The Missouri Senate has defeated an attempt to expand Medicaid eligibility to several hundred thousand lower-income adults.
The 23-9 vote Wednesday followed party lines, with majority Republicans voting against the expansion and minority party Democrats supporting it.
The vote marked the first official rejection of Medicaid expansion this year since Democratic Governor Jay Nixon renewed his call for it during his State of the State address. Republicans repeatedly rejected similar proposals last year.
About half of the states have expanded Medicaid under the terms of President Barack Obama's health care law. States that do so can receive enhanced federal payments.
But Missouri's Republican lawmakers continue to express concerns about the potential long-term costs.