At Martin Luther King Jr. Community Hospital in Willowbrook, four white tents erected for the COVID-19 crisis have become part of a lasting overflow system. Two handle intake and vital sign testing, while two house behavioral health patients experiencing psychiatric episodes.

The tents still cannot contain the demand. Ambulances unload patients onto gurneys beneath an awning near the entrance, where nurses, security personnel, and IV drips turn an outdoor strip into a care area.

MLKCH opened in 2015 on the site of the shuttered King/Drew Medical Center with capacity for 25,000 annual emergency department visits. It now receives four to five times that number, forcing staff to convert nearly every available space.

The former gift shop serves as a procedure room, while patients receive care in the chapel and meditation room. Gurneys crowd the hallways, and when those run out, staff must decide which patients can remain seated in chairs.

MLKCH is the primary emergency department for a large part of South L.A. and the area’s only hospital providing indigent care. Almost three quarters of its emergency patients are on Medicaid, while another 20% are on Medicare or uninsured.

Despite the crush, the average wait for emergency care is less than half an hour, and fewer than 2% of patients leave without being seen. Doctors work near the entrance, the waiting room doubles as treatment space, and triage begins in a tent before patients reach the door.

The hospital has assigned each doctor a zone and placed a laboratory in a repurposed area to reduce delays for blood tests. Other hospitals have sent representatives to study how MLKCH keeps its wait times low despite severe overcrowding.

Yet South L.A. remains a medical desert. A hospital study estimated that the area lacks 1,500 primary and specialty care doctors, pushing residents who cannot obtain community care into the emergency department, sometimes with conditions worsened by delayed preventive treatment.

The Republican backed One Big Beautiful Bill Act adds a punishing new layer to that crisis through $1 trillion in Medicaid cuts. Medicaid enrollment has fallen by 6 million since Donald Trump’s inauguration, including 2.5 million children, while Affordable Care Act exchange enrollment has fallen by 5 million.

As more people lose coverage, emergency departments become their primary source of care. Hospitals must accept emergency patients, but uncompensated treatment tears through safety net hospital budgets, and closures simply send patients toward the next already strained emergency room.

MLKCH expects to lose between $80 million and $100 million next year because of the law, roughly 20% of its total budget. Lower enrollment would leave the hospital unpaid for some patients, while restrictions on provider taxes are expected to cut related payments by about half.

One possible lifeline is a county sales tax of half a cent that narrowly passed in June and could provide MLKCH with $47 million annually. The Libertarian Party of L.A. County sued to block the tax, leaving the collected money in escrow while the courts consider the case.

MLKCH also hopes to receive another $5 million to $10 million through Measure B, a property tax approved in 2002. The hospital has never received ongoing funding from the measure, although $29 million in leftover disbursements during the past three years helped save it.

Other possibilities remain uncertain. MLKCH hopes an alternative Medicaid supplemental payment arrangement could provide $30 million, while another $20 million might come through increased county payments for indigent care, though the county faces its own financial problems.

Kaiser Permanente announced a $25 million grant in August, but that money is restricted to capital expenses for expanding the emergency department. The proposal would redesign a large area and add treatment bays, yet even that project would not create enough room to match demand.

MLKCH continues adding services despite the financial pressure. Its outpatient diabetes management program has reduced amputations, once its most common surgery, to zero, while a mental health unit called EmPATH has freed some emergency department space.

The hospital also kept its maternity ward open despite financial losses because local alternatives are scarce. At the same time, larger hospitals often refuse transfers involving Medicaid patients, leaving MLKCH trapped between inadequate public reimbursements, private insurers, and consolidated hospital systems.

Batchlor warned that the consequences will extend beyond South L.A. if hospitals serving poor communities disappear. “Some patients will die without the services they need.”