Volunteers with the Remote Access Medical of Virginia at Richmond County Elementary School in Warsaw, Va., in 2015. (Reza A. Marvashti for The Washington Post)

Peter Galuszka, a freelance writer, is a regular contributor to All Opinions Are Local.

For more than four years, against strong Republican opposition, the General Assembly battled a proposal to expand Medicaid coverage to nearly 400,000 lower-income Virginians.

Finally, this year, expansionists prevailed. Soon the additional people will be covered.

But before popping the champagne, consider who is still left behind. The Virginia Mercury, a new online news and analysis outlet, reported that as many as 323,000 Virginians will still have no health-care coverage. They will be left to the mercy of free health clinics and hospital emergency rooms if something goes wrong.

According to the Mercury, the state has 60 free health clinics that serve about 60,000 uninsured people.

Now that the state has taken a step, albeit a half step in terms of numbers served, health-care professionals are trying to assess how the health-care system in the state will be affected — no easy task.

How communities handle health care for the uninsured is different. So charity-based services try to adjust as best they can.

“And that’s why these clinics started, to fill a gap,” according to Linda Wilkinson, executive director of the Virginia Association of Free and Charitable Clinics.

A big uncertainty is how many people now eligible for Medicaid will sign up. What happens if they don’t? Who qualifies for the new tranche of Medicaid patients is based on a federal formula based on income.

In Charlottesville, according to the Mercury, there are 12,000 uninsured residents in the city and in adjacent Albemarle County. Thanks to the General Assembly’s tardy action, about 5,000 now qualify for expanded Medicaid. No one knows yet how many will actually take the offer. Those who don’t can be treated for emergencies at hospitals because law requires it. That’s hardly the best situation.

The dilemma raises other unknowns. Will people stop donating to free clinics assuming that the overhang of uncovered people is dissipating? Will it be assumed that Virginia’s problem of providing health care for lower-income people has been solved?

There is, of course, a simple solution. Single-payer, national health care — as in every other advanced industrial country. Sure, there are problems, such as arranging for elective care. But everyone is covered.

That Virginia and the United States don’t provide such help for all residents is a public embarrassment. The idea that health care is some kind of privilege for people able to earn working wages is immoral. It’s time to go the whole way.