The crux of North Philadelphia Health System's perpetual financial struggles is that 65 percent of St. Joseph's Hospital's revenue comes from Medicaid, which pays less than it costs to provide care. The future does not look brighter, said William E. Aaronson, a professor at Temple's Fox School of Business. With the "implementation of the Affordable Care Act, hospitals that have high Medicaid and Medicare loads are going to be even more stressed," he said.