The Kansas House on Thursday passed a Medicaid expansion plan on a 69-54 vote as opponents railed about parliamentary high jinks and budget constraints.

Gov. Laura Kelly, a Democrat who made Medicaid expansion a top priority, applauded the bipartisan movement and urged the Senate to hold a vote.

Medicaid expansion is projected to provide health care coverage to an additional 130,000 low-income Kansans and unlock nearly a billion dollars in federal funding. The plan was estimated to have a yearly budget impact of about $50 million for the state before the addition of monthly fees that could offset most of that cost.

Thursday's vote came a day after Democrats joined with moderate Republicans to insert Medicaid expansion into an unrelated bill during floor debate and rebuff a challenge from House Majority Leader Dan Hawkins.

Hawkins, R-Wichita, said Democrats ignored rules when they used a procedure known as gut-and-go to force a vote on Medicaid expansion.

"We sent a message to every Kansan that rules don't matter," Hawkins said. "With one unprecedented vote, this body became more polarized, more fractured and more political."

GOP leadership for two years had stiff-armed any attempt to hold a hearing or vote on Medicaid expansion. Former Gov. Sam Brownback vetoed a plan that passed in 2017.

Earlier in the week, expansion advocates demonstrated in the Statehouse with voices ringing "we want a vote."

"A bipartisan coalition in the Kansas House put politics aside and came together to pass Medicaid expansion," Kelly said. "I’m proud of their work — and the work of so many advocates and citizens who worked tirelessly to make their voices heard on this issue."

Rep. Don Hineman, a Dighton Republican who lost his majority leader title to Hawkins, said a person's zip code in Kansas is a greater determinant of health outcomes than genetics. Medicaid expansion, Hineman said, gives hope to rural Kansas and struggling hospitals.

“This proposal will provide immediate help for their bottom line, stabilizing operations, aiding in staff improvement and providing a lifeline to much-needed retooling and reconfiguring of health care delivery," Hineman said.

Rep. Ken Rahjes, R-Agra, said his desire to make Kansas a great state isn't diminished by his opposition to Medicaid expansion.

"I will continue to work on solutions to keep our rural hospitals viable," Rahjes said, "but this is not the answer when we simply do not know what the cost will be and how it will be paid for."

Supporters of Medicaid expansion tout the economic impact of increased spending on health care. If 2.5 percent of the new money flows to the state coffers through sales or income tax collections, it could add $18 million to state revenue next year.

But opponents worry that estimates fall short of the actual number of people who will sign up, and they point to a ballooning federal deficit.

"To suggest increasing national debt as an economic development tool is insane," said Rep. Eric Smith, R-Burlington.

Rep. Stephen Owens, R-Hesston, said Medicaid expansion would force a tax increase within the next two years.

“We have a state emergency in our prisons," Owens said. "We have lost kids in our foster care system. We are in the midst of a mental health crisis. We have an underfunded KPERS system and underfunded judiciary. We have roads and bridges that need fixed. We have an unresolved school funding lawsuit."