Shayna Smith, right and Andrea Jergens, left, RNs at Mercy Hospital in Moundridge, Kan., view patient information at the hospitals nurses’ station. The photo illustrated a Gatehouse News Service story on the impact of the Affordable Care Act on rural hospitals. A common thread in the coverage of ACA’s impact is that rural health care providers in states that refuse to expand Medicaid are going to have a tougher time than states that chose to expand Medicaid.