals.
Sykes said the importance of upholding the federal law is even more important now, with a budget reconciliation bill that could reduce Medicaid funding and Affordable Care Act subsidies, causing the loss of health insurance for “millions of people” and forcing hospitals to have to deal with uncompensated care, according to Sykes.
“If this program is cut in the way Republicans want … I am concerned about the ripple effects of what happens to all of the people in this country and their ability to pay … when they show up in the emergency department,” Sykes said.
Right now, the discussion is about emergency abortion care, but in the future, it could be car accidents or heart attacks, Sykes argued.
The concern about access and confusion on available care is shared by reproductive health advocates and researchers who say EMTALA not only helps patients, but also the physicians who are just trying to do their jobs.
“In places where we are seeing contestations and the creation of exceptions for EMTALA, that’s going to be a distraction for clinicians if they have to stop and check if the legal status is at odds with the standards that are laid out in the care,” said Danielle Bessett, a professor at the University of Cincinnati and co-principal investigator at the Ohio Policy Evaluation Network, which focuses on abortion and contraception policies.
While abortion-related visits are generally uncommon, with research showing post-abortion ER visits are typically “for reassurance,” Bessett said the information individuals receive should be dependably accurate and complete.
Confusion of any kind when it comes to health care, particularly when it comes to emergency situations will be “to the detriment of our societal health,” and that includes confusion among lawmakers making policies with direct impact in the sector, according to Bessett.
“It really goes back to the post-Dobbs restrictions that we’ve seen,” she said, referring to legislation in states after the U.S. Supreme Court decision that overturned Roe v. Wade. “They have an impact that goes beyond what lawmakers expected, because abortion is part of routine health care.”
By: Susan Tebben
Source: Ohio Capital Journal