Edited sentence: EDs have also been inundated with patients seeking test and/or exams that generally require long waits for approval by their HMO health plans and patients referred to the ED for admission by their primary physicians who are afraid of being denied payment for pre-admission tests a health plan administrator may decide was not medically necessary.Many have responded by closing their Emergency Departments, further overcrowding surrounding Emergency Departments that have stayed open.Natural or man-made disasters can now quickly overwhelm and shut down even the largest medical centers leaving people without access to any medical care.The combination of these factors has resulted in increasingly longer waits for even seriously ill patients as most EDs in America routinely operate well beyond their designed capacity.The cost of performing these exams has resulted in growing financial losses for hospitals.The latest example of this happening was in New Orleans after hurricane Katrina overwhelmed the cities levee system.The overcrowding is further exacerbated by uninsured or under-insured patients who are forced to use Emergency Departments as their primary care facility because they have been turned away elsewhere.Wait times exceeding 12 or even 24 hours are no longer uncommon in most American cities under normal circumstances