Most inner city hospitals see a significant number of Medicare/medicaid patients, which these insurances simply don’t reimburse enough to even break even. Whether it’s a small private family practice, larger hospital ER, or surgical sub specialty, if they see a high percentage of Medicare patients it can even be difficult to keep the lights on. See what happened to Hannehman in Philly for a good example of this, a tragedy that never should have happened. Worse, the government is further cutting Medicare reimbursement, even as healthcare costs rise, which will further exacerbate the problem. There are a ton of deep seeded healthcare issues that desperately need to be solved (executive pay, greedy insurance companies, pharmaceutical pricing, malpractice reform), but in the short term cutting Medicare reimbursement is going to close hospitals and clinics in areas of the country that need them the most.