More than 140,000 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. Arlington and Alexandria have similar percentages of uninsured.

These are some of the 400,000 people in Virginia who could receive health coverage under an expansion of Medicaid if only officials in the commonwealth are gracious enough to accept on their behalf.

Virginia’s current eligibility requirements for Medicaid are so strict that although it is the 11th largest state in terms of population and seventh in per capita personal income, Virginia ranked 43rd in Medicaid enrollment as a proportion of the state’s population and 47th in per capita Medicaid spending, according to a 2013 Fairfax County report.

Virginia has the option to add new coverage, at least 90 percent funded with federal dollars, that would extend to individuals earning less than about $15,000 per year and families earning less than about $31,000 per year, to low income teens who lose Medicaid when they turn 19, and adults with disabilities not currently eligible.

It isn’t as if there is no health care cost for these currently uncovered residents. Right now, they access health care when they are very sick by going to an emergency room, where the hospital spreads the cost of care around. But this is inefficient, expensive and unhealthy. Expanding Medicaid coverage would allow far less expensive preventative care and lead to better health outcomes. Uninsured people don’t receive preventative care; they seek treatment later in illnesses when the costs are much higher, and the consequences in terms of lost days at work and other productivity are also much higher.

Expanding Medicaid to 133 percent of the poverty level would generate state general fund savings and new revenues that would total more than $2 billion and more than offset the state’s share of expansion costs over the next eight years, plus provide significant numbers of new jobs and economic growth, according to multiple reports including the Virginia Hospital and Healthcare Association. Expanding health care is a job creator, and would add tens of thousands of new jobs.

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.

Turning away 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.

If Gov. Bob McDonnell and members of a General Assembly panel considering whether to accept funding to expand Medicaid decide against this benefit for 400,000 Virginians, perhaps they and their families should go for a year without health insurance as well.