Did you know there’s an Occupy Providence? Yeah, neither did I, and I’m from Rhode Island…. Did you know there’s an Occupy Providence? Yeah, neither did I, and I’m from Rhode Island. It’s clear that the American people are hurting financially. But before the movement spreads, there’s  arguably a more pressing problem we should address: the decreasing number of emergency rooms.

For everyone, an emergency room is a stronghold — a beacon of assurance that, no matter what ills befalls us, at the very least we’ll have access to a doctor. In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act, which requires participating hospitals to provide emergency care for anyone, regardless of citizenship, ability to pay or legal status. “Participating” denotes hospitals receiving payments from the U.S. Department of Health and Human Services — in other words, virtually every hospital.

Many emergency rooms, however, are no longer treated as last resorts; for many Americans, emergency care is the new primary care. According to the Centers for Disease Control and Prevention, annual emergency room visits increased from 123.8 million in 2008 to 136 million in 2009. This drastic change suggests that patients are admitting themselves for more than typical emergencies. Not coincidentally, the Great Recession began in 2008.

Severely compounding this problem is a decrease in the number of emergency departments. A 2011 study from the Journal of the American Medical Association found that from 1990 to 2009, the number of urban hospitals with emergency departments decreased from 2,446 to 1,779.

Emergency departments that operated in competitive markets and in hospitals with meager profit margins were more likely to close, as were departments in areas with higher-than-average populations of minorities. Perhaps this is because these departments simply couldn’t balance the books: According to a 2006 report by The Commonwealth Fund, African American and Hispanic adults were 1.5 to 3 times more likely than white adults to be uninsured.

American health care is changing, of course. The Patient Protection and Affordable Care Act — “Obamacare” — was enacted more than a year ago, and full measures will take effect around 2014. Many historically uninsured groups will become insured and will thus be able to pay for hospital visits. But the problem of decreasing emergency rooms remains: What’s the use of medical insurance if there’s no emergency room in which to use it? Because many Americans consider the emergency room to be their primary care facility — whether or not they’re able to pay — more attention should be devoted to ensuring that they don’t close.

If the Obama administration really wants to improve health care, it needs to address emergency department extinction. What Obamacare does, in effect, is sell tickets to an already sold-out show. Having coverage is fine, but being forced to deprive your child of needed primary care because the next ER is too far away is pitiful. Moreover, more insured Americans means the already limited number of primary-care doctors will be harder to reach. Thus, some people might just use the ER for convenience, which is more costly than a primary care visit.

We experienced our own emergency-department closure recently: West Penn Hospital in Bloomfield terminated its department late last year after reporting a $90 million loss. Fortunately, this will be reversed. West Penn Allegheny Health System and insurance company Highmark just developed a merger, and they have a plan that includes the reopening of West Penn’s emergency department next year. We’re one of the lucky few.

American use the ER for non-urgent situations is not ideal, but it’s reality. And our legislation and future plans should reflect that reality. If our goal is to insure everyone, then we should provide enough facilities to offer them care.

It comes down to quantity versus efficiency — the current health care facilities cannot handle the large quantity of people, and so efficiency is lost.

We will likely see an Occupy Squirrel Hill before we see the number of emergency departments drastically increase. I just hope someone is spreading the word about the crisis, and that it’s on a congressman’s mind.