Trump’s federal change removes protections for emergency abortion care.
This story was originally published by Cardinal & Pine.
Dr. Beverly Gray said she’s already seen what happens when pregnant patients can’t get the care they need. As an OB-GYN and associate professor at Duke University, she regularly treats high-risk patients who travel across state lines with strict abortion bans just to access emergency abortion care.
“Over these past couple of years, we’ve already seen patients who have had emergency or urgent situations have to leave their state for care, and I think that’s probably going to continue to happen,” Gray said. “I would say a couple of times a month there are patients that we see or who are referred to our center, that have these conditions where abortion care can save their lives.”
Now she and her colleagues in North Carolina are worried that a recent decision by the Trump administration could create further barriers and hesitancy in providing care, especially in states with more restrictive abortion bans—making those delays even worse.
The Trump administration has sent a clear message: We are willing to let pregnant people die rather than affirm a person’s right to receive a life-saving abortion.
Jillian Riley, Planned Parenthood South Atlantic
Earlier this month, the Trump administration canceled a 2022 directive issued under the Biden administration that said hospitals had to provide abortion care if it was needed to save a patient’s life or prevent serious harm. The rule was based on a federal law called the Emergency Medical Treatment and Labor Act, known as EMTALA, which requires emergency rooms to treat and stabilize all patients regardless of their ability to pay. The 2022 rule made it clear that this included abortion care in emergencies.
While North Carolina law allows abortions in cases where a patient’s life or health is in danger, the previous federal guidance offered clearer protections. Without it, doctors may be less sure about what’s allowed, and hesitate to act quickly in emergencies.
Gray said the Biden-era guidance reflected what physicians already considered standard medical care.
“If there’s an emergency situation and an abortion is necessary to stabilize the patient, then that care should be provided,” she said. “So whenever new guidance comes out, it can create confusion, even in states where there are protections.”
North Carolina Gov. Josh Stein also sharply criticized the move, calling it “profoundly troubling.”
“Abortion care is medical care, and hospitals and doctors need to be able to provide life-saving care if a woman’s health is at risk,” he said on social media.
The rollback also comes after state Republicans pushed new legislation that would go even further. House Bill 804, introduced earlier this year, seeks to ban nearly all abortions in North Carolina from the moment of conception, with only limited exceptions to save the life of the pregnant person. If passed, it would override the state’s current 12-week law and impose one of the strictest bans in the country.
Though the bill is stalled in committee, reproductive rights groups have warned it could resurface in future legislative sessions.
In a statement, the Centers for Medicare & Medicaid Services (CMS) said it would continue to enforce EMTALA, but confirmed that the 2022 guidance specific to abortion care was being withdrawn.
North Carolina currently bans most abortions after 12 weeks of pregnancy under Senate Bill 20, which was passed by the Republican-led Legislature and went into effect after a veto override in 2023. The law includes exceptions for rape, incest, life-threatening emergencies, and certain fetal anomalies. But doctors and legal advocates have warned that its complex requirements, including a 72-hour waiting period and in-person counseling, can still delay critical care.
Gray said patients in rural areas, where few or no abortion providers are available, are particularly vulnerable.
“North Carolina has one of the largest rural populations in the country, and people who live in rural areas may not have an abortion provider that lives in their county, so they may still have to travel for care,” she said. “But there are people that are providing that care, and fighting for patients to have even better access and to really get to a point where we can provide evidence based reproductive healthcare in our state.”
Reproductive rights advocates said Trump’s rollback sends a dangerous signal—and further compounds the uncertainty that both patients and providers already face under North Carolina’s abortion law.
“The Trump administration has sent a clear message: We are willing to let pregnant people die rather than affirm a person’s right to receive a life-saving abortion,” said Jillian Riley, North Carolina director of public affairs for Planned Parenthood South Atlantic. “In a post-Roe world, emergency care providers in states like North Carolina have been forced to grapple with severe restrictions—or entire bans—on abortion care, leading them to delay or deny time-sensitive care. Although hospitals are still required to provide emergency healthcare, the Trump administration’s actions have caused even more confusion and will inevitably endanger people’s health and lives.”
