STUNNED BY massive losses in last fall’s state legislative races, some Virginia Republicans — enough of them, at least — this year began to acknowledge the senselessness of their opposition to extending Medicaid health insurance to some 400,000 citizens under the Affordable Care Act. That shift, after four years of groupthink GOP obstruction, at last yielded a breakthrough Wednesday, when both houses of Richmond’s Republican-controlled legislature passed a budget expanding Medicaid.

The irony was that it is precisely in some of the state’s most heavily Republican counties — rural areas of Southside and Southwest Virginia — where a lack of health insurance was most widespread, in many areas amounting to 20 percent of adults under the age of 65.

Elections have consequences. And in the November races for the House of Delegates, when Republicans, who had controlled two-thirds of the chamber, came within a single seat of losing their majority, one of the chief consequences for the party was having to reckon with the reality that blocking Medicaid expansion was directly hurting their constituents.

That fact was acknowledged, obliquely, when the dam of GOP obstructionism in Richmond began to crumble after its majority in the 100-seat chamber shrank to 51 from 66. “For my district, for my part of the state, it’s the right thing to do,” said Del. Terry G. Kilgore, who represents an impoverished coal-country district in Southwest Virginia.

Mr. Kilgore was right, and his about-face on the issue was a critical turning point. Along with a handful of other Republicans, including state Sen. Frank W. Wagner, he deserves credit for breaking party ranks and siding with needy people who were pointlessly victimized by Virginia’s rules on Medicaid.

Under the state’s existing guidelines, which are among the nation’s least generous, working parents can’t collect Medicaid if they earn more than about $5,700 a year, and adults without children are ineligible even if they have no income at all. Under the new legislation, which Gov. Ralph Northam (D) says he will sign, Virginia can raise its income limits for eligibility to $16,750 for an adult, and $28,700 for a family of three. The current cutoff for a family of three is $6,900.

The new rules will increase the state’s Medicaid roll, now roughly 1 million, by about 40 percent. At Republicans’ insistence, they will also impose a work requirement for eligibility — a gratuitous measure since the large majority of recipients already work or are exempted as primary caregivers for young children. Ninety percent of that cost will be borne by the federal government, and the balance by a tax on hospitals.

The list of states that have refused to expand Medicaid is shrinking; after Virginia’s expansion starts, in January, just 17 states will remain, nearly all of them in the South and Midwest and controlled by Republicans. They are as out of touch as GOP lawmakers in Washington who have chipped away at the Affordable Care Act, gambling with the health of their own constituents.

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