and
There is some reimbursement (charity care for the uninsured, but for undocumented or homeless, it's usually a writeoff), but more often than not, inner city ERs run in the red... all the time. Not only that, but often the revenue generated doesn't always cover the costs of the services provide, but they are legally required to provide the life saving interventions and assessments, regardless of the ability to pay. They (like EMS) consistently lose money, because they are required to provide services, with no guarantee of ever getting paid. In the EMS world, it's the interfacility transports that tend to generate the most profit and offset 911 losses, while in the hospitals, it's the more profitable departments, such as those listed below:
Hospital revenue from physicians had been increasing steadily prior to the COVID-19 pandemic. Find out which specialties ranked highest in 2019.<br>
www.healthgrades.com
I don't pretend to know everything about hospital budgets or operations, but I do know that some departments historically lose money (ER and trauma come to mind), while others are cash cows, and the reason hospitals continue to operate those money losing departments is those losses are offset by the consistent gains from the profitable departments.