Depending on who's doing the numbers, Georgia's cost to expand its Medicaid program under the health reform law has been projected at between $2 billion and $4.5 billion over 10 years.

But there has not been a publicly available breakdown of potential savings in current state and local spending under an expansion of the government health program.

Those savings would come largely from the federal government paying for at least 90 percent (100 percent the first three years) of the cost of prisoners' hospitalizations; community behavioral health services for many low-income adults; and a Medicaid program for people with high medical costs.

These savings "are flying under the radar'' in the current debate about the costs of expansion, says Tim Sweeney, health care analyst for the Georgia Budget and Policy Institute (GBPI).

The U.S. Supreme Court last year, in its one significant weakening of the Affordable Care Act, made Medicaid expansion more of a choice for states than a requirement. So far, Georgia is among the states that have no plans to pursue expansion.