She said she believes she will cost the medical system less by managing her chronic condition rather than racking up big emergency room bills.

Officials, too, expect long-term health savings from providing coverage to more people, said Chuck Milligan, a deputy state health secretary who runs the Medicaid program.

He cited an analysis by the Hilltop Institute at the University of Maryland, Baltimore County that found $672 million in net savings from implementing the Affordable Care Act in Maryland by 2020. The largest savings will come from moving more people to Medicaid from a state-funded health program for low-income adults.

All state residents will benefit, Milligan said, because hospitals will see cost savings from an expected reduction in uncompensated, or charity, care — expenses now passed on to everyone in higher hospital rates.

"A huge number of people are going to benefit from the expansion," he said. "It was a no-brainer. …It's a win for patients, for the state, for hospitals, for everyone."

A recent study by the Commonwealth Fund supports that view. It also found that states forgoing the Medicaid expansion not only will lose money to help cover their residents, but will pay for other states' expansions through higher taxes assessed to pay for the reform law.

An analysis by the conservative Heritage Foundation found that only 10 states, including Maryland, would see a substantial savings from Medicaid expansion by 2022. Forty other states would eventually pay more, losing a combined $37.9 billion.

Maryland, the group found, would see savings of $1.9 billion over 10 years. New York would achieve savings of $33.8 billion.

But, the analysis read, "The states will only save by shifting the burden to the federal government."

That doesn't sit well with congressional Republicans, including Harris, who, with others, has introduced a bill to shift some of the financial responsibility back to the states.

"The Medicaid expansion is not without risk to the states," he said. "Once people are on Medicaid, it's mighty hard to take them off."

Harris also said adding so many people to the Medicaid system will put a strain on physicians. While he noted that Maryland lawmakers agreed to pay doctors more to provide services to Medicaid patients, the fees are only equal to Medicare payments and are not what physicians earn for treating patients with private insurance.

But the Maryland state medical society, MedChi, said more doctors plan to see Medicaid patients because of the increase. A recent MedChi survey of 251 Maryland physicians found that close to half of doctors who do not accept Medicaid are considering adding them, and more than half of doctors who already see Medicaid patients plan an increase.

There are up to 14,000 doctors actively practicing in Maryland, and about a third accept Medicaid.

"They're saying we can make it work," said Gene M. Ransom III, MedChi's CEO. "More people in Maryland are getting insurance, and now they'll have a doctor to go to."

meredith.cohn@baltsun.com