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 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 change 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’ early adoption.
Rates of emergency department encounters were also influenced by no health–care exception policies. A nonsignificant mean quarterly change of 1701 Medicaid and self-pay visits, alongside -15,739 all-payer visits, was 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. News release. 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
