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Americans, insured and not, make ample use of hospital emergency rooms: One out of every five visited an E.R. at least once in 2007, the latest year for which the National Center for Health Statistics has data.

With fewer places to turn, mental health patients are overwhelming Sacramento County emergency rooms – increasing wait times, straining law enforcement and exposing the limited ability of ERs to deal with serious mental disorders.

Small hospitals in the central San Joaquin Valley, faced with a shortage of radiologists, are turning to companies that employ doctors from across the country to remotely read X-rays and other scans.

UCSF researchers found that ERs are increasingly serving as "safety nets" for basic health care services. Adults on Medi-Cal (Medicaid) visited ERs 5 times more often than adults with private insurance, creating longer wait times for everyone.

The California Health Care Foundation offers a consumer-friendly breakdown of what health care reform means for Californians. It includes highlights of the new law, a timeline of when the changes happen and what coverage options, new costs and benefits are available for those with or without insurance.

What Californians Should Know

In 2007 there were 400 general acute care hospitals in California. The number declined 4 percent between 2001 and 2007. The number of licensed beds also declined by 4 percent from 2001 to 2007. During the same time, the state’s population increased by 9 percent.

The 90-day anniversary of the signing of the federal health care overhaul has come and gone. While budget matters have stalled in the California Legislature, lawmakers are making progress with legislation to implement the federal health reform.

The hard-fought health reforms slowly taking shape across the country are intended to help provide better access to care -- but they could mean financial trouble for so-called "safety-net" hospitals that take care of the poor.

A report detailing record-long waits at the nation's emergency departments comes as no surprise to emergency physicians, who say waits will lengthen as health coverage expands, emergency departments close, and hospitals fail to improve admitting processes.

While the focus regarding health care reform has been on the complexity, cost, and political posturing, one issue hasn’t gotten nearly enough coverage. It’s the very real question of whether health care reform will increase ED patient volumes across the country