A new online petition urging Hunt Regional Healthcare to reopen the emergency department in Commerce is gaining signatures. The petition, titled “Every Minute Matters”, calls for the restoration of local emergency services closed earlier this year.
But data, policy, and economics all point to why that may not happen.
Local and Regional Finances
Both Hunt Regional and local residents are correct about one thing: the decision to close the Commerce and Quinlan emergency departments was about money.
Hunt Regional told KETR in its response to a Texas Public Information Act request that fewer than 15 percent of visits to either ER were low-acuity cases—meaning the overwhelming majority were moderate to critical emergencies. That undercuts the popular belief that the facilities were “overused” for minor issues.
The hospital district has also said that high levels of unreimbursed care made the facilities financially unsustainable. In Hunt County, about 16 percent of residents are uninsured, and one in five lives below the poverty line.
Federal Reimbursement Cuts
Those pressures are now compounded by federal policy changes. The recently enacted One Big Beautiful Bill Act (OBBBA) includes provisions that reduce Medicare and Medicaid reimbursements to hospitals nationwide—cuts expected to hit rural facilities the hardest.
According to the American Hospital Association, reductions in Medicaid funding could “further threaten access” for millions of rural patients.
A Chartis Group analysis estimated that a 15 percent reduction in Medicaid reimbursements would mean more than $1.8 billion in lost revenue for rural hospitals.
The Texas Rural Health Association reports that 43 percent of rural hospitals in Texas are already operating at a loss.
Those numbers paint a consistent picture: the challenge facing Hunt Regional isn’t patient behavior—it’s the changing math of healthcare reimbursement.
Unpaid Care and EMTALA Obligations
Federal law requires emergency departments to treat and stabilize anyone who comes through their doors, regardless of insurance or ability to pay — a protection under the Emergency Medical Treatment and Labor Act (EMTALA).
When patients can’t pay, hospitals must absorb the cost. Federal Disproportionate Share Hospital (DSH) payments and Texas’s uncompensated-care pool once helped offset those losses, but both funding streams have been reduced in recent years. The Centers for Medicare & Medicaid Services announced $8 billion in annual DSH reductions through 2027, and Texas’s waiver pool funding fell by roughly half a billion dollars between 2022 and 2024.
With new reimbursement cuts under the One Big Beautiful Bill Act, hospitals like Hunt Regional face the same EMTALA obligations but with less financial support to meet them.
The Medicaid Gap in Texas
Texas remains one of only ten states that have not expanded Medicaid under the Affordable Care Act — a policy choice that leaves hundreds of thousands of low-income adults without health coverage. Expansion would have extended Medicaid eligibility to many of the uninsured patients now showing up in emergency rooms, allowing hospitals to receive at least partial reimbursement for their care. According to the Kaiser Family Foundation, Texas forfeits an estimated $5.4 billion in federal funds each year by declining expansion. The Texas Hospital Association has said the decision continues to strain rural hospitals, which depend heavily on Medicaid revenue and uncompensated-care programs that are now being reduced.
Expansion in Royse City
Even as emergency departments in rural parts of Hunt County close, Hunt Regional is expanding into higher-income areas just outside the county line. The district has broken ground on a new facility in Royse City, which will include a 12-bed emergency department.
The project, developed in partnership with NexCore Group, is described on NexCore’s website as a “specialty hospital and medical office building” intended to serve the rapidly growing I-30 corridor.
Royse City sits in Rockwall County, where about 91 percent of residents have health insurance and household incomes are among the highest in the region.
Hunt Regional has not indicated whether revenue from the Royse City facility will offset losses from rural operations, but the demographic contrast is stark: ERs in poorer areas have closed, while new ones are opening where patients are more likely to have private insurance.
What Petitioners Should Know
The petition to reopen the Commerce ER reflects a real concern—access to emergency care now requires longer travel times for much of northern Hunt County and all of Delta County.
But reopening an ER under current conditions may not be financially possible for any public hospital district without changes in federal reimbursement policy.
The reimbursement changes created by the One Big Beautiful Bill Act are still rolling out, and hospitals across the country are already feeling the effects. For rural systems like Hunt Regional, those changes could decide whether places like the Commerce ER ever return—and whether others can stay open.
