Pulled Back from Comments
Quite a few California hospitals have no ERs; more every year- ERs lose money. The most recent figures that I could find are at http://www.laalmanac.com/health/he02.htm and show 121 hospitals in LA County with 75 providing some ER services in 2009 (would be fewer today)- a few have only standby which means doc on call, not a place that you should go to. I'm a public sector MD; many hospitals in the area accept Medicaid and Medicare patients as inpatients but typically discharge them without any follow up, even though they may be on a complex and dangerous drug regimen, instructing them to go to the nearest county hospital ER and demand follow up- that clogs our ER and it's often difficult for us to get comprehensive medical records from the gold coast hospital, unless we have a family member go there and make a stink- otherwise we get 6 pages of lab tests, no information as to why doctors did what they did, etc. The doc fix or SGR is a separate issue (and a disgraceful one going back on ACA hospitals and doctors part MMMMMMCCCLXXXV
OK let's see. I think that hospitals without ERs are still required to provide emergency care. Clearly this is an important issue, since EMTs won't drive ambulances to hospitals without ERs. The commenters point is important and news to me (I live in Italy).
It seems to me pretty clear that "follow up" is Medicare plan B. It is important that hospitals generally do this and reduced follow up from ACA seems to me to be another potentially important issue. But I don't know if the incentives to provide follow up will change due to the ACA. I guess I should know. To me it seems that the current clearly inadequate incentives might become more inadequate remain the same or improve (due to penalties for readmission and accountable care blah blah and in way over my head).
My point is just that I don't think that hospitals will drop out of Medicare/Medicaid as many doctors with office practices have.