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With two weeks left in the 2014 General Assembly session, Gov. Terry McAuliffe is stepping up the offensive against state house Republicans firmly opposed to expanding Medicaid under the federal Affordable Care Act.

McAuliffe, a Democrat, delivered his pro-expansion pitch in Loudoun County Monday afternoon when he spoke at an Inova Loudoun hospital conference room packed with health care professionals, most of whom support adding as many as 400,000 Virginians to the Medicaid rolls through the Affordable Care Act.

Health care systems like Inova Loudoun, Mr. McAuliffe said, simply can’t afford not expanding Medicaid through the federal Affordable Care Act. Moreover, residents of the commonwealth shouldn’t be sending tax dollars to Washington only to have that money dispersed to the dozen-plus other states that have accepted the Medicaid expansion, the governor said.

Oft-used projections state Medicaid expansion in Virginia will create as many as 30,000 jobs and inject more than $2 billion annually to the state.

Not expanding Medicaid will cost the Northern Virginia Inova system -- the largest not-for-profit heath care provider in the D.C. Metro area and one of the largest Medicaid providers in Virginia -- more than $95 million in 2015 alone, according to a presentation from Inova hospital executives Monday.

“With $324 million saved out of our budget in the next two years, what could we do with that? We could have 600 more family doctors, 2,100 new police officers, 2,300 social workers or 2,400 new firefights or 5,300 home health care aides,” McAuliffe said Monday. “ … That’s why this is so important.”

Republicans in the House of Delegates have voiced severe skepticism that the federal government will make good on its promise to pay for the bulk of the expansion -- a promise that includes covering 100 percent of the expansion costs the first three years and 90 percent thereafter.

Thus far, in nearly two months of debate in Richmond, the vast majority of GOP lawmakers haven’t budged in their opposition to Medicaid expansion. Last week, the GOP-dominated House voted 67-32 to oppose growing the state health care program.

“Even without expansion, Medicaid is one of the largest and fastest-growing parts of Virginia’s operating budget,” Del. Tag Greason (R-Dist. 32), who opposes expansion, said in a recent email. “Medicaid has grown from 5 percent of the state budget to more than 21 percent … This was already a cause for concern, but adding 248,000 to 400,000 more to the Medicaid rolls will jeopardize the entire system.”

State Del. Dave LaRock (R-Dist. 33) said Gov. McAuliffe “is trying to sell Virginians a promotional package and ignoring the long-term fiscal implications.”

“What he isn’t telling us is how this program will be paid for when federal support begins to drop off in just six years,” Mr. LaRock said in a prepared statement. “How high does he intend to raise taxes? What programs does he plan to cut? Pushing a program like this without any plan to pay for it equates to a huge unfunded mandate.”

Yet another long-time Republican, Virginia Secretary of Health and Human Resources Dr. Bill Hazel, who served under former Gov. Bob McDonnell and was reappointed by Mr. McAuliffe, is backing expansion. Mr. Hazel said Virginians will send $20 billion on a “one-way ticket to Washington” if Virginia doesn’t participate in the expansion.

“It took me awhile to understand the program, but as the economics have become clear … I do believe we need to find a way to ensure everybody,” he said.

Gov. McAuliffe, who made Medicaid expansion a key issue last year in his campaign, said expansion isn’t about politics -- it’s about bringing tax dollars back to the commonwealth.

“This is the right thing to do socially, morally and it also happens to be the right thing to do economically,” the governor said.

“Today, since January 1, we have already forfeited $270 million dollars that would’ve come into Virginia, rolled through our economy and helped provide care … $270 million dollars, it’s gone,” he added. “Every day we wait, another $5.2 million of our money, I remind you, is lost.”