 As a result of financial difficulty, between the period of 1991–2011, 12.6% of EDs in the US closed.Despite the practice emerging over the past few decades, the delivery of emergency medicine has significantly increased and evolved across diverse settings as it relates to cost, provider availability and overall usage.Prior to the Affordable Care Act (ACA), emergency medicine was leveraged primarily by "uninsured or underinsured patients, women, children, and minorities, all of whom frequently face barriers to accessing primary care".