Emergency rooms are expensive for hospitals to operate because they have to remain open 24 hours a day, and there has to be staff on hand in case of, well, medical emergencies. In addition, emergency rooms are required by federal law to treat anyone walking in the door, no matter whether they can pay or not. And for many who are covered by insurance, the reimbursement for services provided to them is less than the cost of providing those services, especially in rural areas. Just over a year ago, we talked about how changes brought on by the Affordable Care Act could affect charity and rural hospitals. The standalone emergency room rule change was one possible idea to address the issue. Unfortunately, it doesn't appear to have had the desired result.