The Trump administration’s decision in early June to rescind guidance to hospitals concerning their obligation to perform emergency abortions is one of several health-related policies Trump has scrapped — or signaled he might — since taking office.
On June 3, the administration announced that it would rescind the federal guidance concerning the Emergency Medical Treatment and Labor Act (EMTALA) that CMS had issued in July 2022 under the Biden administration to reinforce that complications of pregnancy loss, ectopic pregnancies, and similar concerns must be treated as emergency medical conditions.
The Trump administration stressed that CMS would continue to enforce EMTALA for medical emergencies where “the health of a pregnant woman or her unborn child in serious jeopardy” and would “work to rectify any perceived legal confusion and instability created by the former administration’s actions.”
Despite the administration’s actions, Jamila Perritt, MD, MPH, president and CEO of Physicians for Reproductive Health, argued that “EMTALA is still the law of the land. As a doctor, I have a moral and ethical obligation to provide emergency care to those in need, including EMTALA’s mandate to provide abortion care when it is necessary and stabilizing treatment. This action does not change that.”
Sensitive Locations Policy
On his very first day in office, Trump revoked another policy, one that deemed hospitals, doctors’ offices, schools, and places of worship safe from immigration enforcement arrests, searches, and surveillance.
The Obama-era “sensitive locations” or “protected areas” policy was implemented in October 2011 with the goal of ensuring access to essential services, such as medical care and schooling, without the threat of enforcement by Immigration and Customs Enforcement or Customs and Border Protection agents. In October 2021, former President Biden doubled down on the policy, expanding the definition of protected areas to include “places where children gather, disaster or emergency relief sites, and social services establishments.”
In January, under a new Department of Homeland Security directive on “Enforcement Actions in or Near Protected Areas,” the Trump administration stated that officers would now have “enforcement discretion” in determining what actions could occur in a sensitive location.
Studies found that in 2017, during the anti-immigrant rhetoric and immigration policy changes of Trump’s first term, immigrant patients skipped appointments or stopped seeking care completely, as Lara Jirmanus, MD, MPH, co-founder of the Health and Law Immigrant Solidarity Network, and Andrew P. Cohen, JD, MA, of non-profit law firm Health Law Advocates in Massachusetts, pointed out in a a recent MedPage Today editorial.
“Missed appointments can contribute to poor health and even represent a risk-factor for all-cause mortality,” they noted.
Nursing Home Minimum Staffing Rule
On April 22, 2024, under President Biden, CMS issued its final rule on nursing home staffing standards, aiming to reduce residents’ risk of exposure to unsafe and low-quality care.
Under the rule, any nursing home or long-term care facility that receives Medicare, Medicaid, or other federal funding must meet a total nurse staffing standard of 3.48 hours per resident day, with at least 0.55 of those hours being direct registered nurse care. The final rule also called for an RN to be available on site 24 hours a day, 7 days a week. The rule did temporarily exempt facilities in communities with workforce shortages, among other challenges.
While consumer advocates and public health experts lauded the rule as a health and safety boon for residents, the American Hospital Association panned the rule, arguing that it would lead to nursing home closures and threaten access to care, particularly for residents in rural and underserved communities. Republicans in both the House and Senate sought to overturn the rule.
Even before he took office, there were signs Trump would support Republicans in reversing the rule. For example, Trump in his first term reduced fines for facilities where residents were injured or endangered, a policy Biden reversed.
Last month, a federal judge in Iowa stepped in, halting parts of the guidance — including the requirements that a nurse be present 24/7 and specifications for nursing care hours provided to residents each day.
Fred Bentley, an analyst at Washington-based healthcare research firm ATI Advisory, called the ruling a “major blow to the staffing mandate … Not sure if the mandate is officially dead, but it’s clearly got one foot in the grave,” he told McKnight’s Long-Term Care News.
While it’s not certain whether HHS will stop defending the rule, “it’s hard to see how the staffing mandate survives given these legal setbacks,” Bentley said.
Mental Health Parity Rule
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) aimed to prohibit insurers that provide mental health and substance use disorder coverage from offering less favorable benefit limits than they offer for medical and surgical coverage. The law also specifically barred insurers from imposing higher coinsurance and copays or more restrictive treatment limitations than would apply to an insurers’ medical and surgical benefits.
In September 2024, HHS under the Biden administration issued a final rule that gave “teeth” to the original legislation, making it easier to protect patients from unfair restrictions on access to mental and behavioral healthcare, as former American Medical Association President Bruce Scott, MD, characterized the rule.
“Health plans have violated MHPAEA for more than 15 years, and this final rule is a step in the right direction to protect patients and hold health plans accountable for those failures,” Scott had said in a press release.
In early May, the Trump administration indicated in court filings related to a lawsuit concerning the rule that it does not intend to enforce the rule while the administration reviews it, according to Bloomberg Law.
