The Trump administration on Tuesday reversed guidance from the Biden administration that had instructed hospitals in states prohibiting abortion not to refuse pregnant patients facing emergencies.

Enacted in 1986, the federal Emergency Medical Treatment and Labor Act (EMTALA) mandates that doctors offer adequate emergency care. Under EMTALA, hospitals are obligated to either stabilize individuals with emergency medical conditions or transfer them to a capable facility. The Biden administration’s guidance clarified that this requirement encompassed performing abortions for patients with health-threatening conditions, not solely those whose lives were in peril.

Under the Biden guidance, there was sometimes a perceived clash between EMTALA and laws in states with strict abortion bans. In some emergency cases, physicians opted to airlift patients with medical risks to a facility out of state rather than face legal consequences for what might later be considered a violation of state law. Idaho was one such state, and in 2022, the Biden Department of Justice sued Idaho to block it from enforcing its criminal abortion ban for emergency room physicians who perform abortions for pregnant patients, putting patients at risk on the grounds that such action would be a violation of EMTALA.

The Trump Health and Human Services (HHS) letter issued Tuesday revoked the prior guidance, and said that the Centers for Medicare and Medicaid Services (CMS) “will continue to enforce Emtala, which protects all individuals who present to a hospital emergency department seeking examination or treatment, including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy. CMS will work to rectify any perceived legal confusion and instability created by the former administration’s actions.”

Abortion rights supporters reacted critically Tuesday, arguing that the new guidance is certain to put patients at risk.

“The Trump administration cannot simply erase four decades of law protecting patients’ lives with the stroke of a pen,” said Alexa Kolbi-Molinas, deputy director of the ACLU’s Reproductive Freedom Project. “Regardless of where they live, pregnant patients have a right to emergency abortion care that will save their health or lives. By rescinding this guidance, the Trump administration has sent a clear signal that it is siding not with the majority, but with its anti-abortion allies — and that will come at the expense of women’s lives.”

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Likewise, Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said in a statement Tuesday:

If there was ever any doubt about where the Trump administration stands on abortion, it should be clear now: even in cases of life or death, they want to block your ability to get an abortion. Every day, this administration strikes another blow at our most fundamental right: to make our own decisions about our bodies and our futures. Women have died because they couldn’t get the lifesaving abortion care they needed. The Trump administration is willing to let pregnant people die, and that is exactly what we can expect.

The administration’s move stands in conflict with a June 2024 ruling by the U.S. Supreme Court in which the justices ruled 6-3 that Idaho doctors must resume performing abortions in medical emergencies. Justice Elena Kagan penned a concurring opinion in the case in which she said EMTALA “unambiguously requires” Medicare-funded hospitals to provide whatever medical care is needed to get a medical emergency under control, including, “in rare situations,” abortions.