On Wednesday, Virginia’s Senate voted to expand the Obamacare-era Medicaid program to cover approximately 400,000 more people next year.

Virginia to Expand Medicaid In 2019

The state’s Republican-controlled Senate’s bill now just needs to be signed by Democratic Gov. Ralph Northam. Should it pass, Virginia would become the 33rd state to expand Medicaid — which benefits low-income Americans — and the second to approve the program since President Donald Trump took office.

Maine approved an expansion of Medicaid in the fall of 2017, although supporters of the motion filed a lawsuit against Republican Gov. Paul LePage in April for his refusal to institute the expansion.

Led by House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell, Republican lawmakers attempted to pass a healthcare bill to replace Obamacare several time last year but failed. Now, voters across the nation have begun naming health care as a major issue, and could be a key factor in determining the outcome of the midterm elections in November.

In Virginia, GOP lawmakers had repeatedly voiced their opposition to the efforts of Northam’s predecessor, Terrry McAuliffe, to expand Medicaid. Northam has been serving as Governor since January after being elected in November 2017.

White House budget director Mick Mulvaney tried to convince Virginia voters in March not to approve the Medicaid expansion.

Obamacare — more formally known as the Affordable Care Act — first allowed states the option of expanding Medicaid in 2014, and required that the U.S. Government pay at least 90 percent of the cost of it. The ACA permits states to expand Medicaid to adults earning up to 138 percent of the poverty level, in other words an annual individual income that amounts to about $16,643.

Several other Republican-leaning states like Nebraska and Idaho could follow Virginia’s lead in expanding Medicaid.

The New York Times estimated that Medicaid covers around 75 million people, or roughly one in five Americans.

In April, two Republicans in Virginia’s Senate changed their stance on the Medicaid expansion and decided to approve it: Frank Wagner and Emmett W. Hanger Jr. Last fall, Democratic candidates to the Virginia state house gained 14 seats sweeping away Republicans who had stood against the Medicaid expansion.