Pro-expansion lawmakers have a majority in both chambers, and Democratic Gov. Ralph Northam is a strong proponent of expansion. And should Republicans successfully repeal the ACA, Virginia's Medicaid expansion will end, under the bill's language.
The Virginia House of Delegates voted Wednesday night to send legislation containing Medicaid expansion to Democratic Gov. Ralph Northam, who is expected to sign the bills into law. "The budget the Senate passed today expands health care to Virginians, invests in core economic priorities and strengthens the cash reserves we need for a rainy day". The House voted 68-30 to back the budget for fiscal year ending June 30 and 67-31 for the new two-year budget.
Virginia lawmakers crossed an important hurdle Wednesday, ensuring that, despite years of resistance, the state will become the latest to expand access to Medicaid.
The bill now heads to the House of Delegates, who voted for Medicaid expansion earlier this year, to be approved. Several state Republicans, including Augusta County's Emmett Hanger, dropped their opposition this year, saying the state would be better off with increased federal funding for the program.
In an odd twist, it was the Virginia Senate - traditionally the more moderate chamber and the one that had backed expansion in previous years with help from two now-retired moderate Republicans - that had remained dug in.
Those arguments were again replayed in the final hours before Virginia's partisan battle was finally ended.
They fought up to the moment of the vote Wednesday, with a series of procedural moves, passionate floor speeches and an appearance by former U.S. Sen. He said his rural area needs expansion to bolster its hospitals and provide care for constituents.
"I came to the conclusion that no just wasn't the answer anymore", Chafin said.
A majority of Senate Republicans are still trying to block Medicaid expansion in the budget on Wednesday.
Sen. Bill Stanley, R-Franklin, who opposed Medicaid expansion, called the budget "a ticking time bomb" and said lawmakers are spending money like they're "drunk in New Orleans".
The state will become the 33rd to expand Medicaid since the Affordable Care Act went into effect in 2014.
Reading another column about the failure of the Virginia General Assembly to expand Medicaid may be as painful for you to read as it is for me to write.
President Donald Trump has vigorously sought to negate his predecessor's health law.
Virginia GOP Speaker Kirk Cox, however, said the Trump administration's openness to conservative reforms, including work requirements, "was probably the biggest key" in getting Republican support for the Medicaid expansion.
Republican holdouts in the Senate saw the carnage a year ago when Democrats flipped 15 House seats, but they were insulated since they were not on the ballot.
In comments before the final vote, Vogel, who has been mum on about her position on Medicaid in recent months, said she remains concerned about whether the federal government will renege on that funding - a main point of contention among Republicans - and about the growth of the existing Medicaid program, which has averaged about 8 percent a year.
Correction: A prior version of this story misstated the party that controls the Virginia House of Delegates.