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The fiercest Obamacare fight in the country just got even more fraught. But in Virginia, as in the many other states in which conservative holdouts are fighting against expanding health-care access to low-income people, there remains only one reasonable solution: Republicans must ultimately compromise on expanding Medicaid.

For months now, Gov. Terry McAuliffe, a Democrat, has been battling Republicans over whether Virginia should take $2 billion per year of federal money to expand Medicaid within the state, covering some 400,000 people. Amid this deadlock, Phillip Puckett, D-Russell, a state senator, suddenly resigned on Monday, shifting power in the Senate from the Democrats to the Republicans. The newly configured Senate now appears ready to pass a state budget without Medicaid expansion in it, possibly jamming the governor with a spending plan that does not include his top priority. Mr. McAuliffe could try to amend the bill and send it back to the legislature, but it's also very possible that the governor will be thwarted in delivering on his push to expand Medicaid in this legislative round.

Angry Democrats have derided the suspicious circumstances surrounding Mr. Puckett's resignation: He apparently was set to take a job that Republicans on a state tobacco commission were to offer him. Amid all the uproar, Mr. Puckett decided not to take the job, but his daughter still stands to gain from his resignation, as his presence in the legislature has been complicating her rise as a state judge. "I am dismayed by news today that my Republican friends have offered Sen. Puckett an unseemly, shady, backroom deal," House Democratic Caucus Chairman Mark D. Sickles, Fairfax, said.

The appearance of hardball politics doesn't bother us nearly as much as the continuing backwardness of the GOP's anti-Medicaid crusade. The federal government is offering the state a tremendous deal, covering nearly the whole bill in perpetuity for expanding Virginia's Medicaid program. The problem of providing health coverage to the thousands of Virginians hovering around the poverty line, meanwhile, is real. It's not just that a lot of them lack health-care coverage. It's that a lot of them make too much money to qualify for the unexpanded Medicaid program but too little to qualify for subsidies to buy insurance from the Obamacare marketplace.

Instead, Virginia Republicans have offered excuse after excuse, none convincing, for refusing the federal cash. They objected that the Medicaid program is poorly designed. Mr. McAuliffe got behind a proposal to reform it. They objected that the federal government might sometime in the future skip out on its commitment to pay for the expansion. Mr. McAuliffe offered them a time-limited, two-year expansion deal.

The Medicaid issue won't just go away. Too many Republicans in Richmond have refused to entertain any sort of reasonable compromise, despite several moves in their direction. As long as that remains the case, thousands of people in Virginia will be worse off for it.