Mother Jones; Getty
Last week, the Supreme Court heard oral arguments in what could end up being its most consequential abortion decision since Dobbs. In a case pitting Idaho’s extreme abortion ban against a federal law known as EMTALA—that since 1986 has required hospitals to provide emergency care—conservative justices seemed to embrace the idea that states can deny crisis medical treatment to pregnant patients, even if doing so means those patients suffer catastrophic, life-altering injuries. “My reaction can be summed up as ‘appalled,’” says Sara Rosenbaum, emerita professor at George Washington University who is one of the country’s foremost experts in health policy issues affecting women and families. “Will [the court] really say it is fine [to enforce] a law that costs women their organs as long as they don’t die?”
It’s hard to think of a piece of progressive American health care policy since the late 1970s in which Rosenbaum hasn’t played a pivotal role conceptualizing, enacting, or improving. That includes the federal statute that guarantees the right of every American to go to a hospital emergency room and receive medical treatment before being sent somewhere else. The Emergency Medical Treatment and Labor Act, or EMTALA, requires hospitals to screen and stabilize anyone who arrives at the emergency room, including women in active labor. Narrow in scope yet vast in impact, the law has been a “force field around hospital emergency departments,” Rosenbaum says, protecting pregnant patients for four decades. Now, with the Dobbs decision, SCOTUS has “blown up medical care for childbearing people,” she says—and EMTALA could be the next major health care protection that the court decides to explode.
To more fully understand the implications of the case before the Supreme Court, we reached out to Rosenbaum to discuss the history of this unique statute and why it has become even more vital since the end of Roe v Wade.
You’ve called EMTALA “revolutionary” and “the most important American health care law that we have.” Why? What makes this law so special?
It’s the only American law we have that guarantees access to care. For everybody. It doesn’t matter who you are—whether you have insurance or don’t have insurance, what color you are, how much money you have, whether or not you’re disabled. If you come to a hospital emergency department and you believe you have an emergency, they have to screen you. If it is an emergency, they have to stabilize you. The definition of an emergency isn’t that you’re in danger of dying; it includes situations that could lead to severe, long-lasting physical harm. And the decision about what is required to stabilize you—it’s up to the doctor’s medical judgment.
I would say EMTALA is really our only universal health care law.
This law is from 1986. What was happening in the ’70s and ’80s that made EMTALA seem so necessary?
A few things were going on. Back in the early ’80s, a decision was made that the United States was spending too much on hospital care. So Congress changed the payment structure for Medicare [the single largest payer for health care services in the US] to incentivize shorter stays. Pretty soon there were stories emanating from the press about a phenomenon they called “sicker and quicker,” where patients who actually had been........