Virginia Gov. Ralph Northam (D) on Thursday signed a budget that includes Medicaid expansion, making Virginia the 33rd state to expand the program under ObamaCare.

The signing caps a years-long battle in the state over Medicaid expansion, which Democrats have pushed for but Republicans long resisted. After Democratic gains in the state legislature and Northam’s victory last year, enough Republicans got on board with Medicaid expansion for it to pass the General Assembly.

The expansion is estimated to provide health insurance to up to 400,000 people.

“As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative,” Northam said in a statement. “This budget will empower nearly 400,000 Virginians with access to health insurance by expanding Medicaid, without crowding out other general fund spending priorities.”

ADVERTISEMENT

As part of a compromise with Republicans, the expansion will include work requirements for Medicaid recipients, which the Trump administration has approved for the first time.

Advocates are hoping more states, especially Utah and Idaho, where the issue will be on the ballot, will expand Medicaid this November. Activists in Nebraska are seeking to get Medicaid expansion on the ballot as well.

“After years of working on this issue that affects families across the Commonwealth, we are thrilled that hundreds of thousands of Virginians who currently lack basic health care coverage will finally have some peace of mind,” said Virginia Democratic Sens. Tim Kaine Timothy (Tim) Michael KaineDemocrats call for declassifying election threats after briefing by Trump officials Buttigieg stands in as Pence for Harris's debate practice Trump meets with potential Supreme Court pick Amy Coney Barrett at White House MORE and Mark Warner Mark Robert WarnerDemocrats call for declassifying election threats after briefing by Trump officials It's time to upgrade benefits Intelligence chief says Congress will get some in-person election security briefings MORE in a statement.