RALEIGH — The Senate on Tuesday rejected a last-minute amendment that would expand Medicaid eligibility, and with 34-10 bipartisan support passed a bill making sweeping changes to the government insurance program for the poor, elderly, and disabled.

The bill now returns to the House, where it originated, to vote on the changes.

Sen. Terry Van Duyn, D-Buncombe, introduced the amendment to House Bill 372, the Medicaid Transformation Act. The amendment would have expanded Medicaid coverage to everyone under 65 whose incomes are 133 percent of the federal poverty level or less.

The amendment failed on a vote of 29-15.

“I am afraid that this bill will make it even more difficult” for health care providers who treat the uninsured to continue to provide those services, Van Duyn said. It would be difficult for those providers to cover their costs if they are not included in the Medicaid delivery networks that would be created under the bill, she said.

Sen. Tom Apodaca, R-Henderson, asked Van Duyn if she had a fiscal note showing the costs of her amendment. She did not.

“By passing Medicaid reform you are clearing the No. 1 stated objection to expansion,” and making necessary federal approval of the plan more likely, Van Duyn said.

“To expand Medicaid at this point makes absolutely no sense in the middle of a transition,” said Senate Majority Leader Harry Brown, R-Onslow. He said the state spent about $1.8 billion on Medicaid about five years ago, and is now spending close to $4 billion in state funds.

“You double what you spend and people say you haven’t expanded Medicaid,” Brown said.

“Every state that has expanded Medicaid has created a financial problem in their state budgets,” Brown said.

Sen. Ralph Hise, R-Mitchell, a chief architect of the reform bill, said this was the ninth or 10th time in his five years at the General Assembly that Medicaid expansion would be voted down.

“This is a bad deal for the state of North Carolina. It continues to be a bad deal,” Hise said. “I don’t know how more clearly we can state it, the answer to the federal government and the Affordable Care Act is no.”

Hise said the federal government “has given us a one-size-fits-all, must-take-or-leave plan.” And while Van Duyn spoke of the uninsured, Hise said, Obamacare fines and penalizes those who don’t obtain coverage.

The state already is expanding Medicaid rolls, he said.

“We saw in this January [with] about 100,000 individuals that were unexpected that were enrolled in Medicaid,” he said.

“The estimate over the two-year period is we’ve seen an enrollment growth of almost 200,000 individuals,” Hise said. More than one in five North Carolina residents are covered under Medicaid, and Medicaid covers about 55 percent of births.

That growth has cost state taxpayers “somewhere around $300 million,” Hise said.

The reform bill would create a new Department of Medicaid headed by a Cabinet secretary. It would have managed care organizations such as large insurance companies set up Medicaid networks. Hospitals, doctors, and other health care organizations could form provider-led entities to administer Medicaid.

Three statewide plans would be offered, and five to eight regional plans would be established.

The networks would receive a set monthly fee to care for each patient, rather than the state paying for every service. The insurance networks, rather than taxpayers, would be responsible for covering budget overruns.

Dan E. Way (@danway_carolina) is an associate editor of Carolina Journal.