Phil Ennen runs a rural hospital system in northwest Ohio that admits about 2,500 people a year, many of them poor or elderly. He's got the only emergency cardiac catheterization lab between Toledo and Fort Wayne, Indiana. Ennen estimates he'd be out $1.3 million a year and struggle to stay independent if business groups and Governor John Kasich can't persuade fellow Republicans to expand Medicaid to cover more poor people under President Barack Obama's Affordable Care Act. "I don't have any time to be political about this," Ennen, 50, said in a telephone interview from Bryan. "I'm going to have people walking through our door needing care who should have a source of payment and won't, and that's frustrating."