Senate Majority Leader Thomas K. Norment Jr. (R-James City), left, talks with State Sen. Frank Wagner (R-Virginia Beach) during the Senate special budget session at the capitol in Richmond on April 11, 2018. (Steve Helber/AP)

Virginia’s General Assembly launched its second attempt to adopt a state budget Wednesday, kicking off a special session amid a thaw in the Medicaid standoff that brought the first go-round to a halt last month.

Republicans, who control both chambers of the legislature, are split over whether to expand Medicaid to as many as 400,000 low-income Virginians; the House supports expansion while the Senate has opposed it. Those differences prevented the approval of a two-year budget during the regular session that ended March 10.

House Speaker M. Kirkland Cox (R-Colonial Heights) suggested Wednesday that he was willing to tighten work requirements that would be imposed on Medicaid recipients, which might help win support in the Senate.

“We’re going to look at that and try to, you know, strengthen that somewhat,” Cox said. “I think among conservatives that’s something that’s very important.”

In the weeks since the regular session adjourned, opposition to Medicaid expansion among some lawmakers has been softening, with a second Republican state senator announcing last week that he would support it under certain conditions.

Even Senate Majority Leader Thomas K. Norment Jr. (R-James City), who has been a vocal critic of expansion efforts, sounded almost resigned to expansion if the plan could be structured more conservatively and developed collaboratively. “If, in fact, there is going to be a fiscally responsible and conservative Medicaid expansion plan, it has got to be developed on a more collaborative basis,” he told WCVE radio. “One person can’t develop that plan, come in and drop it down in front of 21 Republican senators and say, ‘Here it is.’ That is not going to work.”


State Sen. Mark Peake (R-Lynchburg), foreground, bows his head in the chamber for the start of the Senate special budget session at the capitol in Richmond on April 11, 2018. Peake was one of few Republican state senators at the opening. The rest of the Republican senators arrived at the session several minutes later. (Steve Helber/AP)

The most fervent advocates for expansion say there is a long way to go, with Wednesday merely marking the start of negotiations. The state needs a spending plan in place by July 1 to prevent a government shutdown.

“This is something that should have been done three or four years ago, but better late than never,” said Senate Minority Leader Richard L. Saslaw (D-Fairfax). “Between 350,000 and 400,000 Virginians will get the health care that’s needed.”

In a surprise flip during the regular legislative session, the Republican-led House of Delegates abandoned its years-long opposition to “Obamacare” to pass a budget that included Medicaid expansion, with the federal government promising to pay at least 90 percent of the tab.

But House Republicans could not persuade their counterparts in the Senate.

Gov. Ralph Northam (D), who won office last year on a promise to expand Medicaid, called the legislature back for the special session. The two-hour opening-day session was consumed by procedural moves.

Now, a new budget bill proposed by Northam will make its way through House and Senate money committees, then to each chamber for floor votes. That is expected to take a week or more, and then a conference committee would work out differences between differing House and Senate plans.

It would take two Republicans to pass expansion on a budget vote in the Senate, which Republicans control by 21 to 19. But only one Republican is needed to pass it as a budget amendment. That is because the Senate’s presiding officer, Lt. Gov. Justin Fairfax (D), is allowed to break ties on budget amendments but not on the budget itself.

Northam, who ran as a consensus builder, would prefer not to have to muscle something as consequential as Medicaid expansion through the amendment process. And some Republicans have said they would prefer not to give Fairfax, a likely contender for governor in 2021, the résumé-boosting opportunity to cast the deciding vote on Medicaid expansion, which polls well with voters.

That is one reason that expansion supporters have been hoping to flip multiple Senate Republicans. One of those Republicans — Emmett W. Hanger Jr. (Augusta) — has supported certain forms of expansion for years, although he opposes the hospital tax that the governor and House want to use to fund the state’s 10 percent share of the program’s cost.

Last week, state Sen. Frank W. Wagner (R-Virginia Beach) said he supports expansion under certain conditions. Those include a tax credit for those of middle ­income who already have insurance but are struggling to pay soaring premiums and co-pays. He also wants a beefed-up work requirement.

Wagner’s support has generated a sense of inevitability about the issue. Even those opposed to expansion say privately that it will be difficult to stop it with two Republican senators on board.

But opponents note that the criteria put forth by Wagner and Hanger conflict with each other in some ways and with what Northam and the House want.

Northam and the House project hefty savings from expanding Medicaid. The governor predicts $421 million, while the House calculates $307 million, with different start dates accounting for the gap. They want that money sprinkled throughout the budget, to fund higher education, teacher pay raises and other needs.

But Hanger objects to using savings on anything other than health care. And Wagner wants to use about half of the savings on pay raises and the like, and the other half for his proposed $250-a-year tax credit.

A third Senate Republican, Sen. Jill Holtzman Vogel (Fauquier) posed on Wednesday with protesters who were demonstrating outside the state capitol building and held signs that said “400K Virginians Can’t Wait.” Vogel has opposed expansion. “It does not mean anything,” Vogel said of the photo. “It was a guy from Winchester who had letters for me standing in the crowd with another person from Winchester. They said can we please have a picture? Of course I said yes. I will visit with anyone who comes from home.”

Under the Affordable Care Act championed by President Barack Obama, Washington encouraged states to allow more people to enroll in Medicaid by offering to pick up most of the tab. Thirty-two states, including Maryland, and the District of Columbia accepted the offer.

Virginia, with its legislature under GOP control, staunchly resisted “Obamacare expansion” for four years under Northam’s predecessor, Terry McAuliffe (D). Opposition softened in the House after Democrats nearly took control of the chamber in an anti-Trump wave in November. But the Senate, which did not face voters last year, remained firmly opposed.