The emergency room at Lynchburg General Hospital is often filled with patients who don't have insurance.

"Those patients who come here and seek care are coming to us at the last possible minute," said Diane Riley, spokesperson for Centra, which owns Lynchburg General.

Riley says uninsured patients avoid going to a primary care doctor when they get sick or injured, which causes their condition to deteriorate and later forces them to seek expensive emergency treatment.

Centra leaders believe more people would seek treatment on a regular basis, if they had access to programs like Medicaid.

"They'll have better access, because they will have insurance," Riley said.  "They will be able to come in and get the care that they need, when they need it."

Scott Garrett understands the problem, having worked as a surgeon for more than 20 years.

But as a delegate in the Virginia General Assembly, he voted against Medicaid expansion.

"Simply giving people an insurance card doesn't necessarily equate with them having better health care outcomes," said Garrett, a republican who represents Lynchburg and parts of Bedford and Amherst counties.

Garrett says Medicaid doesn't have enough participating providers in the state to adequately handle an additional 400,000 patients.

He'd rather see the problem addressed through a variety of private-sector solutions.

"(We need to) improve our health safety net, our free clinics, and our federally qualified health centers such as the Johnson center," Garrett said.

Centra will continue to treat patients who don't have insurance, but company leaders say that will be a difficult practice to continue long-term.

They currently only have a three-percent profit margin, which is holding them back from improving their facilities and equipment, and hiring more staff.

"Patients deserve the best care and having a greater profit margin is going to benefit this community," said Riley.

The Medicaid debate will likely continue in Virginia.  Republicans have vowed to address the issue outside of the budget process.