Once Democratic Gov. Ralph Northam signs the bill, a top priority of his new administration, Virginia will become the 33rd state to adopt the Obamacare program. | AP Photo Virginia poised to expand Medicaid

The Virginia Senate on Wednesday approved Medicaid expansion for hundreds of thousands of low-income adults, putting the state on the verge of becoming just the second to approve the major Obamacare program in the Trump era.

Once Democratic Gov. Ralph Northam signs the bill, a top priority of his new administration, Virginia will become the 33rd state to adopt the Obamacare program, which is expected to cover as many as 400,000 people.


Northam was able to make inroads with statehouse Republicans — who had long rebuffed his Democratic predecessor Terry McAuliffe‘s expansion efforts — after the GOP suffered major electoral losses in November that nearly flipped control of one legislative chamber to Democrats.

Trump administration officials and conservative activists had tried to derail the Virginia plan. White House budget director Mick Mulvaney in March urged the state to reject Medicaid expansion, and White House health care aide Brian Blase joined phone calls with Americans for Prosperity as the Koch brothers-supported group tried to rally opposition. Former Sen. Rick Santorum, who is pushing for another Obamacare repeal vote in Congress this summer, was spotted in the Virginia Statehouse on Wednesday before the vote to brief Republicans on the status of that effort.

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The Wednesday vote on a budget that included Medicaid expansion took place after two key Republicans in the House and Senate agreed on a plan that includes a work requirement and mandates that enrollees above the federal poverty line must pay more out of pocket for care. The proposal, which was approved on a 23-17 vote, relies on provider taxes to cover Virginia’s expansion costs.

The vote came after months of Republican party infighting following an electoral shellacking that revealed the state’s leftward shift. Republicans in the House of Delegates, who nearly lost their majority in November, approved Medicaid expansion earlier this year, but the plan faced more resistance from leadership in the Republican-led Senate, which won’t face voters again until 2019. The House is expected to pass the Senate bill as soon as Wednesday before sending it to Northam’s desk.

Virginia is the only state this year where expansion has been the subject of serious legislative negotiations, although advocates in a handful of Republican-led states have mounted campaigns to expand Medicaid through ballot initiatives this fall. Maine voters approved Medicaid expansion last fall, but advocates are now suing Republican Gov. Paul LePage over his refusal to implement the program.