States Report Medicaid Surge After Health-Law Rollout - Great news: More in the wagon, fewer pulling the wagon as prisoners, the homeless & foodstamp recipients are recruited. - Obamacare may yet sink on its own weight. 'It's not about how many people sign up in Medicaid, but how many sign up in the exchanges.'

From The Wall Street Journal:

Some states are signing up tens of thousands of new Medicaid enrollees in the initial weeks of the health law's rollout, while placing far fewer in private health insurance—a divergence that suggests Medicaid expansion may be a larger part of the law than expected.

In one sense, the Medicaid figures are good news for the Affordable Care Act's advocates, who hoped the law would reduce the number of Americans without health insurance.

But the predominance of Medicaid enrollees so far could also fuel criticism that the law will lead to a greater government grip on the health-care system, instead of leaving room for private health insurers to grow.

Even before HealthCare.gov launched with glitches, Medicaid expansion was expected to play the leading role in bringing coverage to Americans in 2014. The Congressional Budget Office projected in May that nine million Americans would be added to Medicaid's rolls in 2014, while it said seven million would sign up for private coverage through new health-insurance exchanges.

The troubles of the federal website—which serves consumers in 36 states that don't run their own insurance marketplaces—are putting that seven million figure in jeopardy. The Medicaid expansion, however, looks closer to being on track.

Some states like Maryland, Washington and California are using aggressive outreach to get people into Medicaid, including contacting those who are already on other programs such as food stamps, said Matt Salo, executive director of the National Association of Medicaid Directors.

"When you actively go out and aggressively target people, they sign up," he said.

In Maryland, state officials spent the past several months reaching out to people in homeless shelters and soup kitchens as well as soon-to-be discharged prisoners. Some were already enrolled in a state program that offered limited health benefits, and About 88,000 are set to transfer Jan. 1 into Medicaid, according to Chuck Milligan, Maryland's Medicaid director.

Medicaid, a federal-state health-insurance program for the poor, was long aimed at women, children and the elderly poor. The Affordable Care Act expanded it to cover people earning up to 133% of the federal poverty level.

After the Supreme Court in June 2012 gave states the choice of whether to join the expansion, roughly half of all states decided to do so.

About half of all states aren't joining the Medicaid expansion. Many cite fears about covering the costs over the long term or expanding government.

Critics of Medicaid expansion say the program is already overburdened and may not improve the health of enrollees. Some are also raising concerns that expanding Medicaid could siphon off some younger, healthy people who could otherwise have gotten private coverage.If private insurers end up with an older, sicker population, it could threaten the Obama administration's promise of affordable coverage, said Drew Gonshorowski, policy analyst at the think tank Heritage Foundation, which opposes Medicaid expansion. "They need young, healthy individuals to support them so premiums don't go up next year," he said.

Insurers already factored in higher Medicaid enrollments when estimating premiums for uninsured Americans who may now buy private insurance, said Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's trade group."There is broad agreement for the new marketplaces to work there needs to be broad participation from the young and healthy to offset the costs of older people with more health care costs," he said. "It's not about how many people sign up in Medicaid, but how many sign up in the exchanges."