News | Study Finds State Abortion Bans Without Health Exceptions Are Affecting Frontline U.S. Obstetric Emergency Care
Although health care is not recognized as a “right” in the United States, the Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, requires Medicare-participating hospitals to provide emergency screening and stabilizing treatment to everyone who comes to an emergency department. A new Tufts University study, however, found that extremely restrictive state abortion laws may interfere with frontline care for pregnancy emergencies despite federal protections, causing potentially life-threatening treatment delays.
The study was led by first author Liana Woskie, an assistant professor in Tufts University's Department of Community Health. She explained that EMTALA is founded on respect for clinical judgment: emergency conditions must be stabilized according to standard medical practice, regardless of the treatment required. “For pregnant patients, stabilization sometimes means ending a pregnancy because continuing it poses a serious health threat. When state laws narrow the circumstances in which clinicians can legally intervene, emergency care may be delayed, directly conflicting with Americans' legal right to emergency treatment.”
State abortion policies varied widely before and after Roe v. Wade was overturned. Some states strictly prohibit abortion and allow intervention only to prevent the pregnant patient's death; others permit abortion under health exceptions when severe complications arise, such as major bleeding, infection or risk of fertility loss.
Analyzing federal enforcement records, the team found a significant rise in pregnancy-related EMTALA violations in states whose abortion bans lacked health exceptions. Such violations may expose hospitals and physicians to substantial fines, loss of Medicare eligibility and civil lawsuits.
Anyone may file a complaint, but Woskie said most are submitted by health professionals who witnessed hospitals fail to provide required emergency care. A smaller share come from patients or family members who say appropriate care was not provided as required by law. Federal CMS and state investigators jointly review the complaints, and cases often take weeks or months to investigate and classify.
Published in JAMA Health Forum, the study used Freedom of Information Act (FOIA) requests to obtain all EMTALA violation records from 2018 through early 2023. Using a difference-in-differences analysis, researchers compared six states without health exceptions—Idaho, Kentucky, Louisiana, Mississippi, Oklahoma and Texas—with 34 states and Washington, D.C., that had broad health exceptions.
The study found:
After strict abortion bans took effect, the six states averaged 1.18 additional pregnancy-related EMTALA violations per quarter—about five more formal violations per state each year.
Woskie emphasized: “Each violation is a confirmed case in which a hospital formally broke federal law. Although the number of cases is small, every one represents at least one pregnant patient who did not receive the emergency care legally owed to them.”
The increase was not uniform across states. Texas, the first to implement a strict abortion ban, showed the clearest upward trend. The other five states experienced more modest increases after Roe v. Wade was overturned in June 2022.
The study also found that the rise was driven mainly by inadequate emergency medical screening and broader compliance failures. This suggests problems often occurred at the start of the emergency-care process, when delays in crucial assessment and triage could allow a patient's condition to worsen.
Earlier qualitative studies showed that strict abortion laws had made some clinicians increasingly hesitant when treating pregnancy emergencies. Legal experts have also long warned of a fundamental conflict between these state laws and EMTALA. Woskie said the new empirical data show for the first time how that conflict appears in actual emergency care.
She warned: “The moment a doctor hesitates, diagnosis can be delayed. When diagnosis is delayed, the condition can worsen. That is precisely what EMTALA was designed to prevent.”
News | Study Finds State Abortion Bans Without Health Exceptions Are Affecting Frontline U.S. Obstetric Emergency Care
News | Study Finds State Abortion Bans Without Health Exceptions Are Affecting Frontline U.S. Obstetric Emergency Care
Although health care is not recognized as a “right” in the United States, the Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, requires Medicare-participating hospitals to provide emergency screening and stabilizing treatment to everyone who comes to an emergency department. A new Tufts University study, however, found that extremely restrictive state abortion laws may interfere with frontline care for pregnancy emergencies despite federal protections, causing potentially life-threatening treatment delays.
The study was led by first author Liana Woskie, an assistant professor in Tufts University's Department of Community Health. She explained that EMTALA is founded on respect for clinical judgment: emergency conditions must be stabilized according to standard medical practice, regardless of the treatment required. “For pregnant patients, stabilization sometimes means ending a pregnancy because continuing it poses a serious health threat. When state laws narrow the circumstances in which clinicians can legally intervene, emergency care may be delayed, directly conflicting with Americans' legal right to emergency treatment.”
State abortion policies varied widely before and after Roe v. Wade was overturned. Some states strictly prohibit abortion and allow intervention only to prevent the pregnant patient's death; others permit abortion under health exceptions when severe complications arise, such as major bleeding, infection or risk of fertility loss.
Analyzing federal enforcement records, the team found a significant rise in pregnancy-related EMTALA violations in states whose abortion bans lacked health exceptions. Such violations may expose hospitals and physicians to substantial fines, loss of Medicare eligibility and civil lawsuits.
Anyone may file a complaint, but Woskie said most are submitted by health professionals who witnessed hospitals fail to provide required emergency care. A smaller share come from patients or family members who say appropriate care was not provided as required by law. Federal CMS and state investigators jointly review the complaints, and cases often take weeks or months to investigate and classify.
Published in JAMA Health Forum, the study used Freedom of Information Act (FOIA) requests to obtain all EMTALA violation records from 2018 through early 2023. Using a difference-in-differences analysis, researchers compared six states without health exceptions—Idaho, Kentucky, Louisiana, Mississippi, Oklahoma and Texas—with 34 states and Washington, D.C., that had broad health exceptions.
The study found:
After strict abortion bans took effect, the six states averaged 1.18 additional pregnancy-related EMTALA violations per quarter—about five more formal violations per state each year.
Woskie emphasized: “Each violation is a confirmed case in which a hospital formally broke federal law. Although the number of cases is small, every one represents at least one pregnant patient who did not receive the emergency care legally owed to them.”
The increase was not uniform across states. Texas, the first to implement a strict abortion ban, showed the clearest upward trend. The other five states experienced more modest increases after Roe v. Wade was overturned in June 2022.
The study also found that the rise was driven mainly by inadequate emergency medical screening and broader compliance failures. This suggests problems often occurred at the start of the emergency-care process, when delays in crucial assessment and triage could allow a patient's condition to worsen.
Earlier qualitative studies showed that strict abortion laws had made some clinicians increasingly hesitant when treating pregnancy emergencies. Legal experts have also long warned of a fundamental conflict between these state laws and EMTALA. Woskie said the new empirical data show for the first time how that conflict appears in actual emergency care.
She warned: “The moment a doctor hesitates, diagnosis can be delayed. When diagnosis is delayed, the condition can worsen. That is precisely what EMTALA was designed to prevent.”
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