Why It Matters
A recent CRS report examines a fundamental tension in federal health law that Congress and the Trump administration must navigate. The Emergency Medical Treatment and Active Labor Act (EMTALA), enacted in 1986 to prevent hospitals from refusing care to poor or uninsured patients, sits at the center of a conflict between federal emergency-care requirements and state abortion restrictions
The stakes are high for hospitals, physicians, and patients: conflicting federal guidance and court rulings have left unresolved questions about legal obligations when abortion is necessary to stabilize a pregnancy-related emergency. For Congress, the report identifies an area in which lawmakers could clarify EMTALA’s interaction with state abortion laws
The Big Picture
EMTALA requires Medicare-participating hospitals with emergency departments to screen patients seeking examination or treatment to determine whether an emergency medical condition exists. If one is found, hospitals generally must stabilize the patient using available staff and facilities or appropriately transfer the patient to another facility. The law restricts transfers of unstable patients unless certain conditions are met, including circumstances in which the patient makes a written request after being informed of the risks. The statute defines an emergency medical condition as involving acute symptoms such that the absence of immediate medical attention could reasonably be expected to jeopardize an individual’s health or result in serious impairment to bodily functions or dysfunction of bodily organs or parts. For pregnant women, this includes conditions that endanger the health of the woman or her “unborn child.”
The conflict emerged after the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization held that the U.S. Constitution does not confer a right to abortion. Two weeks after that decision, the Centers for Medicare and Medicaid Services (CMS) issued guidance asserting that EMTALA compelled physicians to provide abortions when necessary to stabilize an emergency medical condition and that EMTALA preempted conflicting state laws. The 5th U.S. Circuit Court of Appeals rejected that interpretation in Texas v. Becerra, affirming an injunction against enforcement of the guidance in Texas and against the plaintiffs.
In Moyle v. United States, the Supreme Court dismissed its review as improvidently granted without deciding the merits. In accompanying opinions, Justices Elena Kagan, Sonia Sotomayor, and Ketanji Brown Jackson maintained that EMTALA requires emergency abortions when necessary as stabilizing care and preempts Idaho law to the extent it prohibits that treatment. Justices Samuel Alito, Clarence Thomas, and Neil Gorsuch took the opposite view. Justice Amy Coney Barrett, Justice Brett Kavanaugh, and Chief Justice John Roberts suggested the preemption question could depend on unresolved issues, including whether statutes enacted under Congress’ Spending Clause authority that regulate private parties can preempt state law. After the Supreme Court remanded the case to the 9th U.S. Circuit Court of Appeals, the federal government and Idaho agreed to dismiss it in March 2025. Litigation over the issue continues separately in St. Luke’s Health System, Ltd. v. Labrador.
The current administration rescinded the Biden-era HHS guidance in early June 2025. CMS formally rescinded the guidance effective May 29 and announced the change publicly in early June. EMTALA enforcement remains largely complaint-driven, with CMS carrying out investigations after receiving information about potential violations. Civil monetary penalties can reach $136,886 per violation. In July, CMS issued a proposed rule that would authorize hospital-accrediting organizations to assess compliance with certain administrative requirements of EMTALA as part of routine accreditation surveys.
The Bottom Line
Congress could legislate to clarify whether and under what circumstances EMTALA preempts state abortion restrictions in emergencies. It could also enact legislation specifying that EMTALA does not preempt such state restrictions. CRS notes that legislation defining EMTALA’s preemptive reach and hospitals’ obligations could affect ongoing or future litigation
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