Del. Terry G. Kilgore (R-Scott) came out in favor of Medicaid expansion Thursday, saying his poor, Southwest Virginia district needs “hand up.” (Bob Brown/AP)

A prominent Republican state legislator from southwest Virginia announced his support Thursday for expanding Medicaid, an about-face that could make it easier for other rural conservatives to get on board after four years of steadfast opposition.

Del. Terry G. Kilgore (R-Scott), chairman of the powerful House Commerce and Labor Committee, said his struggling coal-country district would get the “hand up” it desperately needs if more uninsured Virginians were made eligible for the federal-state health-care program.

“For my district, for my part of the state, it’s the right thing to do,” Kilgore said. “At the end of the day, I think you’ll see a lot of folks feeling that way.”

Kilgore’s announcement came a few weeks after House Speaker M. Kirkland Cox (R-Colonial Heights) began signaling a willingness to expand Medicaid if work requirements could be imposed on able-bodied recipients. Cox’s party nearly lost control of the chamber in the November elections in an anti-Trump wave, with many Democrats running on the issue of health care.

Kilgore is the first House Republican to explicitly call for expansion, doing so in a Roanoke Times op-ed and on a radio program. More were expected to follow, given Cox’s tacit support. House Republicans met in a closed-door session Thursday to discuss Medicaid.

“Del. Terry Kilgore (R) Breaks The Republican Dam On Medicaid Expansion For GOP,” conservative radio host John Fredericks tweeted after Kilgore announced his change of heart on his show.

The fate of expansion remains unclear in the state Senate, where, like the House, Republicans have a two-seat majority.

When the expansion debate began in earnest four years ago, three moderate GOP senators supported it, but the House was dug in against. Now only one of the three, Emmett W. Hanger (Augusta), remains in the Senate. No one else from his side of the aisle has come out for expansion.

Lt. Gov. Justin Fairfax (D) presides over the Senate with the power to break most ties, but he is not allowed to vote on budget bills, which would be the vehicle for expanding Medicaid.

Gov. Ralph Northam (D), who made expansion a marquee campaign promise, welcomed Kilgore’s announcement.

“Governor Northam thanks Delegate Kilgore for sharing his ideas about how to expand health coverage for Virginians who need it,” said Northam spokeswoman Ofirah Yheskel. “He is encouraged by discussions with members of both parties on this important issue and believes we can reach an agreement that works for everyone.”

Expansion also was a top priority for Northam’s Democratic predecessor, Terry McAuliffe, who said it would provide health care to 400,000 uninsured residents and create 30,000 jobs. More recently, advocates have put the number around 300,000 because not everyone eligible would choose to sign up.

Some Republicans who opposed expansion over the years objected to providing an entitlement to able-bodied Virginians, no matter how poor. Kilgore said work requirements like those the Trump administration has allowed Kentucky to impose, coupled with a mandate that recipients contribute a “small co-pay,” would make for “a conservative approach” to expansion.

“Most people, if you ask them on the street, they’re going to say, ‘Hey, yes, somebody’s trying to help themselves? I don’t mind helping,’ ” Kilgore said. “I grew up like that in southwest Virginia. You always tried to help your neighbor.”

Republicans also have warned over the years that Washington could not afford to make good on its promise to pick up most of the $2-billion-a-year cost. Some fiscal hawks in the House say that concern has hardly gone away given the soaring federal deficits projected to result from President Trump’s budget plan.

But Kilgore sees the failure, by a GOP-controlled Congress and White House, to repeal the Affordable Care Act as proof that the program is here to stay.

“They’ve kept Medicaid expansion in the [federal] budget,” he said. “So it’s time for Virginia to act. But we’ve got to act in the Virginia way.”