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The refusal of Virginia’s Republican legislators to support any form of Medicaid expansion for low-income Virginians is immoral and irresponsible.

It’s immoral because it denies access to needed health services for more than 300,000 lower-income, mostly working Virginians who would be newly covered (according to Urban Institute estimates). To suggest, as one recent letter to the editor claimed, that currently uninsured people already have adequate access to doctors and hospitals through charity care is simply untrue. Extensive research shows that compared to those with health coverage, uninsured people postpone or fail altogether to get needed care and fill prescriptions, that when they do get care it is worse care, and that they are more likely to die when ill.

It’s irresponsible to block Medicaid expansion because the result would be that Virginia would lose approximately $15 billion of federal money over 10 years that would otherwise go to Virginia hospitals, physicians, and healthcare providers and that would ultimately have substantial positive economic spillover effects throughout the state as this money is spent by the original recipients and flows into the economy.

It’s irresponsible because it means that Virginia taxpayers are contributing their federal tax dollars to support Medicaid expansion in other states while Virginia gets nothing back.

It’s irresponsible because failure to expand Medicaid will actually reduce the amount of federal money that Virginia hospitals receive to support the costs of care they provide to lower-income people who cannot pay the full costs of their care. The Affordable Care Act changed the previous system for federal support of such uncompensated care, reducing the direct payments to hospitals because the federal government would now be paying for virtually all of the costs of these services through Medicaid expansion. The ACA would cover the entire costs of care for new Medicaid enrollees for the first two years and thereafter would cover no less than 90 percent of the costs on into the future.

It’s irresponsible because if Virginia fails to expand Medicaid, the costs of uncompensated care won’t go away; they will simply be passed on in the form of higher premiums to Virginia employers and everyone who pays for private health insurance. The result: we turn down federal help that would lower our premiums, and we pay more.

It’s irresponsible to argue that Virginia should pass up the “free” federal money that covers 100 percent of Medicaid expansion now and 90 percent on into the future on the off-chance that a future Congress could renege on the promise to pay. If that were to happen, Virginia could “un-expand” Medicaid.

It’s immoral and illogical to deny people needed health care services in the present for fear that sometime in the unforeseeable future it might be necessary to reduce those services.

The opposition to Medicaid expansion in Virginia is not based on morality, logic, or even fiscal prudence.

It’s time for Virginia’s Republican legislators to set aside their distaste for ObamaCare and to act morally and responsibly. They need to find a way to accept federal funding to support expansion of health coverage for lower-income working people in the Commonwealth.

Elliot K. Wicks, Ph.D., Reston

The writer is a retired health economist, researcher, and policy analyst who worked for more than 30 years on issues related to finding ways to provide health coverage for uninsured Americans.