A Betrayal in Crisis
On June 3, 2025, the Centers for Medicare and Medicaid Services turned its back on women facing medical emergencies. By withdrawing guidance that required hospitals to provide emergency abortion care under the Emergency Medical Treatment and Labor Act, CMS left countless patients at risk. This decision endangers lives, forcing doctors to hesitate when every second counts and exposing women in states with harsh abortion bans to delays or outright denials of care.
Picture a woman in Idaho, rushed to the hospital with a ruptured ectopic pregnancy. Her doctor knows the standard treatment—an abortion to stop the bleeding—but state law threatens years in prison unless her life is clearly at stake. The hospital, wary of legal trouble, delays or transfers her across state lines. This scenario, now more likely, reflects a system where politics overrides medicine. Why should a woman’s survival hinge on her state’s laws?
Governor Gavin Newsom didn’t mince words: this move will lead to deaths in emergency rooms. He’s correct. In California, physicians can act swiftly to save lives without fear of prosecution. Yet in states like Arkansas or Mississippi, where health exceptions are absent, women face a deadly lottery. Their care depends on hospitals navigating vague laws under pressure. This isn’t fairness—it’s abandonment.
The Real Cost of Uncertainty
The fallout from the 2022 Dobbs decision already paints a grim picture. In Texas, a woman was sent home bleeding from an ectopic pregnancy, misdiagnosed as non-emergent. In Oklahoma, another endured hours of travel in premature labor after care was refused. These cases aren’t rare. Each year, 3.8 million pregnant patients visit emergency departments, with 6.4% of abortion patients needing follow-up care soon after. Delays in treatment can cause organ damage, infertility, or death.
CMS’s decision deepens this crisis. With 96% of U.S. hospitals relying on Medicare funding, the lack of federal clarity creates a legal quagmire. Emergency physicians describe an unbearable dilemma: provide lifesaving care and risk jail, or follow state bans and watch patients suffer. In states like South Dakota, where only life-threatening conditions qualify for abortion, doctors must wait until a patient’s health collapses. This approach defies medical ethics and endangers lives.
Groups like the ACLU and Doctors for America argue that EMTALA, enacted in 1986, guarantees stabilizing care for all emergency patients. Removing guidance on abortion as a necessary treatment undermines this promise. Hospitals, fearing penalties, may prioritize compliance over care, leaving women to bear the consequences. How can we accept a system that puts bureaucracy above survival?
The Weak Case for State Power
Some defend this rollback, arguing that states should control emergency care definitions. They claim EMTALA lacks a clear mandate for abortion and that federal guidance oversteps state authority. Pointing to the Supreme Court’s dismissal of Idaho’s challenge and the Fifth Circuit’s rejection of Biden-era rules, these voices assert that Congress intended to preserve state control over medical laws, including abortion bans.
This reasoning doesn’t hold up. EMTALA requires hospitals to provide whatever treatment stabilizes an emergency, whether surgery, medication, or abortion. For conditions like severe hemorrhage or ectopic pregnancies, abortion is often the only option to prevent catastrophic harm. Ignoring this reality dismisses nearly four decades of EMTALA enforcement, which has consistently prioritized patient safety over state politics. Allowing states to narrow emergency care definitions creates deadly inconsistencies.
The idea that EMTALA’s mention of the ‘unborn child’ supports state bans also misinterprets the law. EMTALA aims to protect both the patient and fetus when feasible, but never at the expense of the patient’s life or health. Insisting on state sovereignty risks lives for the sake of legal theory. Shouldn’t a woman’s survival outweigh debates over jurisdiction?
California’s Fight and a Call to Action
Amid this chaos, California shines as a model of resolve. Governor Newsom and state lawmakers have strengthened protections, ensuring doctors can prioritize patients without legal threats. Through the 23-Governor Reproductive Freedom Alliance, California champions access nationwide, offering sanctuary for those escaping restrictive states. This leadership shows what happens when care takes precedence over ideology.
Reversing this crisis requires bold federal steps. The National Women’s Law Center, medical associations, and others demand that CMS restore guidance affirming EMTALA’s authority over state bans. Congress must also enshrine emergency abortion protections in law, guaranteeing consistent care nationwide. Without action, hospitals will continue to falter, and women will pay with their health or lives.
This fight is about more than policy—it’s about dignity and survival. Every woman deserves an emergency room that acts to save her, no matter where she lives. CMS’s retreat pushes us further from that goal, but we can demand better. Will we stand up for those left vulnerable, or let fear and division dictate our future?