Virginia is poised to expand Medicaid after a hard-fought legislative battle, making it one of a growing number of states where there is interest in expanding the program after Republicans failed to repeal the Affordable Care Act last year.

The Virginia Senate on Wednesday approved expansion of Medicaid, the state-federal program for the low-income, and the bill now heads to the House of Delegates, where it is widely expected to pass. Democratic Gov. Ralph Northam has signaled he will sign the bill, making the state the 33rd to expand Medicaid under the ACA.

Efforts are under way in other states, but the outlook is far from certain.

Organizers who support Medicaid expansion in Utah learned this week that they had obtained enough signatures to put the initiative on the ballot in November, potentially expanding coverage to more than 100,000 people. A push is also under way to get expansion on the ballot in Idaho. The odds look less likely in other red states. Organizers are trying to get expansion on the ballot in Nebraska, but GOP Gov. Pete Ricketts has been opposed, saying it would be an expensive burden for state taxpayers.

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Virginia set to expand Medicaid, and other states are following