Seven weeks after the General Assembly convened in special session to adopt a state budget, the decisive battle looms on Wednesday.
Fairfax broke another 20-20 tie to defeat a proposed amendment from Sen.
Republican Senator Emmett Hanger, of Augusta, led the charge on the budget compromise.
House Speaker Kirk Cox (R-Colonial Heights) said he believes Virginia's budget includes the most conservative set of reforms to Medicaid in the country.
Hanger already has given senators copies of a substitute budget he negotiated with House Appropriations Committee Chairman Chris Jones, R-Suffolk, more than a week ago.
Democrats came within one seat of drawing even in the state's House of Delegates in last fall's election. The Trump administration's support of conservative changes to Medicaid, especially work requirements, is a key reason why several Republican lawmakers say they backed expansion this year after years of opposition.
Advocates have been trying to get the Virginia Legislature to expand Medicaid for at least five years, and on Wednesday, Senate lawmakers handed them a big win.
Ralph Northam, a pediatrician and Army doctor by trade, planning to sign the measure into law, Virginians and advocates for Medicaid expansion welcomed the development but emphasized the dangers of the caveat, which, as research from the Center on Budget and Policy Priorities has shown, "will nearly certainly cause many low-income adults to lose health coverage".
"Let's put the excuses aside".
Del. Wendy Gooditis, D-Clarke County, who represents the 10th District, said from the House floor Wednesday that she was happily waiting to vote yes on the budget "with pleasure and pride".
"I came to the conclusion that no just wasn't the answer anymore", Chafin said.
Sen. Amanda Chase, who voted against it, said she's most concerned with what happens next. "While no compromise is flawless, it is a true bipartisan effort that will make our communities healthier, and I'm grateful to the legislators and Governor Northam who are working tirelessly to get it over the finish line", said Virginia Sen.
Under the Affordable Care Act, Washington allows states to open their Medicaid rolls to people making up to 138 percent of the federal poverty level, which is $16,643 for an individual.
Both chambers of the Republican-controlled General Assembly are scheduled to meet Wednesday to take up a state budget plan that expands the publicly funded health care program for the poor. More than 300,000 uninsured Virginians, who do not qualify for ACA subsides, will be granted access to the Medicaid program. Republicans in Virginia's General Assembly have resisted Medicaid expansion for years, despite the fact that 61 percent of residents supported it as early as September 2014. The requirement would have replaced the two-track Hanger proposal, which would allow the state to immediately seek amendment of Virginia's Medicaid plan to begin accepting enhanced federal funding to expand the program on January 1. Dave LaRock, R-Hamilton, said about expanding Medicaid in Virginia. It also would place new taxes on certain private hospitals to cover state costs.
Linda Wilkinson, CEO of the Virginia Association of Free and Charitable Clinics, said some clinics are considering becoming hybrid models that both provide free care while also accepting Medicaid payments.