Huge news out of Virginia: 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 hundred of thousands of families.”

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

The multiyear Republican opposition to expanding Medicaid in Virginia, rooted in hostility toward 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 that 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 elections made such a difference.

The political backdrop to 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 campaigning on the issue. A study released this week by Kantar Media found that Democrats are running campaign ads focusing on support for the Affordable Care Act and Medicare expansions, including a Medicare-for-all proposal by Sen. Bernie Sanders (I-Vt.). By contrast, Republican candidates are emphasizing immigration issues.

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

Under the guise of making coverage cheaper or easier on American budgets, Republicans and Trump did away with the mandate that 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 preexisting 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 reported that experts from right-wing think tanks will release a proposal that is 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 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 those states, 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 is possible that 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.