MINNEAPOLIS — The Hennepin County Board of Commissioners has approved a budget that will mean job cuts at Hennepin County Medical Center in downtown Minneapolis.

The facility is planning to reduce its workforce by as much as 4 percent next year. The elimination of up to 275 full-time positions is aimed at balancing the hospital’s budget and keeping the opening of a new ambulatory and outpatient surgery center on schedule. The more than $200 million expansion is expected to open in 2018.

The hospital’s CEO, Dr. Jon Pryor, said an issue faced by facilities this year that served many uninsured and low-income patients was expenses outpacing income by $11 million.

Commissioner Jan Callison said she understood the challenges the hospital is currently facing.

“For those of us who serve on the hospital board, who’ve put in a lot of time, for those at the hospital itself who deal with this every day, it is difficult to come in here with these numbers,” she said.

The medical center currently employs more than 6,800 people.

Peter Zeftel, a longtime patient, voiced his concerns to the commissioners about the impact to patients. But commissioners rejected his request for public hearings.

“How many poor people are going to die because they’re denied medical care because of cuts?” he said.

Hospital leaders have bemoaned the high share of patients covered by the state’s Medical Assistance program. They say the state’s program poor and disabled residents reimburses hospitals and clinics below the cost of caring for patients.