Doctors are bracing for a possible rollback of a federal law protecting their ability to provide abortions in medical emergencies.

Despite issuing executive orders weakening abortion protections, including restricting the use of federal funds to help people access the procedure, President Donald Trump has so far left the Emergency Medicine Treatment and Labor Act (EMTALA) alone.

The Biden administration clarified that EMTALA requires hospitals to perform abortions when they are necessary to stabilize a patient. That guidance trumped individual state bans on abortion and meant that hospitals had to provide abortions in medical emergencies — and that failure to do so could result in financial penalties.

But the policy’s future remains uncertain. Trump has directed the federal government to identify and rescind policies that support abortion rights. Contributors to Project 2025, the public policy blueprint the Trump administration has largely followed since taking office, have called for reversing the interpretation that EMTALA can protect the right to emergency abortion.

“It was a great show of support by the Biden administration for science and evidence-based medicine that they specifically issued guidance about how EMTALA could be interpreted in cases where abortion was medically indicated,” said Dr. Jonas Swartz, an OB-GYN and abortion provider in North Carolina, where abortion is legal up to 12 weeks of pregnancy. “Changes in that feel like someone’s pulling the rug out from under you.”

Trump administration officials have not clarified how they would approach the Biden policy, which requires active enforcement by the federal government. The White House did not respond to requests for comment on whether the policy would remain in place or be enforced.

In his confirmation hearings, Health and Human Services Secretary Robert F. Kennedy Jr. suggested he was not familiar with how EMTALA works, even though it is supposed to be enforced by the department he now oversees. EMTALA violations are reported to the Centers for Medicare and Medicaid Services, a subsidiary of HHS, which then investigates those claims and can issue penalties. Dr. Mehmet Oz, the celebrity physician nominated to head CMS and effectively the person who would be in charge of those investigations, has spoken out against abortion.

Though even the strictest state abortion bans have nominal exceptions for when the procedure is necessary to save the life of the pregnant person, doctors interviewed by The 19th have repeatedly said it is very challenging to know what qualifies. Some suggested that the EMTALA guidance issued under Biden provided a measure of security for hospitals and physicians treating pregnant patients who needed an emergency abortion.

“Having EMTALA, we are able to take care of our patients more adequately than if we don’t,” said Christopher Ford, an emergency room doctor in Wisconsin, where a near-total abortion ban was enforced from June 2022 to September 2023.

Doctor confusion over what is allowed and what is not has already contributed to denial of medical care for patients, especially in states with active abortion bans. In Texas, one of two states to challenge the EMTALA policy in court, two women have filed complaints alleging that they did not receive appropriate care for their ectopic pregnancies. That, they said, resulted in both of them losing a fallopian tube, which could impair their ability to become pregnant moving forward. News reports have also identified cases where hospital emergency rooms have turned away pregnant patients, including one who ultimately experienced a miscarriage in the bathroom of a hospital lobby. One woman in Missouri could not receive an emergency abortion even when her water broke prematurely, a condition that can be life-threatening.

That has created a difficult calculus for hospitals: determining whether the threat of an EMTALA violation was a strong enough incentive to provide abortions in medical emergencies, especially when compared to the felony charges and hefty penalties associated with potentially violating a state abortion ban. The confusion has resulted in physicians and hospitals waiting until patients have deteriorated to a point where they were near death or sustained irreversible physical harm, such as loss of fertility.

Even without issuing new guidance, the Trump administration will soon have a chance to reshape federal policy. Under Biden, the Department of Justice challenged an abortion ban in Idaho, arguing that its narrow exceptions — abortions are only permitted to save a pregnant person’s life — violated EMTALA’s protections. Physicians in that state said pregnant patients experiencing medical emergencies had to be helicoptered out of state to receive an abortion.

The case is still ongoing and it’s not clear if Trump’s new Justice Department will maintain that stance. Any change from the DOJ could add further confusion about how meaningfully the new administration intends to enforce EMTALA violations

“When providers are faced with having to operate under confusing circumstances with the threat of criminal penalties, it ends up being patients who are turned away and denied care,” said Carrie Flaxman, a litigator at Democracy Forward, an organization that has led multiple lawsuits against the new Trump administration and represented doctors arguing in court in support of the Biden EMTALA policy.

Still, even under Biden, many doctors said it was not clear how much protection federal law afforded. The Biden administration received and investigated dozens of reports of alleged EMTALA violations, but news reports identified only a handful of cases where federal officials had warned hospitals that they risked being expelled from Medicare, the highest penalty for violating the law. EMTALA only applies to a very narrow subset of abortions.

“In Tennessee, I don’t think that a lot of providers felt it was clear even before the change in administration,” said Dr. Nikki Zite, an OB-GYN at the University of Tennessee, a state where abortion is almost completely illegal. “We’ve had outside institutions trying to send patients to us or calling us with questions that demonstrate there’s still a lot of confusion.”