JACKSON, Miss. (AP) — Mississippi’s Republican-led House passed a bill Wednesday that would expand Medicaid benefits to hundreds of thousands more residents in one of the poorest states in the U.S. — a landmark shift after state leaders refused to consider the policy for years.

The bill’s passage was greeted by applause in the House chamber following a bipartisan 98-20 vote. It now heads to the state Senate, where its fate remains uncertain as lawmakers are expected to introduce a competing proposal that could serve as a foundation for further negotiations.

The move follows years of opposition from Republicans, including Gov. Tate Reeves, to the expansion allowed under the Affordable Care Act, a 2010 federal health overhaul signed by then-President Barack Obama. The bill’s Republican sponsor, Rep. Missy McGee, said lawmakers had a “moral imperative” to put ideology aside to improve Mississippi’s poor health outcomes.

“It is a topic that should transcend politics and economics. For at its core, it’s about the well-being and dignity of every Mississippian,” McGee said. “Sometimes, it’s OK to do the right thing, because it’s the right thing.”

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Mississippi has the highest rate of preventable deaths in the U.S. Its top health official has said it ranks at the bottom of virtually every health care indicator and at the top of every disparity. Hospitals are struggling to remain open. The state also has one of the nation’s lowest labor force participation rates. Expansion proponents have said the policy could help ameliorate these conditions.

Opponents of Medicaid expansion say the program would foster government dependency, increase wait times for health services and push people off private insurance. In a social media post on Wednesday before the vote, Reeves repeated those criticisms and tied the bill to the goals of prominent Democrats.

“Representative McGee keeps saying — over and over — that her bill is for working people,” Reeves said. “The truth is this: her bill passed by the House committee yesterday is straight Obamacare Medicaid Expansion.”

The proposal would increase eligibility for Medicaid, a health insurance program that covers low-income people. Those making up to 138% of the federal poverty level, or $20,120 annually for a single person, would be eligible under the proposal. Mississippi has about 3 million residents, and its Medicaid program covered 754,585 people in January. McGee said it could extend benefits to about 200,000 people.

At a committee hearing Wednesday, McGee touted a financial incentive for expanding Medicaid provided by Congress in the American Rescue Plan. The bonus helped with the passage of Medicaid expansion in North Carolina. In Mississippi, the incentive and other cost offsets like increased tax revenues would pay for the program for about four years, McGee said.

House Democratic Leader Robert Johnson said he was stunned by the lopsided vote in favor of the bill. The result brought back memories of when Mississippi voted in 2020 to remove the Confederate battle emblem from its state flag.

“The last time I felt this good I cried because we changed the flag for the state of Mississippi,” Johnson said. “Today is a great day for working Mississippians.”

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Michael Goldberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.