Medicaid expansion: An irresistible tide?

A solid majority of states, if not all, will eventually expand their Medicaid programs, say two health experts from opposite ends of the political spectrum.

Roughly half the states so far have indicated they will go forward with expansion.

Cheryl Smith of Leavitt Partners, former director of the Utah health insurance exchange for small businesses, and MIT’s Jonathan Gruber, a key architect of the Massachusetts health reform law, also told health care journalists Friday to get ready for a bumpy debut when the Affordable Care Act launches health insurance exchanges in January.

Exchanges will be new online marketplaces where individuals and small businesses can purchase health insurance, with new rules and consumer protections in place, such as a ban against insurer discrimination related to patients’ medical conditions.

An exchange will operate in every state. Georgia will have the federal government run its exchange, as will dozens of other states.

Health insurance exchanges, part of the ACA, are “an idea whose time has come,’’ Smith said at a Boston conference of the Association of Health Care Journalists.

But she also listed several potential stumbling blocks for ACA exchanges to be running on time, including the need for data interfaces with Medicaid, state insurance departments, insurance plans and the federal government.

Open enrollment begins in October. (Here’s an AP article about the form that people will fill out to join an exchange.)

Gruber said that journalists should expect the same type of disarray that occurred when Medicare’s prescription drug benefit debuted in 2006.

“This is going to be a mess,’’ he said. “It’s going to take a year or more” to straighten out.

But Gruber added that the likelihood of a rocky start for the program “does not mean it’s a bad idea.’’

Outreach is crucial for the success of health reform, Gruber said. Massachusetts, in setting up its insurance exchange program, used various outreach strategies. One of them was to target fans during Boston Red Sox baseball games, urging them to obtain insurance. Now about 97 percent of residents are covered.

Massachusetts Gov. Deval Patrick, a Democrat, told the journalist group Thursday that the success of the state’s reform effort was largely achieved through marketing. “We sold it,’’ he said.

Health reform in Massachusetts was enacted under Patrick’s Republican predecessor, Mitt Romney. But Romney, in his unsuccessful presidential bid in 2012, distanced himself from how it ultimately was implemented.

In Georgia, it’s not clear what efforts are being made to market the coming exchange to the thousands of people who will be eligible for it.

There will be winners and losers under the ACA insurance changes, Gruber said. Young people who are not poor will see their premium rates increase, he said, while lower-income individuals will see a decrease. But the vast majority of people in self-insured employers will not be affected, he predicted.

Small firms may see a slight increase in health costs, Gruber added.

Smith said accountable care organizations – alliances of providers and/or insurers – may opt to offer plans in an exchange.

While Smith predicted that a majority of states will expand their Medicaid programs, Gruber was more emphatic. “Eventually all states will do Medicaid expansion,’’ he said, noting that the 100 percent federal funding for the first three years will be a huge stimulus.

Any state that rejects expansion, Gruber said, “is doing a massive disservice to its citizens.’’

Democratic governors have shown a strong willingness to pursue Medicaid expansion. Several Republican governors have recently accepted expansion, too, despite strong opposition to it within their party. But other GOP governors, including Georgia’s Nathan Deal, continue to declare they won’t accept it.

Deal, who has expressed skepticism about the federal funding guarantees, says Medicaid expansion would prove too costly to the state in any event, adding to the expense of a financially strapped program.