Gov. Ralph Northam (D) is confident Virginia legislators will give him a budget that includes Medicaid expansion.

In his monthly interview on Richmond’s WRVA, Northam said Medicaid expansion was the right thing to do, both from a business and a moral perspective.

But he also mentioned the real reason expansion, or something like it, gets done: politics.

“What legislators need to realize is that on Nov. 7 Virginia spoke,” Northam said.

“The great majority of Virginians came out and voted and one of the things they voted on was increasing access to health care in Virginia.”

Perhaps. Medicaid expansion may have motivated some voters in some races. But the biggest Democratic motivator in 2017 was Donald Trump.

Senate Republicans won’t test the anti-Trump vote’s potency until 2019.

That bit of insulation, and a firm belief they are right on the policy, makes them confident they can prevent Medicaid expansion again.

Many eyes are focused on Sen. Emmett Hanger, chairman of the Senate Finance Committee, as the mostly likely Republican to break ranks.

His March constituent newsletter fed that speculation.

In it, Hanger said he was “very pleased to see” some of the House’s “rural conservative legislators” get behind “a somewhat limited Medicaid Expansion, with some Virginia specific requirements, in their House budget.”

Sounds like he’s ready to give, doesn’t it?

Except Hanger has a number of conditions that must be met before he’s ready to consider a bigger Medicaid program.

Hanger wants more stringent work requirements — more so than the House or the governor agreed to. He also wants recipients to have regular income verification and objects to the House’s funding mechanism: a new tax on hospitals.

Still, Hanger also said he “will stand with anyone willing to make bold moves to address the need because it impacts all of us, our budget, and my personal beliefs tell me it is the right thing to do.”

So he’s saying there’s still a chance?

A small chance, but not likely.

If Democrats truly believe Medicaid expansion is a potent political issue for them, they should focus on Republican incumbents in districts Democratic presidential nominee Hillary Clinton won in 2016 and Northam won in 2017.

Remember: 14 of the 15 House of Delegates seats Democrats won in 2017 were in seats Clinton carried in 2016.

Consider two freshman Republican senators in suburban districts who fit the Clinton/Northam rubric: Glen Sturtevant in the 10th and Siobhan Dunnavant in the 12th.

Clinton won the 10th District, which covers parts of the city of Richmond and Chesterfield and Powhatan counties 53.2 percent to 41 percent over Trump. In 2017, Northam won the 10th 57.7 to 41 over Ed Gillespie.

In the Henrico and Hanover county-based 12th, Clinton defeated Trump  47.5 to 45.9 percent. Northam won the district 51.5 to 47.2 over Gillespie.

Democrats looking for Medicaid  leverage should be looking at districts like these.

But even if the election trends look good for Democrats, flipping either Dunnavant or Sturtevant won’t be easy — if at all possible.

Sturtevant wrote that the Senate’s version of the state budget is “fiscally responsible” and “does not raise taxes and does not expand the Medicaid entitlement program under Obamacare.”

That doesn’t sound like a man ready to flip. But as a freshman Republican in a Clinton/Northam district, politics might make Sturtevant a bit more pliable.

Dunnavant, an OB-GYN,  also seems firm in opposing expansion. But Dunnavant might consider the fate of another Henrico physician/Republican legislator: John O’Bannon.

O’Bannon was a House go-to guy against Medicaid expansion. His 73rd District, which sits inside Dunnavant’s 12th District, went for Clinton and Northam. He lost his bid in 2017 to Debra Rodman.

One of Rodman’s top issues in the 2017 campaign? Expanding Medicaid.

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The key that could unlock Medicaid expansion in Virginia