HELENA – One day after a lengthy floor battle to free a Medicaid expansion bill from committee, the Montana House on Thursday endorsed the measure, voting 54-46 to accept millions of federal dollars to extend subsidized health coverage to thousands of low-income Montanans.

“I think this is the right thing to do, it’s the right time to do it,” said Rep. Rob Cook, R-Conrad, who carried Senate Bill 405 on the floor. “Let’s pass this bill.”

Thirteen Republicans and all 41 House Democrats supported the measure Thursday, setting up a final House vote later this week.

If the state Senate accepts the one amendment attached Thursday by the House – a likely prospect – the bill goes to Democratic Gov. Steve Bullock for his signature.

Bullock hasn’t said whether he’d sign the measure, but his top health care adviser has testified twice in favor of SB405 in hearings before legislative committees this session.

If the Medicaid expansion contained in SB405 is approved by federal health officials, it’s estimated that anywhere from 27,000 to 45,000 Montanans earning less than 138 percent of the federal poverty level would sign up for coverage under the plan.

The federal government would pay all of the program’s costs in 2016, but then gradually reduce its support to 90 percent by 2020. The state would pick up the remaining cost. Bullock administration officials have estimated that federal money flowing into the state will total $430 million the next two years and $600 million the two years after that.

All 46 House members opposing the bill Thursday were Republicans, including the body’s top GOP leadership.

They criticized the bill as a huge expansion of “welfare” to able-bodied adults, in the form of subsidized medical coverage.

“A bankrupt federal government with a stack of cash, and we’re supposed to be grateful,” said Rep. Nicholas Schwaderer, R-Superior. “All this bill is, is a gimmick to give hospitals, pharmacies and other providers a bunch of money and purchase the vote of the sick, the poor, the vulnerable. Vote no.”

House Majority Leader Keith Regier, R-Kalispell, said expanding Medicaid might sound like a good idea, but that studies have shown Medicaid-covered patients have worse health care outcomes.

He also said the expansion is an extension of “Obamacare,” which is increasing poverty in the nation by forcing businesses to reduce workers’ hours and raising taxes on others to pay for its costs.

Yet one of the Republican supporters of the bill, Rep. Geraldine Custer of Forsyth, argued it would help rural hospitals that are financially hurting and help the “working poor,” most of whom can’t afford health insurance.

“They are not people who are lying on the couch, waiting for a handout,” she said. “Why should they be penalized and not able to afford health care?

“This isn’t Obamacare. ... This bill is a Montana solution for the Montana people who are too rich for (current) Medicaid but too poor for (help from) the Affordable Care Act.”

Opponents tried several times to amend the bill, but were rejected by the coalition that voted to support SB405, which is sponsored by Republican Sen. Ed Buttrey, R-Great Falls.

That same coalition also muscled the bill to the House floor Wednesday, voting several times to interpret the House rules in a manner that allowed a simple majority to remove the bill from a committee that had voted to kill it. The bill came to the floor on a 52-48 vote Wednesday, with 11 Republicans joining all 41 House Democrats.

On Thursday, two additional Republicans – Reps. Bruce Meyers of Box Elder and David “Doc” Moore of Missoula – joined those original 11 in supporting the bill.

The original 11 were Cook, Custer and Reps. Christy Clark of Choteau, Frank Garner of Kalispell, Tom Berry of Roundup, Tom Richmond of Billings, Dan Salomon of Ronan, Jeff Welborn of Dillon, Ray Shaw of Sheridan, Steve Fitzpatrick of Great Falls and Roy Hollandsworth of Brady.

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