Kansas's Democratic governor, Laura Kelly, struck a deal with Republicans to expand Medicaid.Mark Reinstein / MediaPunch / IPX / AP

Imagine: A veteran Democrat with a reputation for bipartisan dealmaking defeats a Republican who complains about voter fraud and crusades against illegal immigration. A GOP legislative leader, recognizing the political ground shifting under him, comes reluctantly to the negotiating table. After months of talks, the two strike a compromise on health care that dramatically expands publicly funded insurance coverage.

This is former Vice President Joe Biden’s 2020 campaign pitch in a nutshell—that he can tap the relationships he forged over four decades in Washington to draw Republicans like Senate Majority Leader Mitch McConnell to negotiations that will yield bipartisan breakthroughs on health care and other key issues. His rivals deride it as a naive fantasy, but Biden’s dream just came true in deep-red Kansas, a state that voted for Donald Trump in 2016 by more than 20 points.

Last week, Kansas’s Democratic governor, Laura Kelly, announced that she had reached an agreement with the Republican majority leader of the state Senate, Jim Denning, on a proposal to expand Medicaid under the Affordable Care Act to as many as 150,000 people in the state. If the measure passes, Kansas would become the 37th state to expand Medicaid. A 2012 Supreme Court ruling allowed states to opt out of raising income thresholds for the program, which provides public health coverage for the poor. Most Republican-run states—including Kansas—initially rejected the money, but Democratic victories in governors’ races and in voter-driven ballot initiatives have led states including Louisiana, Maine, Virginia, Utah, and Idaho to expand Medicaid in the past few years.

No state has seen a more rancorous debate over the issue than Kansas, the home base of the Koch empire, where a decade-long battle over taxes and spending has deepened fissures between the conservative and moderate Republicans who control the state legislature. The moderates rebelled after former Governor Sam Brownback’s signature tax cuts—which the onetime presidential hopeful hailed as “a real live experiment” in conservative governance—blew a hole in the state budget and failed to bring the economic growth he promised. The GOP-led legislature reversed a big chunk of the tax cuts, while Trump air-lifted the deeply unpopular Brownback out of Topeka for a mid-level diplomatic assignment at the Vatican.

For years, conservatives thwarted a coalition of Democrats and moderate Republicans that repeatedly attempted to expand Medicaid. Then came 2018, when the debate figured prominently in the gubernatorial election Kelly won by defeating Kris Kobach, Kansas’s then–secretary of state. (Kobach, a conservative Trump ally who backed crackdowns on voter fraud and illegal immigration, is now running for U.S. Senate.)

Like Biden, Kelly served for years as a legislator. The relationships she built with Republicans during her time in the Kansas state Senate likely helped her strike the Medicaid deal, April Holman, the executive director of the pro-expansion advocacy group Alliance for a Healthy Kansas, told me. Public polling favored expansion, and GOP legislators were also under pressure from rural hospitals and other health-care providers that wanted an agreement. Yet although a coalition of moderate Republicans was in favor of the expansion, Denning was not one of them. “He is someone who has traditionally opposed expansion, and we’re thrilled that he has changed his position,” Holman said.

“It gives me hope that compromise is not a lost art,” she said. “They worked together as senators for many years while she was in the Kansas Senate. So I think by building those relationships over time and a relationship of trust, it can make a huge difference.”

That is Biden’s theory of the case as well: He would enter the White House with closer ties to the congressional leadership of both parties than any president since George H. W. Bush. When Republicans blocked virtually the entire agenda of President Barack Obama after they won control of the House in 2010, it was Biden who stepped in to broker a deal with McConnell to raise taxes on the wealthy and stave off hikes for the middle class in the final days of 2012. And although most Democratic presidential candidates acknowledge that their grand progressive plans depend on capturing the Senate majority from Republicans, Biden predicted to donors earlier this month that McConnell would become “mildly cooperative” if he is elected. Progressives dismiss this as a pipe dream, a Charlie Brown–and-the-football attitude that ignores the ruthlessness of a party that denied Judge Merrick Garland so much as a hearing after Obama nominated him to the Supreme Court in 2016.

In Kansas, Republicans are even more firmly in power in the state legislature than they are in Washington, holding supermajorities in both chambers. But in practice, the state often functions as if there were three distinct parties: conservative Republicans, moderate Republicans, and Democrats. In Washington, the moderate ranks of the GOP have been thinned out in recent years by Democratic victories in swing states and by primaries that favor conservatives.

Despite their apparent success, the bipartisan negotiations over Medicaid expansion were neither easy nor quick: Kelly took office more than a year ago, and her initial efforts to engage Republicans failed. “Things had gotten really far apart really fast,” state Representative Susan Concannon, a Republican backer of Medicaid expansion, told me. She said that “kind of a perfect storm” pushed the two parties toward a deal. The election of a Democratic governor certainly gave Medicaid expansion crucial momentum, and Republicans like Denning were facing political pressure in their home districts and across the state. “Maybe some people saw the writing on the wall that that’s the direction we would be going,” Concannon told me.

I asked her if the compromise in Kansas gave her any hope that Republicans and Democrats could break the logjam on health care in Washington next year. She chuckled. “That’s a big question,” Concannon replied. “If there would be a Democratic president, especially if the Senate stays a Republican majority, I think that there would be an attempt to work across the aisle.” She paused before adding: “I would hope so.”

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