High Court’s Ruling in EMTALA Cases Could Extend Beyond Emergency Abortions

National Health Law and Policy Expert at the George Washington University Available for Comment

January 11, 2024

Outside of emergency department

WASHINGTON (Jan. 11, 2024) — Last week the Supreme Court announced it would hear oral arguments in two related cases from Idaho that focus on the Emergency Medical Treatment and Labor Act (EMTALA) and its relationship to state abortion bans. 

Since 1986, EMTALA has required nearly all Medicare hospitals with emergency departments to screen and stabilize patients who come to the emergency department seeking help with a medical emergency.  The immediate issue raised by the cases is whether EMTALA protects pregnant women experiencing health-endangering emergencies against state abortion bans that limit emergency care to life-or-death situations. According to a new analysis, the deeper issue raised by the Idaho cases goes far beyond abortion:  The outcome in these cases will decide whether states can deprive people of their federal right to emergency care by outlawing disfavored emergency treatments.  

The Supreme Court will hear oral arguments on the case in April, and a decision is expected by the end of its term.

This broader problem, along with the specific abortion question that the Court will consider, is discussed in an analysis by Sara Rosenbaum, professor emerita of health law and policy at the George Washington University Milken Institute School of Public Health. The analysis was published Jan. 9 in Health Affairs.  

The High Court’s decision could leave pregnant patients facing major health threats without stabilization care in states that ban all abortions, other than threats that endanger life itself. Crises in pregnancy that threaten severe and long-lasting health consequences can involve uncontrollable uterine bleeding, infection and preeclampsia (dangerously high blood pressure), Rosenbaum says.

But the stakes in the two cases go well beyond abortion, Rosenbaum says. If the Court permits states to carve health-threatening pregnancy emergencies out of EMTALA, then there is nothing to stop states from carving out other disfavored patients or treatments from all but life-and-death emergency care, such as people experiencing AIDS-related emergencies, people with severe mental illness, or people experiencing emergencies related to gender affirming care. “The list of possibilities is endless.” notes Rosenbaum, “It is as broad as EMTALA’s emergency care protection, which Americans have relied on for decades, as our most basic health care guarantee.” 

She goes on to say, “A state could make all types of hospital emergency care unlawful in health endangering situations, arguing that emergency care for all health endangering situations is simply too costly and diverts state resources from other priorities.” 

“Emergency abortions needed to preserve health face an immediate and existential threat in these cases, but, truly, emergency care writ large is on the line for all of us,” Rosenbaum warns in her conclusion.

The analysis, “EMTALA Pregnancy Protections Versus State Abortion Bans: The Supreme Court Will Decide,” was published in the Health Affairs Forefront section.