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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Drs Prasad and Klingner make a critically important point that health insurance is not the only determinant of health care access. Penchansky and Thomas,¹ building on the work of Donabedian and others, summarize the "five As of access to care" as affordability, availability, accessibility, accommodation, and acceptability.

The studies we reviewed reported that some patients did report the ED as their usual source of care.² Uninsured patients were less likely to have a usual source of care than insured patients, but the best studies also showed that these patients were less likely to use EDs,^3-4 supporting Prasad and Klingner's point that past use predicts future use, as well as our concern that uninsured patients may delay ED use even when clearly medically indicated.

Prasad and Klingner are also accurate in pointing out that lack of satisfaction with available primary care,⁵ lack of trust in local clinicians (seen particularly . . . [Full Text of this Article]

Carla C. Keirns, MD, PhD, MS
carlak@umich.edu
Division of General Internal Medicine

Manya F. Newton, MD, MPH, MS
Department of Emergency Medicine
University of Michigan
Ann Arbor

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