While Florida Attorney General Bill McCollum challenges the legality of the new federal health-care law in the courts, the state's two leading health-care associations are split on the program's medical and fiscal impact.

"The federal health-care law will add millions to a Medicaid system that cannot adequately treat the people who are enrolled now," according to the Florida Medical Association.

Spokeswoman Erin VanSickle said that "while payment for primary care will be increased, unless we increase reimbursement for specialists, the access problem in this sector will get much worse.

"Obviously the state will hardly be in a position to increase specialist pay given the massive increase in enrollment that will result."

The state Agency for Health Care Administration anticipates that most, if not all, of the 4 million currently uninsured Floridians will end up on the state's Medicaid rolls.

With 2.7 million low-income residents already in the system, AHCA Secretary Tom Arnold expects that the current Medicaid budget of $19 billion would rise by at least another $1.2 billion under the federal plan.

The Florida Hospital Association is taking a wait-and-see approach, says its president, Bruce Rueben.

"There will be cuts to hospitals on such things as curbing unnecessary readmissions, but there are also a lot of Floridians who will be covered by health insurance," he said. "We don't really know the net effect yet."

But, Rueben added, there is "no reason to believe that any senior services will be cut."

The only ones taking a hit on Medicare, he said, would be the HMOs that have profited by selling Medicare Advantage policies.

Still, new analyses, including one by the Congressional Budget Office, suggest that young adults who would be required to buy their own insurance will pay an average of 17 percent to 30 percent higher premiums to compensate for the cost of senior health care.

Rueben argues that the primary focus needs to be on reforming the overall heath care delivery system. And he sees signs that could happen under Obamacare.

"Tie the payment method to outcomes instead of volume. This (national health-care reform) is a start."

The FMA, by contrast, warns that the quality of care will suffer under federal rules.

"Florida is already well below national average for number of physicians per population, signaling a current and future physician shortage," VanSickle said. "We fear that this problem will only get worse with the passage of the president’s health-care legislation."

But Rueben, of the hospital association, sees the glass as half full and filling with the federal health program.

"With 32 million more people being insured, there will be ample need for health-care professionals," he said. "The bigger challenge will be in meeting that need."

Rueben is hopeful that the federal program will "eliminate the bureaucratic nonsense" that creates an administrative drag on medical delivery. He said hospitals' back-office overhead has been growing due to ever-increasing insurance paperwork.

"I have as much reason to be optimistic as pessimistic," he said of health-care reform's ability to streamline accounting.

But AHCA is concerned that short-term gain may inflict long-term pain. While the health-care law requires the federal government to pay 100 percent of the cost of new Medicaid enrollees in 2014, reimbursements would ultimately scale down to 90 percent.

Meantime, the new law mandates that Medicaid reimbursements increase to Medicare levels, which are sometimes twice as high.