Virginia Del. Todd Gilbert (R-Shenandoah). (Steve Helber/AP)

VIRGINIA’S STATE Senate Republicans have dug in their heels once again to oppose a Medicaid expansion that would extend health insurance to roughly 400,000 citizens. Their stance is impervious to public opinion, which favors expansion by large margins; at odds with many of the GOP members in the House of Delegates and in some other Republican-controlled legislatures nationwide, who have switched sides in the debate; and heedless of hard-working Virginians for whom there is no health-care alternative save the emergency room.

The Senate Republicans stood pat even though they propose no alternative. They remained unmoved even though their stance left the legislature at an impasse and at risk of a government shutdown unless a solution is found by July, having adjourned this month with no finished budget to present to the governor for his signature.

They have justified their opposition by warning that the federal government, which would pay for 90 percent of the expansion indefinitely, is an unreliable source of funding. Yet here we are, four years after that warning was first sounded in Richmond, and with Republicans in charge of the White House and Senate — and still the federal government shoulders nearly all of the cost in the 32 states (in addition to the District) that have opted for expansion. In the meantime, Virginia has turned its back not just on its own citizens but also on billions of dollars in federal spending.

Republicans have complained that the two-year budget passed by the House, which includes Medicaid expansion, does not feature sufficiently stringent work requirements. It escapes their notice that a large majority of current Medicaid recipients already work, as do an estimated 70 percent of uninsured Virginians. Nor do they mention that many of those who don’t work — college students, sole caregivers for small children, and the disabled — would be exempt from work requirements anyway.

In the GOP-controlled House of Delegates, 19 of 51 Republicans joined ranks with 49 Democrats to support an expansion that would unlock hundreds of millions of dollars in annual federal funding, yielding savings for the state that would provide raises to teachers and state workers. Yet to state Senate Majority Leader Thomas K. Norment Jr. (R-James City), that was somehow evidence not of rare bipartisanship on a contentious issue but of a failure of leadership in the lower house.

We asked another Republican, state Sen. Stephen D. Newman, who represents a district that includes Lynchburg and Roanoke County, how he justifies denying health coverage to as many as 6,500 of his own constituents. He explained he does back measures that would extend coverage to the neediest, but conceded they would cover fewer than 100 people in his district. As for others who lack coverage, he has no plan, no alternative and no vision.

Virginia refuses to cover single adults under Medicaid no matter how poor they are. It turns its back on thousands of indigent residents, including children and the disabled. Its per capita Medicaid spending is close to the bottom of the 50 states. There’s a word for a rich state whose policy suggests contempt for its least fortunate citizens: disgrace.