Emergency Medical Treatment and Labor Act EMTALA

Congress passed the Emergency Medical Treatment and Active Labor Act in 1986, as part of a budget law signed April 7, 1986, after reports of hospitals turning away or transferring uninsured patients, a practice called patient dumping. Any hospital with an emergency department that participates in Medicare, nearly all of them, must give a medical screening exam to anyone who comes in, and if there is an emergency condition, must stabilize the patient or arrange an appropriate transfer, regardless of insurance or ability to pay.

The Centers for Medicare and Medicaid Services enforces the law, and hospitals and doctors that violate it can be fined or lose Medicare funding, while patients can sue. Because hospitals cannot refuse emergency care, emergency rooms became a last-resort source of care for the uninsured, and the costs of unpaid care are spread across other patients and government programs.

After Dobbs, the Biden administration said EMTALA requires hospitals to provide abortions when needed to stabilize a pregnant patient's emergency condition, even in states with bans. Idaho and Texas disputed that, and in Moyle v. United States in 2024 the Supreme Court dismissed Idaho's case without deciding the question. In June 2025 the administration withdrew the earlier guidance, though it said hospitals must still stabilize emergencies. Doctors and patients in states with bans have described delays in care for pregnancy complications, while ban supporters say their laws already allow abortions to save a woman's life.