Hedrick Medical Center in Chillicothe stands to lose over $3 million locally by the decisions that state legislators are going to make in April regarding the Affordable Care Act, according to Matt Wenzel, HMC's chief executive officer.

"That's on top of another $2.2 million that's already going into effect because of sequestration that occurred March first," said Wenzel.

Wenzel introduced Gov. Jay Nixon Wednesday afternoon at the Chillicothe Ambulance and Fire Department, and also explained the impact of Medicaid expansion on Hedrick Medical Center and voiced support of the program.

"Here, at Hedrick Medical Center, we're going to see $3.4 million in cuts associated with the Affordable Care Act," he said. "The issue is not whether you support it or not; we're already paying the money out. It's 'Do you want the money back?'"

Deciding whether to join the expanded Medicaid program is a decision that will impact residents across the state, and especially in rural Missouri, Wenzel said.

Rural areas of the state have more to gain with expanded Medicaid because more people will qualify with the increased poverty level eligibility, Wenzel said. For Livingston County, he said, 18.5 percent of the population is under the federal poverty level. Statewide, that percentage is 14.3.

"So, we stand to gain or lose by this decision," he said. "That's not just Livingston County, but that's all rural areas."

To be Medicaid-eligible by today's standards, one's income must be below the 19 percent federal poverty level, meaning that a family of four cannot make over $4,474 a year. If eligibility requirements increase to 138 percent of the federal poverty level, a family of four with an income of up to $32,500 would be eligible for coverage.

"People who are working in lower-wage jobs that don't offer benefits are the people who are going to be affected," Wenzel said.

The Supreme Court ruled the Affordable Care Act constitutional, but the high court did not mandate it for the states. Each state must vote independently whether to accept the program, and politics shouldn't affect the decision, Wenzel said.

"Four billion dollars are leaving the state of Missouri from 2013 to 2019 from hospitals to fund this program," he said. "The money is already going out. So, it's not, 'Do we want to pay for the program, or not?' That's been decided. It's 'Are you wanting the money back?'"

Missouri's allotment from the federal government is $8.2 billion from 2014 to 2020.

"When people talk about they don't support Obamacare or should we be doing it or not, that discussion was in 2010-11 and '12," Wenzel said. "It is what it is. Those are the cards that have been dealt, and we've got to play them. It's been ruled constitutional, and we need to respond accordingly."