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The Utah Senate voted 21-8 Tuesday to send Gov. Gary Herbert's Healthy Utah plan for a final vote, which could come as early as Wednesday.
"We're just passing the buck if we don't do something," said Sen. Todd Weiler, R-Woods Cross, who voted yes.
"We're delivering health care to many of these people, but we're doing it in the most expensive way possible: through emergency rooms and prisons," Weiler said.
Several of the senators indicated they may change their "yes" vote to "no" on the final vote, but even if they do, Senate Bill 164, sponsored by Sen. Brian Shiozawa, R-Cottonwood Heights, is likely to pass the Senate.
Shiozawa said he was surprised by the margin of support for the Medicaid expansion proposal, and said that should make a difference in the House, where Healthy Utah is floundering.
"It's the best solution we have to a problem we need to address," said Shiozawa, referring to the fact that an estimated 63,000 Utah adults will be below the poverty line next year but unable to get subsidized health care via the Affordable Care Act.
But Speaker of the House Greg Hughes, R-Draper, said, "We do not have the support to move forward on that legislation in any way."
SB164 proposes a two-year pilot program that would cost Utah $25 million even though the federal government would pay 100 percent of the costs nearly $900 million for the first 18 months.
"The actual cost probably would be significantly less," Shiozawa said.
The state's share would not require a tax hike but would be covered through a combination of cost savings, efficiencies and one-time money, according to the governor's office. An estimated 126,000 low-income Utahns would get health coverage via Healthy Utah in its second year.
"There's a lot of speculation on this, what will happen if we have a Healthy Utah program?" Herbert said. "So let's test it out.
"If the House has a better idea, let's hear it," he added. "Doing nothing is not an option."
Hughes said he'd prefer Medicaid expansion start small and expand later, and doesn't like the idea of taking benefits away after two years. When that has happened in the past, it amounted to "human carnage," Hughes said.
"We do not improve the human condition at all," he said, by providing coverage for two years and then pulling it back.
But on the Senate floor, several senators said even short-term coverage would be welcomed by the working poor adults who have no medical coverage.
Healthy Utah goes beyond that coverage gap population to include those earning up to 138 percent of poverty because it's the only way Herbert could get the U.S. Department of Health and Human Services to agree to initially pay 100 percent of the costs.
Sen. Lyle Hillyard, R-Logan, said he at first considered Healthy Utah a "giant bait and switch," but after learning more, is persuaded it's a good plan, especially given the two-year expiration. "By the time this expires, we'll have a new president," he said.
Sen. Margaret Dayton, R-Orem, said she has "real angst about federalizing health care," and Sen. Allen Christensen, R-North Ogden, called Healthy Utah "the opposite" of compassionate.
His own SB153 would expand Medicaid to fewer Utahns, those deemed medically frail.
"We are turning our backs on solid conservative values," he told his colleagues.
Sen. Daniel Thatcher, R-West Valley City, said he has misgivings about Healthy Utah, but voted for it anyway.
"As much as I hate this, I haven't seen a better option," Thatcher said. "I'm going to plug my nose and I'm going to vote aye."
Robert Gehrke contributed to this story.