So-called "safety-net" hospitals are losing billions of dollars in federal aid that helps cover the cost of caring for the uninsured.
In some cases that could mean cutting services or staff and even shutting down.
In Culpeper, Virginia, Culpeper Regional Hospital is the only place to go in an emergency for miles.
For people like Michelle Olinger, hospital cutbacks or closure have a very real consequence.
"If they are talking about cutting the hospitals it's going to be really bad for a lot of people," Olinger says.
At least 25 percent of the patients rushed through the hospital doors have no insurance and can't afford the services they're about to get.
Instead, the government helps cover the cost, through hospital subsidies that will be cut by more than 18 billion dollars over the next seven years.
The Affordable Care Act mandated the cuts assuming more people would be insured in part by expanding Medicaid, but then more than 20 states decided not to expand the government insurance program for the poor.
That has left a large amount of poor people with no coverage.
Even where Medicaid is expanded, hospitals won't be fully reimbursed for the cost of care.
"You are looking at hospitals literally shutting their doors in communities that really depend upon them in possibly three or four years," says Bruce Siegel, President and CEO of America's Essential Hospitals.
Culpeper CEO Lee Kirk is fighting to preserve this community life line.
"We will remain viable but we are currently very challenged," Kirk said.
Kirk says his hospital will lose about 3 million dollars this year and a part of that is coming from the cuts to subsidies.
While that may not seem like a lot of money, with a limited operating budget that essentially eats up the buffer the hospital had.
Kirk has already cut his staff by five percent he says services could be next.
That means fewer options for some of the most vulnerable patients.
Lawmakers in both the House and Senate are considering legislation that would delay the cuts but that's not likely to pass.
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