By pulling out of the EMTALA lawsuit, the Trump administration has paved the way for Idaho to deny emergency abortion care, forcing patients and doctors into devastating, life-threatening dilemmas.
The Trump administration’s March 5 decision to drop the Biden-era lawsuit defending emergency abortion access in Idaho under the Emergency Medical Treatment and Labor Act (EMTALA) is another powerful indication of its intent to dismantle existing federal protections for sexual and reproductive health. (Other examples include the recission of Biden’s post-Dobbs executive orders to protect and secure access to reproductive healthcare, limiting enforcement of the Freedom of Access to Clinic Entrances Act to “extraordinary circumstances,” and the elimination of abortion travel reimbursements for service members and their families who are stationed in states with bans.)
Rebecca Gibron, CEO of Planned Parenthood Great Northwest, Hawai’i Alaska, Indiana and Kentucky (PPGNHAIK) responded in a press release to the Trump administration’s decision to drop the case, calling it “a cruel and callous act that could cost pregnant Idahoans their lives. … We’ve already witnessed how these extreme bans endanger patients, drive away providers, and tear down our communities. These are not games—lives are on the line. To everyone in Idaho who feels abandoned and vulnerable, know that we remain with you now and in the future. Our resolve is strong, and our fight for access to reproductive health care is far from over.
Likewise responding with anger, Idaho state Sen. Melissa Wintrow (D) told TIME: “The Trump administration has abandoned pregnant women in medical crises by abandoning [this case] … which was only holding onto the sliver of protection in a crisis, and they can’t even allow that. Think about that: They can’t even allow a pregnant woman to go to the emergency room, and if her life and health are in jeopardy, to get medical treatment that could save it or preserve her health. That speaks volumes.”
The decision to drop the EMTALA lawsuit fits squarely with Project 2025’s radical antiabortion agenda. As an integral component of Project 2025’s goal of assembling “an army of aligned, vetted, trained, and prepared conservatives to go to work on Day One to deconstruct the administrative state,” it calls for the reversal of the ostensibly “distorted pro-abortion interpretation” of EMTALA. It claims the law “requires no abortion, pre-empts no pro-life state laws, and explicitly requires stabilization of the unborn child.”
Although Trump denied support for Project 2025 during his presidential campaign, this alignment with its antiabortion agenda is no surprise—as TIME reported, almost two-thirds of the executive actions he issued in his first weeks in office “mirror or partially mirror proposals” in this right-wing blueprint for leadership.
So what exactly is EMTALA and what does it have to do with abortion?
In 1986, Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) to “ensure patient access to emergency medical care” by “prevent[ing] the practice of patient dumping, in which uninsured patients were transferred, solely for financial reasons, from private to public hospitals without consideration of their medical condition or stability for the transfer.”
At its core, EMTALA requires hospitals receiving federal Medicare funding to screen and provide stabilizing care to patients presenting with an “emergency medical condition.”
Concerned in the wake of the Dobbs decision that restrictive states might attempt to wiggle out of their obligation to provide stabilizing abortion care as required by EMTALA, the Biden administration issued a memo making clear that, as a federal statute, EMTALA was still the law of the land.
“If a physician believes that a pregnant patient presenting at an emergency department is experiencing an emergency medical condition as defined by EMTALA and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment,” the memo stated (emphasis in original).
In a stern warning to abortion ban states, the memo stressed, “When a state law prohibits abortion and does not include an exception for the life of the pregnant person—or draws the exception more narrowly than EMTALA’s emergency medical condition definition—that state law is preempted” (emphasis in original). The preemption doctrine stems from the U.S. Constitution’s supremacy clause, which declares federal law “the supreme law of the land.”
In August of 2022, the Biden administration filed a lawsuit against the state of Idaho whose near-total ban on abortion was slated to take effect later that month.
The administration argued that once the law took effect, “Physicians will be faced with an untenable choice—either to withhold critical stabilizing treatment required under EMTALA or to risk criminal prosecution and potential loss of their professional licenses. … Patients will suffer … particularly … when dealing with considerations of risk to an individual’s life or health, delayed health care can pose serious harms and is exactly what EMTALA’s requirements are designed to prevent.”
Idaho would eventually go on to argue before the Supreme Court that “nothing in EMTALA requires doctors to ignore the scope of their license and offer medical treatments that violate state law” thus effectively “turn[ing] emergency rooms into federal abortion enclaves.”
Ultimately, after nearly two years of litigation, the Supreme Court declined to rule on the case’s merits and instead kicked it back to the lower courts. Vigorously objecting to this move, Justice Ketanji Brown Jackson chided the Court for “shirk[ing] its duty to resolve a pressing legal issue.” As she wrote, there is a “clear conflict” between EMTALA, which mandates the provision of stabilizing abortion care that is “reasonably necessary to keep a patient from losing her uterus, going into organ failure, or avoiding any number of other serious health risks,” and Idaho’s criminal abortion law that prohibits abortion unless “’necessary to prevent the [patient’s] death.’”
Critically, the Trump administration’s decision to dismiss the case means that the preliminary injunction issued by the federal district court—blocking Idaho from enforcing its abortion ban where it conflicted with EMTALA—is no longer in effect. In due course, this would enable Idaho to deny abortions to patients facing medical emergencies unless the procedure was necessary to prevent their death.
Anticipating this move, St. Luke’s Health System filed filed a new lawsuit against Idaho during the first month of Trump’s presidency. On March 3, upon learning that dismissal was imminent, St. Luke’s sought and was granted a temporary restraining order to preserve the status quo—meaning Idaho remains barred from enforcing its criminal abortion law to the extent it conflicts with EMTALA.
Similar to the Biden administration, St. Luke’s argues in its complaint that “Idaho law makes it a criminal offense for medical providers to comply with EMTALA’s requirement to provide stabilizing treatment, even where a doctor determines that termination is the medical treatment necessary to prevent a patient from suffering severe health consequences, if the consequences are short of death.”
According to the complaint, these severe health consequences can include “loss of reproductive organs or fertility, sepsis, kidney failure, liver damage, stroke, brain damage, increased risk of future cardiovascular disease and heart failure, and severe pain.”
Zeroing in on the “two periods of time, that the injunction was stayed,” during the pendency of the Biden administration’s case, St. Lukes also provides a “first hand” accounting of the “untenable choice” faced by physicians, which illuminates the “cruel and callous” decision of the Trump administration to dismiss the case:
“The St. Luke’s medical providers treating these patients when the law was in full effect faced a terrible choice: they could either wait until the risks to the patient’s health became life threatening, or they could transfer the patient out of state. The first option was medically unsound and dangerous because the conditions that patients experienced could cause serious health complications if untreated, including systemic bleeding, liver hemorrhage and failure, kidney failure, stroke, seizure, and pulmonary edema. Moreover, watching a patient suffer and deteriorate until death is imminent is intolerable to most medical professionals…
“Of course, airlifting patients also puts patients at risk due to significant delays in care while arranging medical transport. And those delays could create a situation where the patient is no longer stable enough that the benefits of transfer outweigh the risks, again leaving St. Luke’s medical providers to wait until termination is necessary to prevent the patient’s death—even while knowing that the wait could have severe health consequences, including damage to the patient’s future reproductive health.”
At least for the moment, pregnant Idahoans with emergency medical conditions that pose serious threats to their health are not faced with the dilemma of whether to be airlifted out of the state to receive stabilizing abortion care or wait until an abortion becomes necessary to prevent their death. However, the case is far from over, and the eventual outcome is uncertain—especially if it winds up again before the Supreme Court’s conservative supermajority.
