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Medicaid expansion takes another big step forward

Virginia Democrats ran on a platform that emphasized Medicaid expansion. It made this week an elections-have-consequences moment.
Lt. Governor Ralph Northam greets his patient Katana Smith(cq), 6, of Clintwood, Va., during the Remote Area Medical clinic, Saturday, July 22, 2017, in Wise...

Going into last year's elections in Virginia, the conventional wisdom was that Democrats would make gains, but thanks to gerrymandering, the Republicans' majority in the state Senate and House of Delegates was effectively voter-proof.

What we didn't know until the results came in was just how big the "blue" wave would be: Democratic candidates ended up with 55% of Virginians' votes, nearly erasing the GOP advantage, en route to Gov. Ralph Northam's (D) surprisingly easy victory.

As for how Dems did so well in the commonwealth, some of their success was no doubt part of anti-Trump backlash, but part of it was also the party's specific message: Democratic power would mean Medicaid expansion in Virginia. With this in mind, yesterday was an elections-have-consequences moment.

The Republican-controlled Virginia General Assembly gave final approval Wednesday evening to a state budget expanding Medicaid coverage to the state's poor, ending years of partisan gridlock on the issue.The state Senate voted in favor of expansion after a full day of debate. The House, which had previously endorsed expansion, gave its final approval shortly afterward. Several Republicans in both chambers joined with Democrats to approve the measure.

Virginia's Democratic governor, not surprisingly, is all but certain to sign the measure into law, making the state the nation's 33rd to embrace Medicaid expansion.

In practical terms, roughly 400,000 low-income Virginians will finally be eligible for health care coverage under the law.

The evolution of the fight has been dramatic: eight years ago, Virginia had a Republican attorney general who tried to tear down the Affordable Care Act; one year ago, Donald Trump and Congress' GOP majority nearly repealed "Obamacare"; and yet one of the nation's largest states is now expanding one of the ACA's key provisions.

But while yesterday's developments in Virginia are an important step forward, there is a catch.

As the Washington Post  noted, GOP leaders in the state legislature agreed to advance Medicaid only if "work requirements, co-pays and other conservative strings were attached." Democrats weren't thrilled with the demands, but felt like they had no choice but to accept them.

The compromise paved the way to a breakthrough.

Looking ahead, there are 17 states that haven't yet embraced Medicaid expansion, but as Jeff Young explained, "Activists in Idaho and Utah gathered enough signatures from residents to place the question on the ballot for voters to decide this November, and a campaign to do the same in Nebraska is underway."

It's tough to keep a good idea down.