Since the Supreme Court ruling on the health reform law, many Georgians involved in health care have been hyper-interested in the state’s decision whether to expand Medicaid.

The reform law envisions that the states will expand Medicaid, and it originally limited their flexibility to refuse. But the court, in its June ruling, restored that flexibility. So expansion is a hot issue in Georgia as well as other states.

For those opposing the Affordable Care Act, which they call Obamacare, the November elections are crucial. Republicans have promised that if they win the presidency and full control of Congress, they will repeal the act.

Under that scenario, the Medicaid expansion issue would disappear. There would be nothing to decide.

But if President Barack Obama wins, or if Democrats remain strong enough in Congress to block repeal, expansion is still on the table. And consumer advocates as well as some industry officials are formulating arguments to persuade Georgia’s Republican political leadership that adding to the Medicaid rolls would be beneficial.

Medicaid, jointly financed by the state and federal governments, currently covers 1.5 million poor and disabled Georgians.

If the state expands its Medicaid program, more than 600,000 lower-income people will become eligible for coverage.

That represents a “huge impact’’ in terms of numbers of people, Judith Solomon of the Washington-based Center on Budget and Policy Priorities told consumer advocates and health care officials Thursday at an Atlanta event hosted by Healthcare Georgia Foundation.

Attendee Cindy Zeldin of the group Georgians for a Healthy Future said a grass-roots coalition of advocates, managed care companies and medical providers have come together to work toward promoting Medicaid expansion.

Mary Eleanor Wickersham, a Valdosta State University professor, also said medical provider groups, convening earlier in the day, had discussed possible benefits of Medicaid expansion.

That meeting included representatives from hospitals, pharmacies, insurance companies, public health and community health centers, she said.

Gov. Nathan Deal recently came out in opposition to Medicaid expansion. Later, through a spokesman, Deal qualified his stand a bit, saying the state might be willing to consider expansion if the Medicaid program is converted to a block grant, giving states more flexibility on how to run it. (Here’s a related GHN article.)

If a state expands Medicaid, 100 percent of the cost would be picked up by the federal government for the first three years, and 90 percent thereafter.

Deal, in a recent AJC editorial, voiced doubts about the ability of the federal government to follow through on that guarantee.

“Washington’s new costs in Georgia alone will amount to $40 billion over 10 years,’’ Deal said in the editorial. “Even if it does live up to its end of the bargain, there’s no money in state treasuries to cover our part of the bill.’’

Changes to Medicaid will cost about $4.5 billion in additional state tax dollars over 10 years, Deal said.

“States, Georgia included, will have to choose between job-killing tax hikes and immense cuts that will dramatically affect public education and public safety.’’

(Here is a link to Deal’s editorial and to one that supports expansion.)

Medicaid is already under extreme financial pressure. For the 2013 and 2014 budget years, the state faces a $700 million shortfall in its Medicaid program, Deal noted.

And the state’s hospital tax is nearing expiration. If that levy is not renewed, Georgia would lose another $600 million for Medicaid.

Still, much of the Medicaid shortfall has to do with chronic budget underfunding, experts note.

Tim Sweeney of the Georgia Budget and Policy Institute pointed out that Georgia spends the second-lowest per-beneficiary amount on Medicaid among the 50 states.

Solomon, of the Center on Budget and Policy Priorities, said Thursday that hospitals face a “double whammy’’ if Georgia declines to expand Medicaid. The Affordable Care Act will cut funding for hospitals that serve a “disproportionate share’’ of low-income patients.

If a state declines to add to Medicaid, hospitals will lose that federal funding and not get the revenue increase from newly insured patients to offset it.

Among benefits that consumer advocates listed for expansion were the economic impact of billions of federal funding; newly insured patients to help keep rural hospitals open; and alleviating the burden on sheriffs in dealing with uninsured residents with mental health or substance abuse problems.

The current Medicaid program in Georgia, though, already has problems besides the financial shortfall, with medical providers citing low pay and hassles in dealing with insurers.

Wickersham unveiled a survey of 1,400 physicians in Georgia that showed half of them do not accept new Medicaid or PeachCare patients.

The state has a substantial physician workforce gap, with a primary care scarcity in many rural communities.

Opponents of expansion warn of a possible flooding of an already overtaxed system if the Medicaid rolls increase.

But consumer groups point out that if there’s no expansion, it could lead doctors and other medical providers to flee Georgia for states that have higher percentages of patients with insurance.