Key takeaways:
- States with abortion bans lacking health exceptions experienced significant increases in obstetric EMTALA violations.
- Legal restrictions delayed essential emergency care for pregnant patients, conflicting with federal EMTALA protections.
- Non-obstetric medical and surgical emergencies were largely unaffected by these state policies.
- Texas’s early adoption of restrictive laws contributed disproportionately to the overall rise in violations.
- Uncertainty around state abortion laws may threaten timely emergency care and patient safety in obstetric emergencies.
Researchers have identified negative impacts of restrictive abortion laws on frontline emergency care despite federal protections, publishing their findings in JAMA Health Forum.1
According to the 1986 US Emergency Medical Treatment and Labor Act (EMTALA), all Medicare-participating hospitals must screen every emergency department patient and provide treatment. However, the study results indicated a significant increase in EMTALA violations in states that ban abortion with no exceptions for patients’ health.
“For pregnant patients, stabilization may mean ending a pregnancy when it presents a serious threat to the patient’s health,” said Liana Woskie, assistant professor at Tufts University. “When state laws narrow the circumstances in which clinicians feel safe intervening, it can delay essential care, which directly conflicts with Americans’ right to timely emergency care.”
Assessing EMTALA trends
The study was conducted to determine trends in EMTALA violations following restrictive state-level abortion policies.2 EMTALA investigation records from the first quarter of 2018 through the first quarter of 2023 were assessed for investigational outcomes, infraction tag, and emergency type.
A complaint-driven process initiated by individuals was the primary method of reporting violations. Obstetric-related EMTALA violations, defined as violations with tags referencing labor or other obstetric diagnoses, were reported at the state policy level as the primary outcome.
Adoption of a total or near-total abortion ban across gestation, with no meaningful health exception, and leading to a documented allegation against preemption of federal EMTALA guidance, was defined as treatment. These criteria were met by Idaho, Kentucky, Louisiana, Mississippi, Oklahoma, and Texas.
Bans from these states were referred to as “no health exception” and were only treated if the ban was in place for at least 3 consecutive quarters during the study period. Seven states with narrow statutory language but no reported conflict with EMTALA or lacking post-ban observations were excluded, while the remaining 34 states and Washington DC were used as controls.
Post-ban increases in obstetric EMTALA violations
Prior to the intervention period, treatment states had a mean of 11.97 EMTALA violations per year, vs 16.49 in controls. This indicated a nonsignificant standardized mean difference of -0.29. Approximately 2 in 3 of the deficiencies were medical emergencies in both groups, and less than 10% were obstetric-related.
Following the adoption of abortion bans without exceptions, significant increases in obstetric EMTALA violations were observed in treated states, with an unadjusted mean excess of 0.50 violations per state-quarter. After adjustments, this rose to 1.18.
In comparison, medical and surgical violations experienced small and nonsignificant changes. This indicated that the policy effect only significantly influenced obstetric emergencies.
State-level effects and the role of Texas
An average treatment effect on the treated (ATT) of 0.69 violations per quarter was reported for Texas. When combined with the other 5 states, the ATT was 0.53 violations per quarter, indicating a significant link between the aggregate increase with Texas’s early adoption.
Rates of ED encounters were also influenced by no health exception policies. A nonsignificant mean quarterly change of 1701 Medicaid and self-pay visits, alongside -15,739 all-payer visits, were reported in Medicaid expansion states. Overall, the data highlighted a significant rise in EMTALA violations in states with no health care exception abortion laws.
“Our findings suggest that legal and institutional uncertainty may contribute to new breakdowns and delays in emergency obstetric care, threatening the foundational promise of EMTALA, which is the right to be treated in an emergency,” wrote investigators.
References
- When pregnancy emergencies collide with state abortion bans. Tufts University. December 5, 2025. December 16, 2025. https://www.eurekalert.org/news-releases/1108658
- Woskie LR, Brower N, Shaffer J, Ladin K. Obstetric-related Emergency Medical Treatment and Labor Act violations and no health exception bans. JAMA Health Forum. 2025;6(12):e254726. doi:10.1001/jamahealthforum.2025.4726
