Get ready for the Virginia version of the hit film “Groundhog Day.” In the coming weeks, Gov. Terry McAuliffe (D) again will try mightily to persuade members of the General Assembly to support Medicaid expansion. They will almost certainly refuse, just as they did in 2014.

There isn’t much the governor can do differently. He tried just about everything imaginable last time to bring coverage to the estimated 400,000 Virginians who would qualify for the Medicaid expansion plan. McAuliffe barnstormed the state, building alliances with Republican-leaning business groups and hospital administrators. He engaged in an aggressive “charm offensive” with legislators, complete with premium booze at Executive Mansion receptions. He held news conferences in community after community, begging GOP lawmakers to negotiate. In desperation, the governor even tried brinkmanship, via a threatened Washington-style government shutdown.

Despite these efforts, the Republican majorities did not budge. No expansion, no compromise, no way.

Virginia public opinion supports the idea of Medicaid expansion by a more than 2-to-1 margin, according to a statewide survey. The poll, conducted by Princeton Survey Research Associates International for the University of Mary Washington’s Center for Leadership and Media Studies, found overwhelming endorsement of the expansion across the state, ranging from a low of 66 percent support of those who expressed an opinion on the expansion idea in the northwest to 74 percent in Tidewater.

But in a state full of gerrymandered legislative districts, delegates and senators who want another term in Richmond must focus on satisfying the more intense, ideologically extreme voters who show up for nomination contests. As a result, most Republican lawmakers are concerned primarily with what GOP voters think. Here’s where Republican lawmakers find strong support for their opposition: Only 38 percent of the state residents who said they were Republican and expressed an opinion on Medicaid expansion favored it, as did only 36 percent of voters who said they backed Republican Ken Cuccinelli in the 2013 gubernatorial election.

Opposition to Medicaid expansion would be even more intense among the subgroup of Republican voters who vote in those all-important but tiny turnout primaries. (Opposition among GOP identifiers likewise would be more intense if the trigger word “Obamacare” were included in the survey question, which asked: “Do you support or oppose Virginia expanding access to health care for low-income, uninsured state residents, the ‘Medicaid expansion’ plan?”)

Virginia Republicans have every incentive to take party activists very seriously. Last June, Rep. Eric Cantor (R), then the House majority leader, was defeated in a primary for not being conservative enough. In 2013, two senior Republican members of the House of Delegates were defeated in primaries for backing a Republican governor’s transportation plan. And nearly all of the moderate Republicans who crafted bipartisan compromises with then-Gov. Mark Warner (D) a dozen years ago have lost primaries or have retired and been replaced by more extreme lawmakers.

Expect most Republicans to see a tea party shadow over the state Capitol this winter, as Virginians watch again how gerrymandered districts generate Beltway-style gridlock over Medicaid expansion.

The writer is professor of political science and director of the Center for Leadership and Media Studies at the University of Mary Washington.