Huge news out of Virginia Wednesday: The State Senate approved expanding Medicaid to cover 400,000 low income residents, putting an end to years of Republican intransigence and opposition. As health care advocate Topher Spiro put it, “This is a major victory that will transform the lives of thousands of families.”

The vote Wednesday is a tribute to the power of voting and the resistance to President Donald Trump, which flipped 15 seats in Virginia’s House of Delegates from Republican to Democrat in last fall’s state elections, helping to break the impasse. The expansion is attached to the Virginia state budget, which Gov. Ralph Northam, who campaigned for office last fall on a promise to expand Medicaid in the state, is expected to sign as soon as it reaches his desk.

The multi-year Republican opposition to expanding Medicaid in Virginia, routed in hostility to the Affordable Care Act, thwarted the will of the state’s voters for years. A poll conducted late last year by Public Opinion Strategies and the Virginia Hospital and Healthcare Association found 83 percent of the state’s residents supported the expansion, including a majority of self-identified Republicans. The hostility was most pronounced in the House of Delegates — which is why last November’s election made such a difference.

The political backdrop to all this is that polls routinely show Americans — no matter how they receive their health coverage — identify health care coverage as a top concern. Democrats are increasingly likely to campaign on the issue. A study released this week by Kantar Media found Democrats running campaign ads focusing on support for the Affordable Care Act and Medicare expansions, including Bernie Sanders’ proposed Medicare for All. (By contrast, Republican candidates emphasize immigration issues.)

But don’t expect the Trump administration or Republicans in Congress to take the hint. Even as the main result of attempts to repeal the Affordable Care Act has been to increase its popularity, the Trump administration keep pushing attempts to make health insurance coverage harder for Americans to access.

Under the guise of making coverage cheaper or easier on American budgets, Republicans and Trump did away with the mandate Americans must obtain coverage, and the administration is now looking to loosen the regulations on less comprehensive short-term plans, which are allowed to screen applicants for pre-existing conditions.

All this, in turn, is leading to a surge in the costs for coverage on the exchanges — in Maryland, one plan is seeking a 91 percent increase from state regulators. Yet the repeal drive continues. The Wall Street Journal reports that experts from right wing think tanks will release a proposal that’s supported by the White House to end the Medicaid expansion, and instead use the money for block grants for the states.

That would roll back major progress. Virginia is now poised to become becomes the 33rd state (34 if you count the District of Columbia) to expand Medicaid. True, plenty of states have still not taken the expansion. In them, Medicaid eligibility is still set by state guidelines, which the Kaiser Family Foundation says is a median of 44 percent of the poverty line for families with children, with many not covering childless adults at all. But some red states have expanded Medicaid, and others could follow.

Indeed, it’s possible Utah will become the 34th to do so. On Tuesday, state election officials said a voter initiative to expand Medicaid collected enough signatures to appear on the ballot in November. Polls show that two thirds of Utah voters support the Medicaid expansion in their state. So it’s unlikely to be close. At least, that’s what will happen if the voters get to decide.

Helaine Olen

Helaine Olen is a contributor to the Plum Line blog and the author of “Pound Foolish: Exposing the Dark Side of the Personal Finance Industry.”