Despite Speaker Paul Ryan’s ill-fated attempt at repealing and replacing the Affordable Care Act, Virginia Republicans recently doubled down on their opposition to the ACA and rejected a proposal by Democratic Governor Terry McAuliffe to expand Medicaid. “Every taxpayer should know that we have forfeited $10.4 billion,” said McAuliffe at a press conference. “$6.6 million of our taxpayer dollars we could bring back to Virginia, at no obligation to the state, to help 400,000 Virginians get healthcare.”

Despite Governor McAuliffe’s recent attempt to paint conservative lawmakers as heartless scrooges, Republicans are spot-on in their refusal to expand Medicaid. While Democrats fawn over a $10.4 billion pot of “free” money, sensible lawmakers stand by a familiar adage: There is no such thing as a free lunch.

First, expanding Medicaid would threaten healthcare access for all Virginians—especially those already on Medicaid. According to the Alexandria-based Galen Institute, a non-profit health and tax policy research organization, “[e]xpanding Medicaid means that patients who are already enrolled in the program—many of whom have nowhere else to go for coverage—will be competing for medical services.” Such an influx of Medicaid patients would overburden healthcare facilities and result in either higher premiums or lower-quality care for all Virginians.

For many states that have expanded Medicaid, this prediction is now reality. A 2017 study covering 15 major metropolitan areas published by Merritt Hawkins, for example, revealed a clear correlation between higher Medicaid acceptance rates and higher average wait times across five practice areas (cardiology, dermatology, OB/GYN, orthopedic surgery, and family practice). Compounding the problem, the number of doctors accepting Medicaid is less than impressive—roughly 53%, or two percent less than when the ACA was enacted. This is unsurprising, given that Medicaid frequently fails to cover even the costs of treatment, let alone fairly compensate the treating physician.

An increased demand for healthcare created by expanding Medicaid combined with a waning supply of doctors willing to accept Medicaid is a recipe for disaster. As a general law of economics, when demand outstrips supply, the value of the commodity in question (in this case, quality healthcare) skyrockets. To avoid a loss, doctors accepting Medicaid have two choices: recoup their losses by shifting the costs to privately insured patients, which results in higher premiums, or reduce the quality of care they provide.

Second, expanding Medicaid accelerates the tragic march toward cradle-to-grave government dependency. With an anemic labor force participation rate and the number of Americans receiving federal aid at record-high levels, a close reexamination of American priorities is warranted. Work for welfare programs—like the kind President Clinton established in 1996 with the bipartisanPersonal Responsibility and Work Opportunity Reconciliation Act, which resulted in a nationwide decline in poverty—should stand front-and-center in the minds of serious legislators. Rather than fixating on how to buy votes with short-sighted welfare gimmicks designed to keep their constituents comfortably poor, lawmakers should seek solutions that are proven antidotes to poverty. This includes safeguarding natural, free-market forces that breed prosperity. Kansas Governor Sam Brownback, who recently vetoed an attempt to expand Medicaid in Kansas, said it best: “The most effective welfare program is one that helps people find a good paying job, escape poverty, and gain economic security . . . [w]e cannot help our citizens build better lives without also incentivizing them to find a permanent path out of poverty.”

Finally, the future of the ACA is growing increasingly bleak. Yes, House Republicans fumbled their initial chance to repeal and replace the ACA—but the war is hardly lost. Only a week after failing to pass the American Health Care Act, House Republicans renewed their commitment to dismantling President Obama’s signature law and finding new, innovative ways to reduce the cost of healthcare for all Americans.

Although Governor McAuliffe apparently sees no issue with threatening Virginians’ healthcare access, raising premiums, restricting the poor’s socioeconomic mobility, or investing Virginia’s future in a volatile law as a means boost his poll numbers, Republicans have admirably chosen to forego the popularity contest and protect their constituents’ long-term interests. For that, they deserve a round of applause.

Thomas Wheatley is a regular contributor to The Washington Post’s All Opinions Are Local blog and a law student at the Antonin Scalia Law School. Email him at [email protected] and follow him on Twitter @TNWheatley.

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Virginia Republicans Are Wise To Reject Medicaid Expansion