March 18, 2025 • 29 mins
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a landmark federal law that revolutionized the right to emergency healthcare and provides crucial protections for pregnant people. Alexa Kolbi-Molinas, Deputy Director at the ACLU’s Reproductive Freedom Project, sits down to talk with us about the status of the case and what we can continue to do to protect emergency abortion services.
When EMTALA was originally passed by Congress in 1986, the law directed every hospital in the country with an emergency department to provide whatever healthcare was necessary to any individual who visited the hospital presenting with an emergency medical condition. This is especially important for pregnant people, who require intensive attention in and outside of emergency situations. For the nearly 40 years EMTALA has been in effect, it was understood across party lines that if someone needs emergency abortion care, EMTALA protects that access. But following the overturning of Roe v. Wade, Idaho’s extreme abortion ban did not feature an exception for those in emergencies. The Department of Justice sued Idaho to ensure EMTALA’s nationwide reach and the case advanced to the Supreme Court. The lawsuit against Idaho has now been dismissed under the new administration.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Welcome to Repro Fight Back a podcast on all
things related to sexual andreproductive health rights and
justice. Hi. Re pros. How'severybody doing? Apparently
Cinder decided she wanted totake part in the intro as well
as the rest of the podcast. Shehas been a little chatty the
last couple episodes. Peoplemay have heard her last week
(00:26):
share her thoughts on Medicaid.
She also shares her thoughtstoday on Tala during the
episode. So I guess it's onlyfitting she chirps in during
uh, the intro. She's lucky,she's cute, but she wants to
participate so she hasthoughts, so, so glad she can
participate. Uh , let's see,what else? I'm enjoying the
(00:48):
weather. It has been nice. I'vebeen able to have my windows
open. I love having windowsopen to get some fresh air in
the place. It makes me happy,but nowhere near as happy as it
makes Luna, y'all ,when she hears me unlock a
window, she comes barrelingfrom wherever she is to get in
that window. The second I getit open , uh, and we'll sit
(01:10):
there all day just enjoying thefresh air and staring out
outside. It is so funny. Butthat is like her happy place.
So she gets mad when it's toohot and I have the air
conditioning on and when it'stoo cold and the heat's on so
she can't sit in the openwindow, but it's a sweet spot
right now where she can sit andenjoy the outside . I think
(01:35):
other than that, like I'm stilluh , feeling a little stressed
and all the things, but theworst of it should hopefully be
over tomorrow because we arereleasing our annual 50 state
report card and sexual andreproductive health. So you can
see how your state fairscompared to other states when
it comes to sexual andreproductive health. And this
(01:57):
year, super exciting. Wecreated a microsite where you
can go and not just see theusual static map we have, but
you can also go and play byindicator so you can see how
your state compares to otherstates on a specific indicator.
I'm really excited about thenew microsite and the releasing
the report card in general. Ithas been a lot of work this
(02:18):
year with uh , creating themicrosite and the report card,
but I think they are greattools and I am very excited for
y'all to see it. And this yearwe are gonna do something a
little different. I am terribleat promoting myself. Uh, it is
just, I think it's maybe someof the Midwestern in me, like
it feels like bragging orsomething. I don't know. But,
(02:41):
so I'm not good at coming andtalking about my work, but this
year I was convinced that weshould have an episode where I
talk about the report card. Sonext week I will be joined by a
special guest who will put meon the other side of the mic
and interview me for a changewhere I will talk about our new
50 state report card. And I amso excited to have that
(03:03):
conversation so y'all can learnall about it and I can talk
like I know what I'm talkingabout instead of just being the
person asking the questions.
Uh, so very exciting to lookforward to. I think with that
maybe we'll turn to this week'sinterview. I am very excited to
talk about , um, Tala and theTrump administration's decision
(03:26):
to drop the lawsuit againstIdaho. And joining me, I am so
lucky to have Alexa ColbyMolinas with the A CLU to talk
about what is happening andwhat it means. And , uh, let ,
with that, let's go to myinterview with Alexa. Hi Alexa.
Thank you so much for beinghere today.
Speaker 2 (03:48):
Hi, thank you so much for having me. Before
Speaker 1 (03:50):
We get started, would you like to take a second
and introduce yourself andinclude your pronouns?
Speaker 2 (03:55):
Sure. I'm Alexa Colby Molinas pronouns. She
her, and I'm a deputy directorat the ACLU's Reproductive
Freedom Project.
Speaker 1 (04:04):
I am so excited to have you on to talk about Tala
and what the Trumpadministration did recently,
but I feel like maybe forpeople who aren't as familiar,
we should take a couple stepsback before we get to that and
maybe start with the reallybasic, like what is Tala ?
Speaker 2 (04:22):
Yeah, I think that is the right place to start. So
Tala, which stands forEmergency Medical Treatment and
Labor Act, is something mostpeople may ha probably haven't
heard of unless they work inhospitals. But it really was
and is a landmark federal lawthat revolutionized emergency
(04:45):
care in this country and inparticular has provided crucial
protections for pregnantpeople. So Tala was enacted
nearly 40 years ago, and at thetime, Congress was responding
to what was a nationwide crisisin American hospitals because
(05:07):
state laws didn't adequatelyprotect people's ability to get
emergency care. People werebeing turned away from
hospitals altogether left outin the street, or they were
being what is called dumpedfrom one hospital to another
while their conditionsdeteriorated because the
hospitals essentially justdidn't want to deal with them
(05:29):
and they had no obligation todo so. And this was
particularly bad for pregnantpeople because as you know, I
think we know it's pregnancycare is expensive, liability is
high. So pregnant people inparticular were suffering from
being from basically thehospital's rights to just turn
(05:51):
them away. So in response tothis nationwide crisis,
Congress provided a nationwidesolution, which uncommon to
hear of these days, right ? Butapparently back in 1986 they
could do this. And so Congressprovided a nationwide solution
by enacting a law tah that saysessentially every hospital in
(06:16):
the country with an emergencydepartment has to provide
whatever emergency care isnecessary to any individual who
comes to that hospitalexperiencing an emergency
medical condition. And Congressinserted a clause into Tala
that says, and by the way, ifthere are any state laws that
(06:40):
conflict with what Tala isrequiring, then Tala overrides,
right? Because Congress reallywanted to make it clear and
ensure that wherever you werein the country, if you went to
a hospital, you would get thecare you need. It didn't matter
what state law said. So that'swhat Tala is and was. And I
(07:03):
think, you know, for manypeople may not remember the
time before Tala, and of coursethat's not to su suggest that
our healthcare system isperfect in any way, but it
really was a very differentworld, particularly for
pregnant people before mt a
Speaker 1 (07:21):
It is kinda wild to think that hospitals would just
not treat somebody who came tothe emergency room.
Speaker 2 (07:28):
Yes. I mean, and there were, you know, when
Congress was deliberating overthis law and then ultimately
enacted it, you know, there isso much in the legislative
history about stories that werein newspapers at the time of
pregnant people delivering intheir cars, delivering on the
street, you know, people dyingfrom lack of care. And again, I
don't wanna suggest that wehave a , a perfect world right
(07:50):
now. Yeah . But it really, itwas bad enough to get Congress
to respond and President Reaganto sign this into law.
Speaker 1 (07:59):
Okay. So that brings us up to the Dobbs decision and
how we saw states reacting andin response to what their state
laws required when they bannedabortion.
Speaker 2 (08:13):
Yes . For 40 years, you know, that tala has been,
or nearly 40 years that it'sbeen in effect, it was
understood across democraticand Republican administrations
that if emergency abortion careis the emergency care someone
needs, then that's what m to Arequires. Even the first Trump
(08:34):
administration recognized that.
But then, like you said, wehave the summer of 2022 and the
Dobbs decision overturning Roev Wade, and in the wake of that
decision, Idaho passed anabortion ban that is an outlier
even among abortion bans,right? Any abortion ban is
(08:55):
extreme. But this one was evenmore extreme than most because
it didn't have an exception,any exception for the health of
the pregnant person, even inemergencies. So the only time a
doctor in Idaho wouldn't go tojail for providing emergency
abortion care was if they couldprove that the care was quote ,
(09:20):
necessary to avert death. Andof course, that's not how
medicine works. If we had acrystal ball, if doctors had a
crystal ball, then I think, youknow, the, our treatment and
care would be very different.
The whole point in an emergencyis you want someone to act
before you are on the brink ofdeath.
Speaker 1 (09:38):
Yeah. It feels like a giant game of chicken with
people's lives.
Speaker 2 (09:41):
Oh, absolutely.
Absolutely. And so veryquickly, you know, this law,
this ban took effect in July of2022. The next month, DOJ sued
Idaho, the Department ofJustice sued Idaho and said,
look, Tala is a federal law andit overrides any attempt to
(10:03):
prohibit emergency care. So weare seeking a preliminary
injunction against your banonly to the extent that it
prohibits essentially talaabortions. And I just think
it's important to recognize hownarrow that was. I mean, you
know, I think if they couldhave sued over the entire
(10:23):
abortion ban, they wouldn't.
But there's no federal law thatwould let the DOJ sue a state
over just banning abortion. Itwas just about emergency care.
So it was so narrow, right?
Idaho could continue to enforceits abortion ban in the vast
majority of circumstances. Butapparently even this one
(10:45):
segment of emergency care wastoo much. And so to make a long
story short, Idaho went all theway to the Supreme Court in
their pursuit of the right toput doctors in jail for
providing emergency abortioncare to their patients. And in
January of 2024, the SupremeCourt issued what's called a
(11:10):
stay of the preliminaryinjunction that was in Idaho.
So essentially the districtcourt had issued an order that
was protecting emergency carein Idaho while the case was
going on and the Supreme Courtstopped it. And at that point,
hospitals in Idaho, which nowlacked any protection for
(11:31):
EMTALA abortions were put inthe position of airlifting
pregnant people out of state toget the care they need at a
rate of two a month, which wasvastly more than they had, you
know, ever seen in like a yearright before then. Um, so it
was,
Speaker 1 (11:51):
I know it was really bad, buddy. Hilarious.
Speaker 2 (11:55):
Um, and so as a result, the hospitals were
airlifting people out of state.
Then last summer the SupremeCourt decided actually we're
not gonna rule on this case atall likely because of the
impending election , and theyrestored the preliminary
injunction. So after sixmonths, the emergency care was
(12:18):
restored in Idaho and theybasically just sent the case
back down for furtherarguments, which brings us to a
couple weeks ago , um, on March5th when the new
administration, rather thancontinue to defend this basic,
(12:38):
basic but essential right toemergency care, decided to
dismiss the case against Idahoaltogether. And so that's where
we are today. I do think thoughit is important to note that St
. Luke's Hospital, the largesthospital system in Idaho,
essentially fearing that thiswould happen when the
(13:00):
administrations changed,brought their own lawsuit and
was able to secure a temporaryrestraining order. So
fortunately the very cowardlyact by the Trump administration
to dismiss this suit hasn'tresulted in a gap in coverage.
Emergency care is stillprotected by court order in
(13:22):
Idaho, but we know Idahopoliticians are gonna continue
to fight tooth and nail as theyhave, you know, for the past
two and a half years to try todeny people this care. This
Speaker 1 (13:33):
Is just like one of those things that I know I
shouldn't be shocked orsurprised, but like, it is just
completely unbelievable to methat we are fighting over
letting people's health sufferand possibly die rather than
let them get a needed abortionlike it is again, it shouldn't
(13:55):
be shocking, but it is stillshocking that this is the fight
we are having to have.
Speaker 2 (14:00):
I mean, just two years after ROE is overturned,
this is where we are, we'rebegging for scraps essentially,
right? Yeah. We are begging forthe right not to die or suffer
severe health consequences frompregnancy loss. And I think
it's important to recognize thecases in which this emergency
(14:22):
abortion care is required arecases of pregnancy loss. There
is no saving the pregnancy, butwhat there should be is the
ability to save the health andlife of the pregnant person.
And that is what we areapparently having to fight for.
Speaker 1 (14:41):
. I, this
makes me think, oh man, so I
grew up and went to Catholicschool and so back when I
started at PopulationInstitute, I was like building
our Facebook page and, andwhatever, and I was working on
maternal health and did a postlike trying to get track people
(15:02):
talking about, I think it was awoman was dying every minute
globally at that time. Andsomebody I went to grade school
with then came on and was like,a woman's greatest joy should
be to die bringing , uh, lifeinto the world. And I was just,
I , I couldn't believe that wasa stance somebody would take.
So like it was just so shockingto me that those are the types
(15:25):
of conversations some peopleare having.
Speaker 2 (15:27):
Yeah. And you could really, I don't know if you
listened to the Supreme Courtarguments in this case last
year, but the women justicesreally were feeling that rage.
And I also think there was avery sort of important symbolic
(15:48):
exchange between the thensolicitor general , um,
Elizabeth Pre Lagar and JusticeAlito, where essentially he had
to say, well, I'm notsuggesting that women aren't
people under the law. And itwas pretty clear that that's
exactly what was beingsuggested,
Speaker 1 (16:07):
But like actually that's what you are .
Okay, so what, what do we needto do to ensure that people are
able to access this emergencycare?
Speaker 2 (16:17):
Yeah, I mean look, this is not just an Idaho
issue, right? Theadministration has sent a clear
message that they would ratherwomen die than access abortion
care. And so they haveabandoned pregnant people
nationwide. But still it'simportant to note Tala is still
law, right? An individual canstill sue a hospital if they're
(16:40):
denied care that's requiredunder Tala . So I do think one
thing people can do is knowtheir rights and if they are a
loved one or a loved one arepregnant, talk to their doctors
about how their hospitalshandle emergencies. Especially
if you live in a state whereabortion is restricted to some
(17:02):
extent, you know, doctors andhospitals should be putting
patients first, notpoliticians. And we hear a lot
about over compliance orpre-compliance, you know, in
response to President Trump.
But I think, you know, thisstarted even before President
Trump took office and startedreally with the Dobbs decision.
(17:24):
I think if hospitals reallywere able to take a stand, and
I completely understand thefear that criminal liability
poses to hospitals and to thedoctors who work there, but
Tala is still law. And sopeople should talk to their
doctors and hospitals to ensurethat they are getting the care
or will get the care they needbecause of course you can't
(17:46):
plan for an emergency, youcan't schedule your emergency
abortion, right? So you shouldfind out , um, what is going to
be provided to you if theunfortunate , um, the
unfortunate circumstancehappens. You know, the vast
majority of people in thiscountry do support access to
(18:07):
abortion and emergency abortioncare in particular, but not
everybody may realize what theadministration has done. So I
think that's another thingpeople can do, right? Talk to
those in your community andfind local groups like a CLU
affiliates or other localgroups that are working on
these issues and then you canreally plug in to learn about
(18:29):
future actions to make yourvoice heard.
Speaker 1 (18:32):
So one of the things I, right before I talked to
you, I had a conversation with, uh, Jess Pula at Boom
Lawyered, and she was talkingabout Colorado looking to pass
a state version of inala . Isthat going to be enough to
protect people or are weworried that the administration
would then sue those states?
Like what, what are theprotections that we could get
(18:55):
with state level laws?
Speaker 2 (18:56):
There are a number of states like Colorado that
are looking at passing theirown, basically, we'll just call
them a state tala . Some ofthem are abortion specific,
some of them are generalemergency care laws. Some
states that already haveemergency care laws are maybe
are also considering amendingthem to make clear that
(19:19):
abortion can't be excluded. Ingeneral, this is something
states are permitted to do. Ithink the one area, you know, I
don't wanna give anybody ideas.
The one area in which you couldsee the Trump administration
respond is the extent if theselaws have mandates that don't
(19:44):
allow refusals. We saw this inthe first Trump administration
when they went after Californiafor their abortion insurance
coverage law and stripped themof hundreds of millions of
dollars of federal money inresponse to that. So I think
(20:05):
sometimes when you see attemptsto mandate abortion care,
sometimes you will see , um, afederal, the federal government
using these so-calledhealthcare refusal laws that
are at the federal level to tryto coerce and threaten states
not to do it. But I think, youknow, you can also write laws
(20:27):
that can get around that, or atleast try to protect yourself
from that. So I don't think thegovernment will, I mean it's
famous last words with thisadministration . So
maybe I shouldn't even saythis, but I don't think that
the , you know, they're justgonna be going willy-nilly
after state emergency carelaws, but that is an angle that
(20:48):
could arise.
Speaker 1 (20:49):
Yeah. So like mentioning refusals, it makes
me think back to, you know,even pre dos , the importance
of making sure people wereeducated on what care hospitals
could maybe refuse you. So likethinking through making sure
people knew if they were goingto a Catholic hospital, that
that may be something that theycould face at a Catholic
(21:11):
hospital. I just remember youhear people, I'm sure you get
this the same, right? Someonestarts to tell a story of, I
have a friend who is in laborand like, and I'm like, I'm
gonna stop you right there. Ialready know where this is
going. Exactly. Um, and yeah, I, I just, it's so important
that people know what theirrights are and know what, what
(21:35):
risks they may face when theygo to certain hospitals as
well.
Speaker 2 (21:39):
I think that's exactly right. And I think it's
also really important fordoctors, particularly
residents, to know what they'regoing into when they start
working at a hospital. Becausea lot of people just assume
that, well of course theseabortions are gonna be allowed,
right? This is not, you know,she's not just having the
(22:02):
abortion because she wants one.
Yeah, yeah. Which is a wholeother problem. But you know,
people assume that theseabortions will be permitted and
have been shocked to find whenthey have a patient before them
that all of a sudden they'rebeing denied the ability to
treat them . So I think thatthat's also something that's
really important for people todo. And we, we are seeing that
(22:25):
residents medical residencyapplications are going down in
abortion ban states forprecisely this reason. Which
ultimately means that themedical workforce in those
states is going to decrease,right? Because the people who
are providing emergencyabortion care are also
providing all other kinds ofreproductive healthcare .
(22:47):
They're providing gynecologicalcare and they're providing
obstetrical care to peoplecontinuing their pregnancies
and they're not going to wantto work in those states. I
mean, Idaho itself has seen anexodus of OB-GYNs and maternal
fetal medicine doctors whospecialize in high risk
pregnancies. So the damage isreally long term .
Speaker 1 (23:11):
I think the important thing also to
remember is like this isn'thappening in a vacuum. Like
this conversation is alsotaking place on the background
of we are in a maternalmortality crisis , um,
particularly for black women.
So this is all happening at thesame time and we're already
seeing increased maternalmortality in some states and
(23:34):
assuming the states are stilllooking at it, 'cause a lot of
them have then disbanded their, uh, maternal morbidity
boards.
Speaker 2 (23:40):
Yes, I think you're exactly right. This is, these
are not happening in a vacuumand we know that states that
have had abortion restrictionsin the past have always had
worse maternal health outcomes.
And now that we are seeing allout bans, that's only going to
become worse. And obviously ifyou are prohibiting emergency
(24:02):
care, that is going to lead toeven more increased morbidity
and mortality. And I think itall really just boils down to
if any anti-abortion politiciantells you that they can ban
abortion but still protectpregnant people's health and
(24:22):
lives, they're lying because noabortion ban can do that.
Whether we're talking aboutemergency care or whether we're
talking about other kinds ofcare, abortion bans undermine
people's health and lives fullstop. Yeah,
Speaker 1 (24:38):
That feels like the perfect place to, to stop that.
'cause that is absolutely true.
Like we know , we've seenexceptions don't work. People
are always gonna fall intothose cracks where things
aren't explicit. I think thelast thing I would ask, and I
think we already touched on alittle bit of this, but what
can the audience do to getinvolved ?
Speaker 2 (25:00):
I think the audience, you know, if you're
not already plugged into localreproductive health groups or
local groups that work on thisissue, again, local A CLU
affiliates , um, will work onthis issue. And there are many
grassroots organizations instates that work on this. Um, I
think it's important to getplugged in because look, this
(25:22):
is the first thing we've seenthe Trump administration do. I
hope it's the last, but youknow, I don't think it will be.
And so it's good to getconnected now so that as these
things keep happening, you arealready connected to folks who
are working on the response andyou can much easier lend your
(25:43):
voice , um, or learn, you know,whether it's making calls,
whether it's writing letters,whether it's lobbying local
officials. It's good to getplugged in as early as possible
so then, you know, and are ableto mobilize as quickly as
possible.
Speaker 1 (25:59):
Well Alexa, thank you so much for being here. I
had a wonderful time talking toyou. Thank
Speaker 2 (26:04):
You so much for having me. I had a wonderful
time as well.
Speaker 1 (26:06):
I hope y'all enjoyed my conversation with Alexa and
hopefully I didn't set off yourAlexa too many times. As mine
went off a couple times andenjoyed our conversation. I
really did have a wonderfultime talking to her about Tala
and what is happening and um ,just really lucky to have her
on. So thank you Alexa. Andwith that, I will see everybody
(26:27):
next week for our episode onthe 50 state report card. If
you have any questions,comments, or topics you would
like us to cover, always feelfree to shoot me an email. You
can reach me at jenny jn nie@reprofightback.com or you
can find us on social media.
We're at re pros, fight back onFacebook and Twitter or re pros
(26:47):
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Or if you wanna make sure tosupport the podcast, you can
also donate on ourwebsite@reprofightback.com.
Thanks all .
Welcome to Repro Fight Back a podcast on all
things related to sexual andreproductive health rights and
justice. Hi. Re pros. How'severybody doing? Apparently
Cinder decided she wanted totake part in the intro as well
as the rest of the podcast. Shehas been a little chatty the
last couple episodes. Peoplemay have heard her last week
(00:26):
share her thoughts on Medicaid.
She also shares her thoughtstoday on Tala during the
episode. So I guess it's onlyfitting she chirps in during
uh, the intro. She's lucky,she's cute, but she wants to
participate so she hasthoughts, so, so glad she can
participate. Uh , let's see,what else? I'm enjoying the
(00:48):
weather. It has been nice. I'vebeen able to have my windows
open. I love having windowsopen to get some fresh air in
the place. It makes me happy,but nowhere near as happy as it
makes Luna, y'all
window, she comes barrelingfrom wherever she is to get in
that window. The second I getit open , uh, and we'll sit
(01:10):
there all day just enjoying thefresh air and staring out
outside. It is so funny. Butthat is like her happy place.
So she gets mad when it's toohot and I have the air
conditioning on and when it'stoo cold and the heat's on so
she can't sit in the openwindow, but it's a sweet spot
right now where she can sit andenjoy the outside . I think
(01:35):
other than that, like I'm stilluh , feeling a little stressed
and all the things, but theworst of it should hopefully be
over tomorrow because we arereleasing our annual 50 state
report card and sexual andreproductive health. So you can
see how your state fairscompared to other states when
it comes to sexual andreproductive health. And this
(01:57):
year, super exciting. Wecreated a microsite where you
can go and not just see theusual static map we have, but
you can also go and play byindicator so you can see how
your state compares to otherstates on a specific indicator.
I'm really excited about thenew microsite and the releasing
the report card in general. Ithas been a lot of work this
(02:18):
year with uh , creating themicrosite and the report card,
but I think they are greattools and I am very excited for
y'all to see it. And this yearwe are gonna do something a
little different. I am terribleat promoting myself. Uh, it is
just, I think it's maybe someof the Midwestern in me, like
it feels like bragging orsomething. I don't know. But,
(02:41):
so I'm not good at coming andtalking about my work, but this
year I was convinced that weshould have an episode where I
talk about the report card. Sonext week I will be joined by a
special guest who will put meon the other side of the mic
and interview me for a changewhere I will talk about our new
50 state report card. And I amso excited to have that
(03:03):
conversation so y'all can learnall about it and I can talk
like I know what I'm talkingabout instead of just being the
person asking the questions.
Uh, so very exciting to lookforward to. I think with that
maybe we'll turn to this week'sinterview. I am very excited to
talk about , um, Tala and theTrump administration's decision
(03:26):
to drop the lawsuit againstIdaho. And joining me, I am so
lucky to have Alexa ColbyMolinas with the A CLU to talk
about what is happening andwhat it means. And , uh, let ,
with that, let's go to myinterview with Alexa. Hi Alexa.
Thank you so much for beinghere today.
Speaker 2 (03:48):
Hi, thank you so much for having me. Before
Speaker 1 (03:50):
We get started, would you like to take a second
and introduce yourself andinclude your pronouns?
Speaker 2 (03:55):
Sure. I'm Alexa Colby Molinas pronouns. She
her, and I'm a deputy directorat the ACLU's Reproductive
Freedom Project.
Speaker 1 (04:04):
I am so excited to have you on to talk about Tala
and what the Trumpadministration did recently,
but I feel like maybe forpeople who aren't as familiar,
we should take a couple stepsback before we get to that and
maybe start with the reallybasic, like what is Tala ?
Speaker 2 (04:22):
Yeah, I think that is the right place to start. So
Tala, which stands forEmergency Medical Treatment and
Labor Act, is something mostpeople may ha probably haven't
heard of unless they work inhospitals. But it really was
and is a landmark federal lawthat revolutionized emergency
(04:45):
care in this country and inparticular has provided crucial
protections for pregnantpeople. So Tala was enacted
nearly 40 years ago, and at thetime, Congress was responding
to what was a nationwide crisisin American hospitals because
(05:07):
state laws didn't adequatelyprotect people's ability to get
emergency care. People werebeing turned away from
hospitals altogether left outin the street, or they were
being what is called dumpedfrom one hospital to another
while their conditionsdeteriorated because the
hospitals essentially justdidn't want to deal with them
(05:29):
and they had no obligation todo so. And this was
particularly bad for pregnantpeople because as you know, I
think we know it's pregnancycare is expensive, liability is
high. So pregnant people inparticular were suffering from
being from basically thehospital's rights to just turn
(05:51):
them away. So in response tothis nationwide crisis,
Congress provided a nationwidesolution, which uncommon to
hear of these days, right ? Butapparently back in 1986 they
could do this. And so Congressprovided a nationwide solution
by enacting a law tah that saysessentially every hospital in
(06:16):
the country with an emergencydepartment has to provide
whatever emergency care isnecessary to any individual who
comes to that hospitalexperiencing an emergency
medical condition. And Congressinserted a clause into Tala
that says, and by the way, ifthere are any state laws that
(06:40):
conflict with what Tala isrequiring, then Tala overrides,
right? Because Congress reallywanted to make it clear and
ensure that wherever you werein the country, if you went to
a hospital, you would get thecare you need. It didn't matter
what state law said. So that'swhat Tala is and was. And I
(07:03):
think, you know, for manypeople may not remember the
time before Tala, and of coursethat's not to su suggest that
our healthcare system isperfect in any way, but it
really was a very differentworld, particularly for
pregnant people before mt a
Speaker 1 (07:21):
It is kinda wild to think that hospitals would just
not treat somebody who came tothe emergency room.
Speaker 2 (07:28):
Yes. I mean, and there were, you know, when
Congress was deliberating overthis law and then ultimately
enacted it, you know, there isso much in the legislative
history about stories that werein newspapers at the time of
pregnant people delivering intheir cars, delivering on the
street, you know, people dyingfrom lack of care. And again, I
don't wanna suggest that wehave a , a perfect world right
(07:50):
now. Yeah . But it really, itwas bad enough to get Congress
to respond and President Reaganto sign this into law.
Speaker 1 (07:59):
Okay. So that brings us up to the Dobbs decision and
how we saw states reacting andin response to what their state
laws required when they bannedabortion.
Speaker 2 (08:13):
Yes . For 40 years, you know, that tala has been,
or nearly 40 years that it'sbeen in effect, it was
understood across democraticand Republican administrations
that if emergency abortion careis the emergency care someone
needs, then that's what m to Arequires. Even the first Trump
(08:34):
administration recognized that.
But then, like you said, wehave the summer of 2022 and the
Dobbs decision overturning Roev Wade, and in the wake of that
decision, Idaho passed anabortion ban that is an outlier
even among abortion bans,right? Any abortion ban is
(08:55):
extreme. But this one was evenmore extreme than most because
it didn't have an exception,any exception for the health of
the pregnant person, even inemergencies. So the only time a
doctor in Idaho wouldn't go tojail for providing emergency
abortion care was if they couldprove that the care was quote ,
(09:20):
necessary to avert death. Andof course, that's not how
medicine works. If we had acrystal ball, if doctors had a
crystal ball, then I think, youknow, the, our treatment and
care would be very different.
The whole point in an emergencyis you want someone to act
before you are on the brink ofdeath.
Speaker 1 (09:38):
Yeah. It feels like a giant game of chicken with
people's lives.
Speaker 2 (09:41):
Oh, absolutely.
Absolutely. And so veryquickly, you know, this law,
this ban took effect in July of2022. The next month, DOJ sued
Idaho, the Department ofJustice sued Idaho and said,
look, Tala is a federal law andit overrides any attempt to
(10:03):
prohibit emergency care. So weare seeking a preliminary
injunction against your banonly to the extent that it
prohibits essentially talaabortions. And I just think
it's important to recognize hownarrow that was. I mean, you
know, I think if they couldhave sued over the entire
(10:23):
abortion ban, they wouldn't.
But there's no federal law thatwould let the DOJ sue a state
over just banning abortion. Itwas just about emergency care.
So it was so narrow, right?
Idaho could continue to enforceits abortion ban in the vast
majority of circumstances. Butapparently even this one
(10:45):
segment of emergency care wastoo much. And so to make a long
story short, Idaho went all theway to the Supreme Court in
their pursuit of the right toput doctors in jail for
providing emergency abortioncare to their patients. And in
January of 2024, the SupremeCourt issued what's called a
(11:10):
stay of the preliminaryinjunction that was in Idaho.
So essentially the districtcourt had issued an order that
was protecting emergency carein Idaho while the case was
going on and the Supreme Courtstopped it. And at that point,
hospitals in Idaho, which nowlacked any protection for
(11:31):
EMTALA abortions were put inthe position of airlifting
pregnant people out of state toget the care they need at a
rate of two a month, which wasvastly more than they had, you
know, ever seen in like a yearright before then. Um, so it
was,
Speaker 1 (11:51):
I know it was really bad, buddy. Hilarious.
Speaker 2 (11:55):
Um, and so as a result, the hospitals were
airlifting people out of state.
Then last summer the SupremeCourt decided actually we're
not gonna rule on this case atall likely because of the
impending election , and theyrestored the preliminary
injunction. So after sixmonths, the emergency care was
(12:18):
restored in Idaho and theybasically just sent the case
back down for furtherarguments, which brings us to a
couple weeks ago , um, on March5th when the new
administration, rather thancontinue to defend this basic,
(12:38):
basic but essential right toemergency care, decided to
dismiss the case against Idahoaltogether. And so that's where
we are today. I do think thoughit is important to note that St
. Luke's Hospital, the largesthospital system in Idaho,
essentially fearing that thiswould happen when the
(13:00):
administrations changed,brought their own lawsuit and
was able to secure a temporaryrestraining order. So
fortunately the very cowardlyact by the Trump administration
to dismiss this suit hasn'tresulted in a gap in coverage.
Emergency care is stillprotected by court order in
(13:22):
Idaho, but we know Idahopoliticians are gonna continue
to fight tooth and nail as theyhave, you know, for the past
two and a half years to try todeny people this care. This
Speaker 1 (13:33):
Is just like one of those things that I know I
shouldn't be shocked orsurprised, but like, it is just
completely unbelievable to methat we are fighting over
letting people's health sufferand possibly die rather than
let them get a needed abortionlike it is again, it shouldn't
(13:55):
be shocking, but it is stillshocking that this is the fight
we are having to have.
Speaker 2 (14:00):
I mean, just two years after ROE is overturned,
this is where we are, we'rebegging for scraps essentially,
right? Yeah. We are begging forthe right not to die or suffer
severe health consequences frompregnancy loss. And I think
it's important to recognize thecases in which this emergency
(14:22):
abortion care is required arecases of pregnancy loss. There
is no saving the pregnancy, butwhat there should be is the
ability to save the health andlife of the pregnant person.
And that is what we areapparently having to fight for.
Speaker 1 (14:41):
grew up and went to Catholicschool and so back when I
started at PopulationInstitute, I was like building
our Facebook page and, andwhatever, and I was working on
maternal health and did a postlike trying to get track people
(15:02):
talking about, I think it was awoman was dying every minute
globally at that time. Andsomebody I went to grade school
with then came on and was like,a woman's greatest joy should
be to die bringing , uh, lifeinto the world. And I was just,
I , I couldn't believe that wasa stance somebody would take.
So like it was just so shockingto me that those are the types
(15:25):
of conversations some peopleare having.
Speaker 2 (15:27):
Yeah. And you could really, I don't know if you
listened to the Supreme Courtarguments in this case last
year, but the women justicesreally were feeling that rage.
And I also think there was avery sort of important symbolic
(15:48):
exchange between the thensolicitor general , um,
Elizabeth Pre Lagar and JusticeAlito, where essentially he had
to say, well, I'm notsuggesting that women aren't
people under the law. And itwas pretty clear that that's
exactly what was beingsuggested,
Speaker 1 (16:07):
But like actually that's what you are
Okay, so what, what do we needto do to ensure that people are
able to access this emergencycare?
Speaker 2 (16:17):
Yeah, I mean look, this is not just an Idaho
issue, right? Theadministration has sent a clear
message that they would ratherwomen die than access abortion
care. And so they haveabandoned pregnant people
nationwide. But still it'simportant to note Tala is still
law, right? An individual canstill sue a hospital if they're
(16:40):
denied care that's requiredunder Tala . So I do think one
thing people can do is knowtheir rights and if they are a
loved one or a loved one arepregnant, talk to their doctors
about how their hospitalshandle emergencies. Especially
if you live in a state whereabortion is restricted to some
(17:02):
extent, you know, doctors andhospitals should be putting
patients first, notpoliticians. And we hear a lot
about over compliance orpre-compliance, you know, in
response to President Trump.
But I think, you know, thisstarted even before President
Trump took office and startedreally with the Dobbs decision.
(17:24):
I think if hospitals reallywere able to take a stand, and
I completely understand thefear that criminal liability
poses to hospitals and to thedoctors who work there, but
Tala is still law. And sopeople should talk to their
doctors and hospitals to ensurethat they are getting the care
or will get the care they needbecause of course you can't
(17:46):
plan for an emergency, youcan't schedule your emergency
abortion, right? So you shouldfind out , um, what is going to
be provided to you if theunfortunate , um, the
unfortunate circumstancehappens. You know, the vast
majority of people in thiscountry do support access to
(18:07):
abortion and emergency abortioncare in particular, but not
everybody may realize what theadministration has done. So I
think that's another thingpeople can do, right? Talk to
those in your community andfind local groups like a CLU
affiliates or other localgroups that are working on
these issues and then you canreally plug in to learn about
(18:29):
future actions to make yourvoice heard.
Speaker 1 (18:32):
So one of the things I, right before I talked to
you, I had a conversation with, uh, Jess Pula at Boom
Lawyered, and she was talkingabout Colorado looking to pass
a state version of inala . Isthat going to be enough to
protect people or are weworried that the administration
would then sue those states?
Like what, what are theprotections that we could get
(18:55):
with state level laws?
Speaker 2 (18:56):
There are a number of states like Colorado that
are looking at passing theirown, basically, we'll just call
them a state tala . Some ofthem are abortion specific,
some of them are generalemergency care laws. Some
states that already haveemergency care laws are maybe
are also considering amendingthem to make clear that
(19:19):
abortion can't be excluded. Ingeneral, this is something
states are permitted to do. Ithink the one area, you know, I
don't wanna give anybody ideas.
The one area in which you couldsee the Trump administration
respond is the extent if theselaws have mandates that don't
(19:44):
allow refusals. We saw this inthe first Trump administration
when they went after Californiafor their abortion insurance
coverage law and stripped themof hundreds of millions of
dollars of federal money inresponse to that. So I think
(20:05):
sometimes when you see attemptsto mandate abortion care,
sometimes you will see , um, afederal, the federal government
using these so-calledhealthcare refusal laws that
are at the federal level to tryto coerce and threaten states
not to do it. But I think, youknow, you can also write laws
(20:27):
that can get around that, or atleast try to protect yourself
from that. So I don't think thegovernment will, I mean it's
famous last words with thisadministration
maybe I shouldn't even saythis, but I don't think that
the , you know, they're justgonna be going willy-nilly
after state emergency carelaws, but that is an angle that
(20:48):
could arise.
Speaker 1 (20:49):
Yeah. So like mentioning refusals, it makes
me think back to, you know,even pre dos , the importance
of making sure people wereeducated on what care hospitals
could maybe refuse you. So likethinking through making sure
people knew if they were goingto a Catholic hospital, that
that may be something that theycould face at a Catholic
(21:11):
hospital. I just remember youhear people, I'm sure you get
this the same, right? Someonestarts to tell a story of, I
have a friend who is in laborand like, and I'm like, I'm
gonna stop you right there. Ialready know where this is
going. Exactly. Um, and yeah, I, I just, it's so important
that people know what theirrights are and know what, what
(21:35):
risks they may face when theygo to certain hospitals as
well.
Speaker 2 (21:39):
I think that's exactly right. And I think it's
also really important fordoctors, particularly
residents, to know what they'regoing into when they start
working at a hospital. Becausea lot of people just assume
that, well of course theseabortions are gonna be allowed,
right? This is not, you know,she's not just having the
(22:02):
abortion because she wants one.
Yeah, yeah. Which is a wholeother problem. But you know,
people assume that theseabortions will be permitted and
have been shocked to find whenthey have a patient before them
that all of a sudden they'rebeing denied the ability to
treat them . So I think thatthat's also something that's
really important for people todo. And we, we are seeing that
(22:25):
residents medical residencyapplications are going down in
abortion ban states forprecisely this reason. Which
ultimately means that themedical workforce in those
states is going to decrease,right? Because the people who
are providing emergencyabortion care are also
providing all other kinds ofreproductive healthcare .
(22:47):
They're providing gynecologicalcare and they're providing
obstetrical care to peoplecontinuing their pregnancies
and they're not going to wantto work in those states. I
mean, Idaho itself has seen anexodus of OB-GYNs and maternal
fetal medicine doctors whospecialize in high risk
pregnancies. So the damage isreally long term .
Speaker 1 (23:11):
I think the important thing also to
remember is like this isn'thappening in a vacuum. Like
this conversation is alsotaking place on the background
of we are in a maternalmortality crisis , um,
particularly for black women.
So this is all happening at thesame time and we're already
seeing increased maternalmortality in some states and
(23:34):
assuming the states are stilllooking at it, 'cause a lot of
them have then disbanded their, uh, maternal morbidity
boards.
Speaker 2 (23:40):
Yes, I think you're exactly right. This is, these
are not happening in a vacuumand we know that states that
have had abortion restrictionsin the past have always had
worse maternal health outcomes.
And now that we are seeing allout bans, that's only going to
become worse. And obviously ifyou are prohibiting emergency
(24:02):
care, that is going to lead toeven more increased morbidity
and mortality. And I think itall really just boils down to
if any anti-abortion politiciantells you that they can ban
abortion but still protectpregnant people's health and
(24:22):
lives, they're lying because noabortion ban can do that.
Whether we're talking aboutemergency care or whether we're
talking about other kinds ofcare, abortion bans undermine
people's health and lives fullstop. Yeah,
Speaker 1 (24:38):
That feels like the perfect place to, to stop that.
'cause that is absolutely true.
Like we know , we've seenexceptions don't work. People
are always gonna fall intothose cracks where things
aren't explicit. I think thelast thing I would ask, and I
think we already touched on alittle bit of this, but what
can the audience do to getinvolved ?
Speaker 2 (25:00):
I think the audience, you know, if you're
not already plugged into localreproductive health groups or
local groups that work on thisissue, again, local A CLU
affiliates , um, will work onthis issue. And there are many
grassroots organizations instates that work on this. Um, I
think it's important to getplugged in because look, this
(25:22):
is the first thing we've seenthe Trump administration do. I
hope it's the last, but youknow, I don't think it will be.
And so it's good to getconnected now so that as these
things keep happening, you arealready connected to folks who
are working on the response andyou can much easier lend your
(25:43):
voice , um, or learn, you know,whether it's making calls,
whether it's writing letters,whether it's lobbying local
officials. It's good to getplugged in as early as possible
so then, you know, and are ableto mobilize as quickly as
possible.
Speaker 1 (25:59):
Well Alexa, thank you so much for being here. I
had a wonderful time talking toyou. Thank
Speaker 2 (26:04):
You so much for having me. I had a wonderful
time as well.
Speaker 1 (26:06):
I hope y'all enjoyed my conversation with Alexa and
hopefully I didn't set off yourAlexa too many times. As mine
went off a couple times andenjoyed our conversation. I
really did have a wonderfultime talking to her about Tala
and what is happening and um ,just really lucky to have her
on. So thank you Alexa. Andwith that, I will see everybody
(26:27):
next week for our episode onthe 50 state report card. If
you have any questions,comments, or topics you would
like us to cover, always feelfree to shoot me an email. You
can reach me at jenny jn nie@reprofightback.com or you
can find us on social media.
We're at re pros, fight back onFacebook and Twitter or re pros
(26:47):
FB on Instagram. If you loveour podcast and wanna make sure
more people find it, take thetime to rate and review us on
your favorite podcast platform.
Or if you wanna make sure tosupport the podcast, you can
also donate on ourwebsite@reprofightback.com.
Thanks all .
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