AUGUSTA — The Maine House of Representatives voted 78-61 Monday to allow income-eligible noncitizens to receive health coverage under the state’s Medicaid program.

The bill sponsored by House Speaker Rachel Talbot Ross, D-Portland, was supported by the majority of the Health and Human Services Committee but has faced opposition from Republicans, who criticized the proposal’s $17 million price tag.

Rep. Kathy Javner, R-Chester, said passing the bill would be too much of a burden for Maine taxpayers because it would cover a group of people ineligible for the federal Medicaid program, leaving the state to pick up the costs.

“This bill increases taxes for our residents and citizens of this state by $17 million,” Javner said. “I really encourage everybody in this room to think about your elderly neighbors. (Think) about those young families that are really being taxed astronomically, and their budgets are getting smaller, smaller and smaller.”

But Democrats argued the bill was a matter of fairness because asylum seekers are allowed to work and pay taxes for months and sometimes years while waiting for their applications to be approved by the federal government, but are unable to receive health care benefits.

“MaineCare should cover every Mainer (with) low income – no exceptions, no exclusions,” said Rep. Deqa Dhalac, D-South Portland. “Exclusions based on immigration status are unfair and shortsighted, and they harm our community’s health and our ability fully participate in the workforce.”

The House vote comes as a record number of asylum seekers have flowed into Portland and surrounding communities, straining the emergency shelter system as housing prices and a lack of available housing make it difficult for people to find permanent homes.

The bill received initial approval on a near party-line vote, with Rep. Lucas Lanigan, R-Springvale, breaking ranks and voting with Democrats in support.

The measure now goes to the Senate for debate and a vote later this week. If it passes there, the bill still would need to receive funding approval by legislative leaders, who also are looking to free up funding for big-ticket priorities such as paid family and medical leave and increasing access to child care.

Low-income noncitizens are currently eligible for only a limited scope of emergency health services. They do not have access to routine or preventive care. The costs of uncompensated care are usually passed onto other patients with private or public health insurance.

Rep. Sam Zager, D-Portland, said the $17 million cost represented a “small investment” into individual and community health, while helping to ease health care costs and burdens placed on emergency rooms, by addressing health issues earlier, rather than when they turn more serious and require emergency care.

“We collectively pay for health care one way or the other, so why not pay for more appropriate care earlier in the condition when it’s less expensive and more effective,” said Zager, a physician, adding that a trip to the ER is 12 times more expensive than a regular doctor’s visit.

The bill was mostly supported during a public hearing in March, with dozens of immigrants and advocates discussing the impacts of not being able to access routine health care, including medications for chronic illnesses.

Medicaid is paid for with a combination of federal and state funds. Each state administers its own Medicaid program, which is called MaineCare in Maine. The state spends about $800 million on MaineCare each year.

CONCERN ABOUT COSTS

An official for the Department of Health and Human Services did not take a position during the March public hearing, but warned that expanding the program to cover noncitizens would have to be paid out of the general fund because federal funding could not be used.

Forty states cover noncitizens who are lawfully residing children or pregnant women, or provide prenatal care regardless of immigration status or use state funds to cover certain immigrants, according to the National Immigration Law Center. But it’s unclear how many states cover all noncitizens who would otherwise qualify for Medicaid.

Maine provided public health benefits to noncitizens up until 2011, when former Republican Gov. Paul LePage eliminated their eligibility.

Last session, lawmakers extended health insurance coverage to noncitizen pregnant mothers and children under the age of 21.

Rep. Michael Lemelin, R-Chelsea, strongly objected to the proposed measure, framing the discussion as providing health care to “illegal immigrants” who are excluded under the federal program. Opponents of extending benefits to noncitizens have used the term illegal immigrants to refer to people seeking asylum, although asylum seekers are allowed to stay in this country and move around while making their case for more permanent status in immigration courts.

“If this passes, I will personally request a congressional investigation into this matter,” Lemelin said.

Groups supporting the proposal include Maine Equal Justice, Maine Center for Economic Policy, Presente! Maine, Maine Coalition Against Sexual Assault, the ACLU of Maine, American Cancer Society Cancer Action Network, Maine Chapter of the American Academy of Pediatrics, American Heart Association and the Maine Council of Churches.