Gov. Nathan Deal’s decision to reject the expansion of Medicaid prescribed by the Affordable Care Act would leave thousands of the poorest Georgians uninsured and threaten the bottom lines of hospitals that were counting on new income from the changes.Deal’s spokesman noted Wednesday that the governor might agree to expand Medicaid if the federal government gave Georgia a “block grant” of money and the freedom to tailor the program as it saw fit — none of which is currently in the health care law. Without that flexibility, Deal believes the state could not afford the expansion.“The fix for an unsustainable program is not to make it even more unsustainable,” spokesman Brian Robinson said.Word of Deal’s decision set off a wave of anxiety among hospital officials and patient advocates in the state, with one saying that the governor is “certainly putting hospitals at risk,” and another calling the decision a mistake.“I have diabetics who lose legs because they do not get wound care or get to see a podiatrist,” said Carole Maddux, CEO of Good Samaritan Health & Wellness Center in Pickens County.