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Virginia Democrats won the governor’s seat this week and, in election night’s biggest shock, might have taken back the Virginia House. Hundreds of thousands of low-income Virginians could end up getting Medicaid coverage as a result.

We don't know for sure yet. Democrats have 49 seats, Republicans have 47, and four seats are too close to call: Republicans lead them all, but by as few as 12 votes. Recounts should finish around Thanksgiving.

Either way, Democrats will have swept or very nearly swept into power when nobody thought such a feat was possible — and Medicaid might be due the lion's share of the credit.

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Democratic Gov. Terry McAuliffe and Virginia Republicans in the statehouse have been locked in a battle for years over expanding Medicaid under Obamacare. Virginia is one of the 19 states that have refused to expand Medicaid eligibility as the health care law allows. (Maine, which had a Medicaid expansion initiative on the ballot Tuesday, is also looking likely to pass the expansion Tuesday night.)

The state estimates that more than 400,000 people in and near poverty have been denied Medicaid coverage as a result.

The anti-Trump backlash surely accounts for a big part of the unexpected Democratic gains on Tuesday. But the exit polls also told us that health care — after a years-long fight over Medicaid — might have been equally decisive.

Check out this chart, courtesy of HuffPost's Ariel Edwards-Levy.

Health care was the biggest issue for nearly two out of five voters, and more than three-quarters of them broke for Democrats. This is on the same day that Maine voted overwhelmingly to expand Medicaid after years of Republican obstruction.

They say three is a trend, so I think we need one more data point to be sure. But it sure seems like Medicaid is a winning issue at the ballot — and Democrats can win elections by running on Medicaid.

In Virginia, we wait for the recounts to know what comes next. If Democrats were to take over the House, the attention would then turn to the Virginia Senate, which Republicans control by a narrow margin but which was not on the ballot Tuesday. State senators will face reelection in 2019.

The state Senate, while under Republican control, has actually voted before to expand Medicaid, albeit with an alternative plan in which Medicaid dollars would buy used to buy people private health coverage.

The House, which was more firmly in Republican hands, has always been the bigger problem. But now the Democrats could control it.

It’s possible Virginia’s GOP senators would see Tuesday’s wave and decide, given their narrow margin, that it’s in their best interest to pass Medicaid expansion. Public polling has consistently found that Virginia voters support expanding Medicaid, and Republicans have only a 21-19 edge in the state Senate.

Or Democrats could win the Virginia Senate back in 2019, while Northam is still in office. That would also pave the way for Medicaid expansion, after a bit longer of a wait.

For hundreds of thousands of Virginians, it might now be only a matter of time before they’ll have access to health care.

Table of the Day

The monopolizing Obamacare market. The law's marketplaces avoided any bare counties this year, but as this table shows, more and more areas have only one insurer available.

We can therefore expect an autumnal ritual of state lawmakers and insurers scrambling to fill empty spots on the map. This new report from RWJF and the Urban Institute takes a look at the strategies state officials and plans undertook this year. It could be a blueprint going forward.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

“Initial Senate tax bill does not repeal ObamaCare mandate”: “The tax reform bill that Senate Republicans are releasing Thursday does not repeal ObamaCare's individual mandate, though the provision could be added down the line, GOP senators said.” —Peter Sullivan, the Hill

“The tax reform bill that Senate Republicans are releasing Thursday does not repeal ObamaCare's individual mandate, though the provision could be added down the line, GOP senators said.” —Peter Sullivan, the Hill “Pace of Sign-Ups Under Affordable Care Act Blows Past Prior Years”: “In a report on the first four days of open enrollment, the Trump administration said on Thursday, 601,462 people had selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.” —Robert Pear, New York Times

“In a report on the first four days of open enrollment, the Trump administration said on Thursday, 601,462 people had selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.” —Robert Pear, New York Times “Former Drug Exec Is Said to Be Trump's Expected Health Secretary”: “Azar, who worked at Eli Lilly & Co., would be the administration’s point person on running — or dismantling — Obamacare, the health program enacted by Trump’s predecessor that insures millions of Americans. He will also oversee Medicare and Medicaid, along with dozens of public health programs and sub-agencies.” —Anna Edney, Bloomberg

Analysis and longer reads

“Election results bolster Medicaid expansion hopes in Maine, Virginia and other states”: “Tuesday's elections in Maine and Virginia brought victories for supporters of expanding Medicaid to low-income adults, bolstering the hopes of expansion advocates across the country.” —Harris Meyer, Modern Healthcare

“Tuesday's elections in Maine and Virginia brought victories for supporters of expanding Medicaid to low-income adults, bolstering the hopes of expansion advocates across the country.” —Harris Meyer, Modern Healthcare “A hospital without patients": “Mercy Virtual is arguably the world’s most advanced example of something gaining momentum in the health care world: A virtual hospital, where specialists remotely care for patients at a distance. It's the product of converging trends in health care, including hospital consolidation, advances in remote-monitoring technology and changes in the way medicine is paid for.” —Arthur Allen, Politico

“Mercy Virtual is arguably the world’s most advanced example of something gaining momentum in the health care world: A virtual hospital, where specialists remotely care for patients at a distance. It's the product of converging trends in health care, including hospital consolidation, advances in remote-monitoring technology and changes in the way medicine is paid for.” —Arthur Allen, Politico “Explore: How many young doctors does your state retain after residency?”: “On this crucial metric, some states are faring far worse than others. California, with an abundance of space and jobs for doctors, retains 70 percent of residents and fellows trained in-state — compared to just 28 percent in tiny New Hampshire, where full-time physician jobs are few and leaving the state may only mean moving a short distance.” —Rebecca Robbins and Natalia Bronshtein, STAT

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