LANSING (AP) – The Republican-led Michigan House voted late Thursday to make hundreds of thousands more low-income adults eligible for Medicaid, sending the legislation across the Capitol to a chamber where its prospects are less certain.

Lawmakers, on a bipartisan 76-31 vote shortly before 10 p.m., approved expanding Medicaid eligibility in 2014 to 320,000 adults making up to 133 percent of the poverty line. Nearly a half-million Michiganders could enroll by 2021 under the federal health care law, according to estimates from Republican Gov. Rick Snyder, who supports providing the government-funded health insurance to more people.

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“I believe it’s time for us to stop playing defense with something that is the law of the land and begin to play offense,” said Rep. Mike Shirkey, R-Clark Lake, who was a staunch opponent of Medicaid expansion before changing his mind. “This is a very unique opportunity for us to negotiate from a position of strength to get reforms in what have been long-held entitlement reforms, real reforms that will help people and help taxpayers.”

The measure heads to the Senate, where passage could prove more difficult because the chamber is dominated by Republicans, 26-12, while GOP control of the House is narrower. Under legislative rules, the House had to vote this week if the Senate is to approve the bill before lawmakers break for the summer in a week.

“The majority leader has listed Medicaid reform as one of the issues he’s interested in taking a hard look at before the session is done and he intends to talk to his caucus about further action on Tuesday,” said Amber McCann, spokeswoman for Senate Majority Leader Randy Richardville, R-Monroe.

Medicaid covers roughly one in five Michigan residents – mainly low-income children, pregnant women and the disabled along with some poorer working adults.

Under the federal health care overhaul, states can expand Medicaid to adults making up to 133 percent of the poverty level, or about $15,300 for an individual. The U.S. government is offering to cover the entire cost initially and 90 percent down the line.

The House bill includes GOP-written requirements that new enrollees pay some of their medical expenses after being on the program for six months and pick up more costs after getting Medicaid for four years. They could lower their costs by not smoking, for instance, or adhering to other healthy behaviors.

The newly eligible also would no longer be covered if savings from the expansion do not cover the state’s costs in the future.

The federal government would have to sign off for Michigan to proceed with its plan.

“I think it’s a failed program, so why would we expand it? It’s as simple as that,” said Rep. Tim Kelly, R-Saginaw, who said his understanding is House leaders would not have called a vote without assurances of Senate passage.

Adults ages 21 to 64 and making between 100 and 133 percent of the poverty line would have two options after four years under the legislation: buy government-subsidized insurance through a new health insurance market or stay on Medicaid by paying more out-of-pocket costs.

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The four-year provision would not apply to those earning under the poverty level.

Supporters contend that offering health insurance to more poor people will make them healthier and minimize their expensive trips to the emergency room, saving money throughout the health care system and also helping businesses meet requirements under the Affordable Care Act. The state would save $200 million a year initially because more people covered by state aid would be covered with federal Medicaid dollars.

Opponents say federal money still comes from taxpayers and question such as large government expansion when the U.S. is trillions of dollars in debt. A group of tea party and conservative activists said earlier this week they would oppose Snyder’s expected re-election bid because of his push to expand Medicaid coverage.

Kelly was among 30 Republicans and one Democrat to vote no. Forty-seven Democrats, 28 Republicans and one independent voted yes.

“I don’t buy the assumptions,” he said. “I don’t buy anything about it. I don’t think by simply handing somebody a certificate that says, `now you’re insured,’ all of a sudden you’re going to modify their behavior. These people are still going to go to the emergency manager. They’re not going to change their behavior. If you give Michael Jordan’s basketball shoes to a kid, all of sudden he’s not the best basketball player in the world.”

Expanding Medicaid eligibility could cut Michigan’s uninsured by nearly half. Uninsured residents with higher incomes will be covered by a new federal insurance market offering taxpayer-subsidized private plans.

No legislators rose to speak against the bill before the vote. After it passed, Democrats erupted in applause.

“I’m proud that this Legislature for the first time in a long time – this goes for both sides – rejected the extremes that too often define who we are,” said Rep. Brandon Dillon, D-Grand Rapids. “We haven’t listened to the loudest voices but listened to the voice of people who are experts. … This isn’t just a philosophical argument about size and scope of government. This is a bill that will immediately impact people in a very positive way.”

Snyder, who has made Medicaid expansion a top priority, applauded Republicans and Democrats for coming together.

“With their input, the Healthy Michigan Plan is an innovative, visionary model for other states to emulate,” he said in a statement.

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