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Republican lawmakers in Virginia rejected another bid to expand Medicaid, saying the cost of providing new health coverage to thousands of poor adults would cripple the state. The House of Delegates voted against Medicaid expansion Wednesday as lawmakers reconvened for a one-day session to consider Democratic Gov. Terry McAuliffe’s amendments and vetoes. (Suderman and Rankin, 4/5)

In the House, delegates soundly rejected the governor’s effort to restore language in the budget that would allow him to begin the expansion of Medicaid under the Affordable Care Act. Del. R. Steven Landes (R-Augusta) said he doubted the ACA would still be in place by the end of the year and argued that expanding Medicaid would blow a hole in Virginia’s budget. Under the ACA, the federal government would pay 100 percent of the expansion to an estimated 400,000 Virginians through next year; after that, the state would be on the hook for about 10 percent of the additional cost. (Vozzella and Schneider, 4/5)

Mr. McAuliffe has made Medicaid expansion a priority since taking office in 2014, saying 400,000 people would be covered if the state accepted the federal aid that was part of the Affordable Care Act. In light of the recent congressional decision to pull a bill to repeal and replace the health-care law, Mr. McAuliffe said Virginia “has no excuses left to hold out on Medicaid expansion.” But Republican legislators on Wednesday blocked a McAuliffe amendment meant to allow expansion, saying the state cannot afford it. “We rejected expansion in 2013, 2014, 2015, 2016, and again in 2017 because it was the wrong policy for the Commonwealth,” they said. (Bauerlein, 4/5)

Gov. Terry McAuliffe’s latest bid to expand Virginia’s Medicaid program died on a party-line vote in the House of Delegates on Wednesday. But Republican opponents left open the option of finding ways to improve health care for uninsured Virginians in impending discussions by a new joint legislative subcommittee. (Martz and Moomaw, 4/5)

A federal judge has given the parties additional time — through mid-April — to negotiate Gov. Roy Cooper’s request to expand North Carolina’s Medicaid program. N.C. Senate leader Phil Berger, R-Rockingham, and N.C. House Speaker Tim Moore, R-Cleveland, sued both the federal and state departments of health and human services on Jan. 13. At that time, the federal DHHS was under the Obama administration. The lawsuit is an attempt to prevent Cooper from submitting an amendment request to the federal Centers for Medicare and Medicaid Services, or CMS, that would affect a state Medicaid waiver request submitted June 1 by the administration of Cooper’s predecessor, Pat McCrory. (Craver, 4/5)