As Medicare and private insurance strike back against providers with lower reimbursements, and denials of care, more large providers and hospitals will drop out of insurance or go out of business.
In poor areas, only heavily government subsidized facilities could exist. However, small clinic models that accept cash only, could emerge even in poorer communities. Obviously, these clinics could not provide advanced services and procedures, but they could treat relatively common conditions at vastly lower costs than the ER. A high clinic staffed with mid-levels and overseen by a physician would be able to legally circumvent many Medicare requirements and save on billing costs. Sure, it would be assembly line medicine, but it would be better for many than clogged ERs.
If ebola gets out of hand, and I believe it will, you will see the national guard stationed at hospitals preventing the infected from entering.