No state has seen a more rancorous debate over the issue than Kansas, the home base of the Koch empire, where a decade-long battle over taxes and spending has deepened fissures between the conservative and moderate Republicans who control the state legislature. The moderates rebelled after former Governor Sam Brownback’s signature tax cuts—which the onetime presidential hopeful hailed as “a real live experiment” in conservative governance—blew a hole in the state budget and failed to bring the economic growth he promised. The GOP-led legislature reversed a big chunk of the tax cuts, while Trump air-lifted the deeply unpopular Brownback out of Topeka for a mid-level diplomatic assignment at the Vatican.

Read: The death of Kansas’s conservative experiment

For years, conservatives thwarted a coalition of Democrats and moderate Republicans that repeatedly attempted to expand Medicaid. Then came 2018, when the debate figured prominently in the gubernatorial election Kelly won by defeating Kris Kobach, Kansas’s then–secretary of state. (Kobach, a conservative Trump ally who backed crackdowns on voter fraud and illegal immigration, is now running for U.S. Senate.)

Like Biden, Kelly served for years as a legislator. The relationships she built with Republicans during her time in the Kansas state Senate likely helped her strike the Medicaid deal, April Holman, the executive director of the pro-expansion advocacy group Alliance for a Healthy Kansas, told me. Public polling favored expansion, and GOP legislators were also under pressure from rural hospitals and other health-care providers that wanted an agreement. Yet although a coalition of moderate Republicans was in favor of the expansion, Denning was not one of them. “He is someone who has traditionally opposed expansion, and we’re thrilled that he has changed his position,” Holman said.

“It gives me hope that compromise is not a lost art,” she said. “They worked together as senators for many years while she was in the Kansas Senate. So I think by building those relationships over time and a relationship of trust, it can make a huge difference.”

That is Biden’s theory of the case as well: He would enter the White House with closer ties to the congressional leadership of both parties than any president since George H. W. Bush. When Republicans blocked virtually the entire agenda of President Barack Obama after they won control of the House in 2010, it was Biden who stepped in to broker a deal with McConnell to raise taxes on the wealthy and stave off hikes for the middle class in the final days of 2012. And although most Democratic presidential candidates acknowledge that their grand progressive plans depend on capturing the Senate majority from Republicans, Biden predicted to donors earlier this month that McConnell would become “mildly cooperative” if he is elected. Progressives dismiss this as a pipe dream, a Charlie Brown–and-the-football attitude that ignores the ruthlessness of a party that denied Judge Merrick Garland so much as a hearing after Obama nominated him to the Supreme Court in 2016.