The number of U.S. EDs decreased by 27% between 1990 and 2009, from 2,466 to 1,779, an average of 89 ED closings per year, according to a study in the May 18 issue of JAMA. Smaller hospitals were more likely to close their EDs, as were for-profit hospitals, compared with those that kept EDs open (25% versus 16%). Twice as many hospitals that closed EDs fell in the lowest quartile of profit-margin distribution and were located in areas with a high proportion of minorities who were poor and without insurance. The findings show that "market-based approaches to health care do not ensure that care will be equitably distributed. In fact, the opposite may be true," the authors write. Federal law mandates that EDs treat all patients regardless of their ability to pay; however, no law guarantees access to EDs.