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The Virginia legislature voted Wednesday to make government health insurance available to 400,000 low-income residents, overcoming five years of GOP resistance. The decision marks a leftward shift in the legislature and an enormous win for Gov. Ralph Northam (D), the pediatrician who ran on expanding access to health care. (Vozzella and Schneider, 5/30)

The House passed the Senate bill within hours; it will now go to Mr. Northam’s desk. The measure includes a requirement that many adult recipients who don’t have a disability either work or volunteer as a condition of receiving Medicaid — a provision that was crucial to getting enough Republicans on board. (Goodnough, 5/31)

White House officials, including budget director Mick Mulvaney, urged Virginia lawmakers this year not to expand Medicaid. ... But Virginia GOP Speaker Kick Cox said the Trump administration’s openness to conservative reforms, including work requirements, “was probably the biggest key” in getting Republican support for Medicaid expansion this year. And a failure by the GOP-led Congress to repeal and replace the health law helped spur several Republican state legislators to flip positions. (Suderman, 5/31)

As votes were still being counted on election night in 2017, then-Virginia Gov. Terry McAuliffe said the blue wave would finally sweep Medicaid expansion through the General Assembly. When that prediction came true Wednesday night, members of the big Democratic freshman class of 2018 were some of the last people left on the floor of the House of Delegates, savoring the moment and sharing the news on their phones. (Moomaw, 5/30)

The breakthrough — made possible by a coalition of Democrats and a handful of Republicans in the statehouse — continues the expansion of the government safety net made possible by the 2010 healthcare law, often called Obamacare. Virginia’s move also serves as something of a retort to President Trump and his Republican allies in Congress, who have called for sweeping cuts in federal aid to states for Medicaid. (Levey, 5/30)

Virginia has yet to work out the final details of the work requirement, but Senate proponents of the policy rejected arguments from expansion opponents that the requirement would be weak and unenforceable. Northam has not said he supports work requirements, but he has said he will sign any legislation that expands Medicaid. (Weixel, 5/30)

[Gov.] Northam was able to make inroads with statehouse Republicans — who had long rebuffed his Democratic predecessor Terry McAuliffe‘s expansion efforts — after the GOP suffered major electoral losses in November that nearly flipped control of one legislative chamber to Democrats. (Pradhan, 5/30)