A lot of people are going to connect this to trump, but it’s really just a byproduct of the capitalization of medicine as a whole. This is more of an issue in conservative states who rejected the Medicaid expansion, but it’s also happening in states that vote heavily blue.
Emergent care is a huge money sink, and the roll of money making departments like orthopedics or cardiovascular care’s main job is to make enough profits to keep the lights on in the ER. When physician owned or private “hospitals” that don’t feature a ER open, they are taking revenue out of the emergent care network.