The frequent flyer visits to an ED is definitely high volume for people with no insurance. Those people really do not care about incurring charges from non county hospitals or clinics because they never intend to pay. Now that they are insured, hopefully they pick a plan and get educated on what to do when you have a medical problem. This should decrease the ED non acute visits. There will always however be drunks, drug addicts, homeless, etc who need a place to crash for a while and will probably never sign up under federal law to hold medical insurance.