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 96-20 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.”

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.

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.