The Virginia Senate on Wednesday voted to approve Medicaid expansion, which would impact the lives of up to 400,000 citizens in the state.

As such, Virginia becomes just the second state during the Donald Trump presidency to approve such a program, following only Maine. Yet even there, Republican Gov. Paul LePage faces a lawsuit for his refusal to actually implement the program.

Virginia’s Democratic Gov. Ralph Northam, who handily won election last November sweeping in enough Democrats to nearly flip the state’s House of Delegates, campaigned on expansion and will undoubtedly sign it into law.

The House of Delegates had previously voted in favor of expansion but would have to now approve the Senate bill or go to conference prior to getting Northam’s signature.

Virginia will become the 33rd state overall, plus Washington D.C., to expand Medicaid under the Affordable Care Act, which was first signed into law in 2010.

The budget, however, does include work requirements for those who are newly covered, a concession that may have been necessary to get some Republican votes. Four Republican members of the Senate broke ranks to vote for the bill on Wednesday.

In other more red states, advocates have been fighting to get Medicaid expansion on the ballot, including a recently successful effort in Utah. In Idaho, a group of volunteers criss-crossed the state to get the necessary signatures for putting Medicaid expansion on the state ballot in November.

“It’s time to put the excuses aside,” Northam said in an interview on Wednesday prior to the vote. “Whether you’re in favor of the Affordable Care Act or not… it is the law of the land, and we need to take advantage of the resources that we’ve sent to Washington, and bring them back to Virginia.”