Update, February 21, 10:00 a.m.: The Virginia House of Delegates voted 67-32 against Medicaid expansion Thursday, in a move designed to diminish the senate’s bargaining power during upcoming budget negotiations, when the matter will be decided.

For Gov. Terry McAuliffe (D-VA), the process of bringing Medicaid expansion to Virginia has been a struggle, thanks to the politically divided general assembly.

The latest developments in the battle include the Democrat-controlled senate proposing expanded health coverage for low-income Virginians under another name, the Republican-controlled house continuing to try and reject the effort, and an upcoming budget reconciliation process during which the bargaining will begin.

Virginia is one of 25 states that declined to expand Medicaid under the Affordable Care Act, after the Supreme Court declared that the law was constitutional but made its provision to expand Medicaid optional to the states. Because of this, 400,000 uninsured, lower-income Virginians have not received coverage they are otherwise eligible for under the law.

The state senate has proposed a budget that doesn’t include “Medicaid expansion,” per se, but that would help those 400,000 people purchase plans through a new program called “Marketplace Virginia.” The program would be paid for using the same $2 billion in federal funds that the commonwealth could receive for Medicaid expansion under Obamacare.

Meanwhile, the house budget includes no plans for Medicaid expansion, nor anything else that resembles it. This is no surprise and reflects earlier statements from House Speaker William Howell (R-Stafford) that Medicaid expansion will not happen this year.

What happens next in the budget reconciliation process between the two bodies will determine whether access to health-care coverage is expanded or not.

A report by the National Women’s Law Center that looks at data on the uninsured found that Medicaid expansion is especially critical for women.

On its website, Planned Parenthood Advocates of Virginia stated, “If Virginia fails to expand Medicaid, 112,642 women of reproductive age will fall into the coverage gap … leaving them with no options for affordable health care coverage.”

Meanwhile, the Virginia Pro-Choice Coalition recently hosted a day of action to push Medicaid expansion as a top priority for the legislature.

We will know the outcome of the budget reconciliation process by March 8, when the legislature is scheduled to close for the session.