To expand for you then there's a requirement that Emergency Rooms treat anyone regardless of their ability to pay. So there's a somewhat chronic issue of people who are unable to get regular treatment who's condition worsens to the point they can go to an Emergency Room to get treatment for what could be otherwise managed more cheaply at a regular doctor earlier, but because those doctors aren't forced to treat anyone that comes to them like ERs people that fall into the gap between Medicaid and regular insurance or being able to afford thing without insurance often wind up using the ER as a doctor of last resort. Treating things in the ER is much more expensive even without the chronic nature of some of the issues affecting those patients.