Obstetric-Related Emergency Medical Treatment and Labor Act Violations and No Health Exception Bans

The Emergency Medical Treatment and Labor Act (EMTALA) guarantees access to emergency care, including for pregnancy-related conditions. Many states have enacted abortion bans that may conflict with the federal mandate under EMTALA to screen and stabilize patients in obstetric emergencies.

To evaluate changes in obstetric-related EMTALA violations following state and federal restrictions on abortion.

This study used a staggered difference-in-differences design and Callaway-Sant'Anna estimator, leveraging a 100% sample of EMTALA filings from 2018 through quarter 1 of 2023 that was obtained via the Freedom of Information Act from the US Centers for Medicare & Medicaid Services. Filings were classified by clinical context and associated with stringency of state abortion laws. Additional models incorporated emergency department (ED) utilization data from the Healthcare Cost and Utilization Project and Medicaid expansion status to understand if violation trends were associated with shifting utilization patterns. Data were analyzed from February to July 2025.

State-level abortion bans that prohibit abortion and lack a clinically meaningful health exception for the pregnant person. Treatment was defined as adoption of a total or near-total abortion ban that (1) were effectively comprehensive across gestation, (2) provided no meaningful health exception, and (3) generated a documented allegation against preemption of federal EMTALA guidance during the study period.

The primary outcome was the count of EMTALA violations involving obstetric emergencies. Secondary analyses examined ED utilization trends and the distribution of violations by infraction type (eg, failure to provide a medical screening examination).

States that enacted abortion bans with no health exception experienced a substantial increase in the number of EMTALA violations that were obstetric related, with an additional 1.18 violations per quarter (95% CI, 0.49-1.86; P = .001). Texas, which implemented Senate bill 8 in 2021, showed an average treatment effect on the treated of 0.69 violations per quarter (95% CI, 0.46-0.91; P < .001). The 5 states that triggered no health exception bans had a smaller, imprecise increase (0.49; 95% CI, -0.13 to 1.12; P = .12). A concurrent rise in ED utilization in non-Medicaid expansion states and a growing number of obstetric violations due to failures in medical screening were also observed, suggesting delays in initial triage or assessment.

The results of this difference-in-differences analysis suggest that strict abortion bans, particularly Senate bill 8 in Texas, were followed by a measurable escalation in EMTALA violations involving obstetric emergencies. Uncertainty regarding state policies and deferral to state law may reshape frontline emergency care and compromise federally protected access in obstetric emergencies.