The Affordable Care Act was originally written such that every state would have to accept a Medicaid expansion. But the Supreme Court struck down that part of the law last year. The result is an unexpected bind for safety-net hospitals in states that are refusing Medicaid. How bad of a bind? Just look at the choices facing Atlanta's Grady Memorial Hospital. Grady, Georgia's largest hospital, with more than 950 beds, has long been considered the backbone of metro Atlanta's health-care system. It serves about 600,000 patients every year, trains one-quarter of Georgia's physicians and provides medical care to more uninsured patients than any other hospital in the state.