Lawmakers in the Kansas House broke a stranglehold on Medicaid expansion movement and gave first-round approval Wednesday to a plan to extend health care coverage to 130,000 low-income Kansans.

Rep. Kathy Wolfe Moore, D-Kansas City, put the plan in play by gutting legislation crafted by House Majority Leader Dan Hawkins, a Wichita Republican and outspoken opponent of Medicaid expansion, and securing enough bipartisan support to overcome a rules objection.

GOP leadership throughout the session has blocked a Medicaid expansion bill from getting a hearing, and Wolfe Moore said her amendment on the floor was the only way to secure a debate on the issue.

"Today is most definitely the day to stand with the people of Kansas," Wolfe Moore said.

The Kansas Health Institute estimates expansion would have a $47.4 million impact on the state budget in 2020. The federal government would assume 90 percent of the costs for those served by KanCare, as Medicaid is known in Kansas, including the 416,000 seniors, children of low-income families, disabled adults and pregnant women already in the system.

The House advanced the expansion package on a 70-54 vote. A final action vote will be needed to pass the bill and send it to the Senate.

"This was a rare demonstration of political bravery in the House," said Rep. Brett Parker, D-Overland Park. "Kansans are better off for the bipartisan coalition that cast aside partisan obstruction to deliver a desperately needed policy."

Republicans succeeded in modifying Wolfe Moore's plan to ban coverage of abortion procedures and require monthly fees for those who sign up.

Rep. John Eplee, R-Atchison, proposed a $25 per month service cost, with a $100 cap for a single household, as an alternative to work requirements favored by some Republicans. Eplee said the fees could produce enough revenue to fully offset the state's financial obligation.

"I think this is a reasonable compromise," Eplee said.

The prohibition on abortion services, introduced by Rep. Susan Humphries, R-Wichita, doesn't provide exceptions for rape, incest or saving the life of a mother, as federal law does.

The long-anticipated debate over Medicaid expansion unfolded after Hawkins objected to the obliteration of his bill, which dealt with nursing qualifications. A majority vote allowed the debate to proceed.

Rep. Steve Huebert, R-Valley Center, cautioned lawmakers about the "huge impact" Medicaid expansion is sure to have on the state budget. He said there was no question the federal government eventually will dial back its financial support for the program.

"When you see me in five years," Huebert said, "I'll wish you the best on whatever cuts you're making."

Wolfe Moore's plan includes a "poison pill" provision that authorizes the Kansas Department of Health and Environment to back out of expansion if the federal match rate drops below 90 percent.

Rep. Brenda Landwehr, R-Wichita, said the "poison pill" provision won't have an effect because it would be politically untenable for the Legislature to take away health care coverage after the plan passes.

As chairwoman of the health committee, Landwehr hasn't held a hearing on Medicaid expansion legislation. Instead, Landwehr held three days of roundtable discussions on the issue.

Landwehr questioned Wolfe Moore on the details of the plan for 40 minutes and urged lawmakers not to rush when unanswered questions remain.

"We're not done this week," Landwehr said. "There are discussions going on. This isn't the last vehicle out of there."

Rep. Jim Kelly, R-Independence, said he found it hard to believe the magic answer will appear next week. He said he supports Medicaid expansion after seeing the chaos in his town when its hospital closed.

Kelly said elderly residents struggled to figure out what to do while they watched doctors leave town.

"Let's move forward and try to put something positive in place for Kansas, and in particular for those of us who live in rural Kansas," Kelly said.