POTSDAM -- A repeal of the Affordable Care Act would have serious, long-term negative consequences to the region’s health care providers, St. Lawrence Health System CEO David Acker believes.

The upcoming vote on the American Health Care Act is a pivotal moment for North Country hospitals. Today’s scheduled House of Representatives vote on a Republican health care bill to replace “Obamacare” is expected to be extremely close.

The exact time of the vote is not known.

The new bill, nick-named “Trumpcare,” would likely cover far fewer people than the ACA, allow insurers to raise deductibles and out-of-pocket costs, and cut Medicaid by large amounts, analysts say.

A repeal of the bill would have severe, negative impact on rural hospitals and lower income people, Acker said.

“I would strongly encourage our elected representatives to oppose this legislation in its current form,” Acker said in a prepared statement. Canton-Potsdam Hospital and Gouverneur Hospital operate under St. Lawrence Health System.

“Many will lose their existing coverage, adding to the negative impact on our region's residents,” Acker said.

A report released by Gov. Cuomo in January says that over 11,000 St. Lawrence County residents would lose insurance if the ACA is repealed. The report says over 2.7 million residents statewide would lose their insurance.

“Rural areas such as ours are heavily dependent on Medicare and Medicaid reimbursement and its healthcare infrastructure is innately fragile,” Acker said.

In January, Acker said as part of the negotiation that occurred in the creation of the ACA, there was an agreement between Medicare and hospitals: cuts to Medicare reimbursement were passed.

In exchange, having more people insured through expanded Medicaid and health care exchange subsities was presumably to offset these cuts, Acker said.

Lawmakers have not offered a replacement for the lost incomes CPH could face.

Disproportionate Share payments (also known as DSH payments), which are supposed to offset rural hospitals' disproportionate share of Medicaid patients, have been substantially reduced; they are still being reduced and will go away and there is nothing on the horizon to replace these payments, Acker said in January.

If the reimbursement that was taken away remains and there is no off-setting revenue which the ACA provides, then that hurts rural hospitals.

Acker said rural hospitals have a heavier reliance on Medicare and Medicaid than in urban places. Rural America is where you find the smaller hospitals and smaller means fragile.

The ACA was made to solve issues in the individual insurance market, which is made up people not covered through workplace insurance or government programs.

Under the old system, insurance companies could deny coverage to people with pre-existing conditions or charge higher premiums. Obamacare (ACA) requires insurers to accept everyone, regardless of health and charge the same price.

Everyone is required to buy insurance or pay a penalty. To help people afford their plan, the law pays out subsidies to people making up to 400 percent of the federal poverty line. It also offers states more Medicaid dollars to cover adults at lower incomes.