Virginia Gov. Terry McAuliffe (D) has made it a top priority to remove the commonwealth from the list of 25 states that have declined to expand the number of individuals eligible for Medicaid under Obamacare. On Monday, House Speaker William Howell (R-Stafford) said his majority caucus is not going to play along.

“I believe Medicaid expansion is not going to happen this year,” Speaker Howell said.

In another influential development Monday, an official election recount certified Democrats took control of the Senate with a margin of 11 votes by winning the seat vacated by Lt. Gov. Ralph Northam (D). The Senate is now evenly split between the parties, with Northam holding a tie-breaking vote.

The governor’s battle for Medicaid expansion that would affect 400,000 Virginians is a political story, particularly in the context of an electorate that ranges from red to purple to blue, as well as a Republican Party chastened by recent election sweeps and a 14-count indictment against former Gov. Bob McDonnell (R) and his wife Maureen. But it is also a practical story for a significant number of women in Virginia who through Medicaid expansion could gain access to health care, as highlighted by a new report released by the National Women’s Law Center.

In Mind the Gap: Low-Income Women in Dire Need of Health Insurance, the group highlights challenges faced by women in the gap between qualifying for traditional Medicaid and qualifying for Medicaid after expansion. In particular, low-income women experience significant statistical differences in access to health care based on whether they have insurance.

According to the report, 128,000 women in Virginia would gain access to Medicaid if McAuliffe prevails. If Republicans follow through on their intention to block expansion, however, sharp disparities in access to health care would be expected to continue between low-income women in the state. In one finding, more than double the percentage of those low-income women without insurance in Virginia did not go to a doctor when they needed to because of cost sometime in the last 12 months, as compared to those who were low-income but had insurance. In another finding, a little less than half of low-income women without insurance in Virginia have a primary care doctor.

One week ago, Gov. McAuliffe gave the legislature 60 days to approve Medicaid expansion and indicated that if it did not operate on his timetable, he would attempt to do it himself through a budget amendment. It was not the first time McAuliffe created political controversy in pursuit of Medicaid expansion; recently, he rankled his own base by retaining Gov. McDonnell’s Secretary of Health, Bill Hazel, as a sort of preliminary peace offering to Republicans judged by Democrats to be open to expanding Medicaid despite a steady stream of statements to the contrary that continued Monday.