There have been mixed reactions regarding the Affordable Care Act after it was upheld by the Supreme Court last week. And while the disagreement has become a hot political issue, it's the hospitals that will ultimately see the biggest impact. Our Cara Thomas spoke with two different rural hospitals in the North Country about their current financial situation and how the new law might help.

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ST. LAWRENCE COUNTY, N.Y. --"There are many challenges being a rural hospital. Especially in a rural area with a limited population base," said Robert Kimmes, CEO of Clifton-Fine Hospital.

Hospitals across the country have one mission: to provide the best care for their patients. But in rural areas, it can be a more challenging feat. And hospital officials say it all begins and ends with cost.

Rick Jacobs, the Vice President of Finances at Canton-Potsdam Hospital, said, "For us, our Medicaid, Medicare population is more than 60 percent of our business. And the more business you have that's funded from Medicare and state programs, the harder it is to strike that financial balance."

A lack of quality insurance forces people to choose the cheaper options.

"With a shift from in patient care to outpatient care, it does impact the volume of patients we have and the revenue generated by the hospital," said Kimmes.

Low income patients will also avoid expensive tests even when they're necessary and sometimes, hospital bills aren't paid at all. It's those choices that keep hospitals from accomplishing their mission. But hospital officials hope now that the Affordable Care Act has been upheld by the Supreme Court, things could change for the better.

Jacobs said, "The Affordable Care Act is hoping to expand coverage, the Medicaid program. Therefore, we would have less charity care, less uninsured patients that would come to our hospital for care, hopefully improving our reimbursement."

"It's hard to say what the impact is going to be. We're going to have to wait and see," said Kimmes.

So officials will have to wait to see if with insurance, more people will go to the hospital for care and more of that care will be paid for. That could mean more money for hiring and more services offered. And that could once again mean more money to the hospitals, hopefully continuing a cycle of financial stability.

Local government officials say they are aware of the financial constraints in rural hospitals. Senator Patty Ritchie says she is working to pass a new bill that would provide additional funding for rural health care institutions.