Question: How did obstetric-related Emergency Medical Treatment and Labor Act (EMTALA) violations change in association with state-level abortion policy?

Findings: In this difference-in-differences analysis of EMTALA violations from 2018 to the first quarter of 2023, states with no health exceptions saw a substantial rise in obstetric-related violations that were associated with policies adopted by Texas. There was a concurrent rise in emergency department utilization, and screening failures suggest that violations may have increasingly occurred on arrival before treatment.

Meaning: The study results suggest that state abortion laws may undermine federally protected care in obstetric emergencies.

Medicare is often regarded as a universal benefit for most US citizens and legal permanent residents. The program is financed through payroll tax contributions during individuals’ working lives with the expectation of coverage at age 65 years for most people. However, those who die prematurely are unable to realize the benefits they helped fund—raising equity concerns for populations with lower life expectancies.

In 2022, the mean life expectancy in the US was 77.5 years, down from 78.9 years in 2014,2 partly due to rising mortality among working-age adults and widening disparities across racial and socioeconomic groups.3-5 As health declines begin earlier—especially for Black individuals—a growing number may not reach Medicare eligibility. This inequity in unrealized Medicare benefits underscores the need to understand how premature mortality before age 65 years has varied over time and by race.

Federal health spending plays a central role in the nation’s long-term fiscal outlook. In 2024, Medicare, Medicaid, and the Children’s Health Insurance Program accounted for 31 percent of all federal program spending—$1.8 trillion—and this total is projected to rise significantly over the next 30 years. At the same time, private health insurance spending per enrollee is expected to grow by over 50 percent by 2032. These unsustainable trends—occurring without commensurate improvements in population health— create a burning need for reform: Without meaningful change, rising health care costs will increasingly strain household budgets, crowd out other federal and state priorities, and undermine the nation’s long-term fiscal stability.

Against this urgent backdrop, the United States Government Accountability Office issued its 2024 report, “Highlights of a Forum: Reducing Spending and Enhancing Value in the U.S. Health Care System”. The report summarizes the discussions of an expert forum convened in October 2024. The forum brought together participants from government, academia, and industry to explore persistent challenges in United States (US) health care spending and identify opportunities to improve value. The report’s recommendations were structured around five pre-identified areas of potential reform: strengthening primary care; expanding the health care workforce; reforming pricing to better align with high value care; revising Medicare physician payments; and mitigating anticompetitive actions and practices. As two of the forum participants, we highlight below the areas we believe are most critical for policymakers to consider and offer new insights that have gained salience given shifts in the policy landscape since the forum was conducted.