Chances are that if you are reading this, you have employer-provided health insurance. While you might worry about the young adults in your family or the lower wage workers in your organization, you also know that if you are sick, you can go to the doctor.

Incredibly, 144,873 residents of Fairfax County have no health insurance. That's more than 13 percent of the slightly more than 1 million people who live in the wealthiest county in the nation. Household income in Fairfax County averages more than $122,000 a year.

Under the health care reform act, many of Virginia's uninsured residents could be covered by an expansion of Medicaid that would be paid for almost entirely by federal funds. But while the reform act itself was upheld by the U.S. Supreme Court, the court also opened a door for states to opt out of the expansion of Medicaid.

From a practical perspective, declining federal money to provide healthcare to uninsured Virginians makes no more sense than declining federal funds for transportation because you don't like the feds telling you to wear your seatbelt.

But Gov. Bob McDonnell says expanding Medicaid is a terrible idea.

The state's refusal to be included in the program would deny health insurance coverage to a quarter-million Virginians, said U.S. Rep. Gerry Connolly and others in urging McDonnell to accept the expanded coverage.

Medical care for uninsured Virginian adds up to $1.65 billion a year in uncompensated costs. Medicare expansion would help reduce that by $860 million per year, according to the Virginia Health Reform Initiative Advisory Council.

Virginia stands to lose more than $9.2 billion in federal funds over the first five years of the new law if it opts out of the provision that expands Medicaid to individuals and families with incomes up to 133 percent of the poverty level, $14,856 for an individual; $30,656 for a family of four, Connolly said.

A revealing look at the possible local role of the health care reform act appears in this week's Mount Vernon Gazette, written by Del. Scott Surovell (D-44).

Surovell represents a district of 80,000 residents with stark differences between wealthy and poor in Fairfax County. The Mount Vernon area district is tied for the highest percentage of Medicaid beneficiaries in Fairfax County. One in seven people in the 44th District receive health insurance from Medicaid; 74 percent of these are children, 5 percent are pregnant, 6 percent are poor adults, with the rest elderly residents and people with disabilities. Surovell reports the largest number of Medicaid births at any hospital in Virginia occurs at Fairfax INOVA Hospital. The 44th District has a higher percentage of uninsured individuals compared with the rest of Fairfax County.

Surovell argues that his district desperately needs the help that would come with the expansion of Medicaid and other provisions under the new law.

Here is how he explains the mechanism: Health insurance reform would expand coverage by two means. First, if states expand their Medicaid programs to all individuals at 133 percent of Federal Poverty Level, the federal government picks up 100 percent of the cost in 2014-2016, and 90 percent after 2020. Second, states are required to set up healthcare exchanges to make more affordable health insurance available for individuals without employer health insurance benefits, and individuals with incomes between 100-400 percent of the federal poverty level receive a tax credit to help with the cost. Coverage was also expanded by banning coverage denials based on pre-existing conditions and requiring companies to cover college students through age 26.