It’s nearly a done deal now. The Virginia state Senate voted Wednesday to expand Medicaid under the Affordable Care Act, with four Republicans crossing party lines to join all Senate Democrats in backing the move. The House of Delegates, which already passed a version of Medicaid expansion, will need to vote again to make expansion a reality, but the odds now seem overwhelming that Virginia will become the 33rd state to expand Medicaid (Washington, DC, has also expanded). That’s big news for about 400,000 poor and near-poor Virginians who will gain access to affordable health insurance, and a big deal to the state’s health care providers, who’ll get an injection of clients and money — an important topic for residents of rural areas writ large since expansion helps ensure that hospitals can stay in business, which helps even people who aren’t directly assisted by Medicaid expansion. In political terms, expansion is a huge victory for the state’s Democratic governor, Ralph Northam, w