Trump has made it even more dangerous to be pregnant

When we served as the Administrator of the Centers for Medicare & Medicaid Services (CMS) and CMS Senior Advisor during the Biden-Harris Administration, we heard from women all over the country who were denied emergency care during their pregnancies. In one case, a woman visited three emergency departments over two days, begging for care after her water broke too early and put her at risk for a life-threatening infection. In another, a woman in pain went to the emergency room and was found to have an ectopic pregnancy — a pregnancy growing outside of her uterus, endangering her life and future fertility. Instead of treating her, the hospital sent her home, and the fertilized egg later ruptured, requiring emergency surgery to remove part of her reproductive system. And these are two stories from women who lived – others were not so lucky.

Unfortunately, the Trump Administration just made incidents like these more likely by throwing out the guidance reminding hospitals that federal law requires them to help patients, like these two women, who walk into the emergency department with an emergency medical condition.

In 1986, Congress passed the Emergency Medical Treatment and Labor Act (EMTALA) to ensure that everyone can access emergency medical care, regardless of their ability to pay. EMTALA requires hospitals accepting Medicare and providing emergency medical services to provide a medical screening exam to anyone who requests care, provide treatment to stabilize anyone with an emergency medical condition and not transfer the person to another hospital unless the original facility doesn’t have the ability to provide the stabilizing treatment.

CMS is the agency that enforces EMTALA and ensures that hospitals are complying with these requirements. After the Supreme Court overturned Roe v. Wade, hospitals and doctors from around the country reached out to CMS with questions about what the decision meant for emergency care. In June 2022, we released guidance reinforcing that if a woman walks into an emergency department with an emergency medical condition — for example, if she’s pregnant and her water breaks too soon, leaving her at high risk of a serious infection — doctors are required to give her the care she needs to stabilize her. This requirement applies even if the treatment she needs is an abortion and the state where she lives has banned the procedure.

It’s not yet clear what CMS intends to change by rescinding this guidance. We hope that it changes nothing — legally, our guidance didn’t create EMTALA’s requirements, which existed long before the Biden-Harris administration and are still in effect today. But we do know that since Roe v. Wade was overturned, hospitals and doctors in states with harsh abortion restrictions have frequently found themselves caught in a web of legal nuance, unable to care for the patient in front of them. Many of these doctors have told us that they live in fear of being prosecuted for saving their patients’ lives. Others have changed specialties, or even moved to a different state, to avoid the stress of practicing medicine under a legal microscope.

Rescinding the guidance creates enormous uncertainty. And where there’s uncertainty, providers will be far less likely to intervene — even when women’s lives hang in the balance.

This isn’t theoretical. When we served at CMS, we were faced with specific cases every day — complaints from women who went to the emergency department in distress and despair, and who were turned away and denied the care they needed to regain their health and their future fertility. And we heard from doctors across the country, desperate for clear guidance that would protect medical professionals who were simply trying to do their jobs — to provide the care their patients needed.

That’s why CMS’ choice to rescind the guidance we released in 2022 is so dangerous. Not because it changes the law; EMTALA is still in place. But absent clarity on how the law applies to emergencies, doctors won’t be able to provide the care their patients need. And once again, pregnant women and their families will pay the price.