Federal healthcare reforms may not kick in officially until 2014, but that doesn't mean local hospitals aren't already feeling the effects of the complex and wide-reaching legislation. Earlier this month, St. Francis Medical Center in Trenton laid off 37 employees, blaming the downsizing partly on lower patient reimbursement rates and other anticipated changes of the healthcare reform law. Heads of some of the other area hospitals say the sweeping changes proposed in the Patient Protection and Affordable Care Act signed into law by President Obama in March 2010 have yet to affect their bottom line. But that doesn't mean hospital administrators aren't gearing up for program and revenue shifts, even as the debate over the federal health care overhaul continues. In the fight over the nation's healthcare system, most of the attention has been on the so-called individual mandate portion of the plan, the piece that will require virtually all Americans to purchase some form of health insurance.