Chandler Ralph is head of Adirondack Health, headquartered in Saranac Lake.

"The worst case would be $4 million," she says, "which would be 4 percent. Which would be huge, huge for our system."

Hospital administrators say both CVPH and Adirondack Health operate with a one percent margin in their budget.

Daniel Ashline-Beaudet is president of the Service Employees International Union at CVPH.

"My biggest concern is we are going to lose people who provide quality care," Ashline-Beaudet says. "I'm concerned that if they don't maintain the revenue they're not going to maintain the staff and have cutbacks and layoffs."

Stephens Mundy, head of CVPH, says these are budget issues that can't be solved by staffing adjustments alone. The hospital will have to look at which programs earn money, and which don't.

"I just think that you would have to say that services would be cut. And I'd have to look at it at that time and say okay – those would be just terrible decisions to make."

"We'd have to look at all our services," adds Chandler Ralph. "Can we run two nursing homes? Can we run two hospitals? I mean I could go on and on – I don't think anything is off the table. It's depressing, because health care is such a basic fundamental right for people in our community."