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In this Friday, Jan. 24, 2014 photo, emergency care center paramedic Michael Gilbert cleans equipment in an exam room at Grady Memorial Hospital, in Atlanta. In two years, federal payments to hospitals treating a large share of the nation’s poor will begin to evaporate under the premise that more people than ever will have some form of insurance under the federal health care law. The problem is that many states have refused to expand Medicaid, leaving public safety net hospitals there in a potentially precarious financial situation and elected officials facing growing pressure to find a fiscal fix. And in an election year, Democrats are using the decision by Republican governors not to expand Medicaid as a major campaign issue and arguing the hospital situation could have been avoided. (AP Photo/David Goldman)

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