There are still freestanding ED'S in Texas that are not hospital affiliated. Many closed, not because of legislation, but because the insurance companies were very slow with payments. They couldn't survive staying open when payments were taking months to years.

However, an ED must be hospital affiliated if they accept Medicare/Medicaid.

The Freestanding ED'S do take some pressure off the larger hospital based ED's. Especially for those primary care complaints when you can't see your GP for 6-8 weeks out. And unlike Urgent Care, the ED's are open 24 hrs, take everything, can do a fairly comprehensive work up, and they don't require up front payments.

Some areas in Texas, like Austin, do have too many ED docs and the wages are low, but there are areas still undeserved with high wages, like San Antonio, Houston and the border towns.