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CHARLOTTE - The president of North Carolina's largest health care system said the Supreme Court ruling means hospitals need to get ready.

"With more people coming into the system, having access, providing access is going to be a challenge," said Carolinas HealthCare System President Joseph Piemont.

He said the health care law will immediately impact North Carolina's hospitals.

"We tend to serve a disproportionate amount of the Medicaid population, the uninsured, the indigent folks," he said. "So to get some reimbursement from that would be a near term benefit for us."

Public health experts said the industry needs to figure out how to handle the influx of new patients.

"One of the chronic problems we have with the system is that primary care is underfunded and understaffed," said Michael Thompson, a professor at UNC Charlotte who studies public health.

As for the long-term financial impact to hospitals, executives said it's still a mixed bag.

“It could end up being a zero-sum game,” Piemont said. “That there are more people covered but the dollars remain the same and are redistributed. "

Many health care providers waited to see what the court would decide before making major changes, partly because the law was so vague.

"The statute itself was not much of a road map," Piemont said.

Providers said they still need to see what the final regulations look like, though experts admit there could be unintended consequences.

"If having more people insured brings in more forms it could actually create more bureaucracy,” Thompson said.

And hospital executives said this ruling is far from the last step in reforming our nation's health care system.

"I don't know that we've gotten to where we need to be which is how it's delivered and how it's consumed and not just how it's paid for,” said Piemont.