After five hours of debate, the House Health and Welfare Committee voted along party lines, 11-8, to defeat the measure and support the stance of Gov. Bobby Jindal. Republicans opposed the Medicaid expansion and Democrats supported it.
Wednesday's vote wasn't expected to be the Louisiana Legislature's final word on the Medicaid expansion, however. The Senate's health committee planned to take a vote on the idea next week, and other similar proposals remain pending before the House panel.
The health care law pushed by President Barack Obama allows the expansion to cover adults making up to 138 percent of the poverty level — less than $32,000 for a family of four. The federal government will pick up most of the cost.
Expansion opponents say it would still be too costly for the state and would expand an inefficient and outdated Medicaid program.
"We are worried about the state of Louisiana and its fiscal house and is it in order for years to come," said Rep. Lance Harris, R-Alexandria, chairman of the House Republican Delegation.
Kathy Kliebert, interim secretary of the Department of Health and Hospitals for the Jindal administration, said the expansion could shift people from private insurance to government-funded health care.
She said federal regulations on the expansion remain sketchy, and she questioned whether Congress would continue funding the expansion at the higher payment rates in later years or leave states scrambling to fill the gap.
"There are many, many unknowns for the future which could result in significant impact for Louisiana taxpayers that could reach into the billions," she said.
Supporters say Louisiana could save money with the expansion while also offering thousands of working adults access to health insurance in a state where one in five residents are uninsured.
"We have a responsibility to the people to make sure that they receive the best affordable health care," said Rep. Barbara Norton, D-Shreveport, sponsor of the expansion bill.
She urged committee members, "Don't think about the governor. He's not here. He's not voting."
Steve Spires, a policy analyst with the left-leaning Louisiana Budget Project, said the expansion could provide an influx of money for the state's budget, while pumping billions into the state's economy, creating new jobs and improving health care coverage.
"We cannot simply afford to maintain the status quo," Spires said.
The nonpartisan Legislative Fiscal Office estimates the Medicaid expansion could save Louisiana as much as $510 million over 10 years, with the state receiving up to $15 billion in federal funding to cover about 500,000 people through Medicaid.
Analyst Shawn Hotstream said the savings are frontloaded when the federal government is picking up the full cost of the expansion and the state would start facing a cost in 2020 and thereafter.
The Jindal administration disputes the fiscal office analysis, though its own health department also has estimated that the state could save money with an expansion under certain scenarios.
The Republican governor, considered a potential 2016 presidential candidate, has made defeat of the Medicaid expansion a main focus of his agenda for the legislative session, and he's been backed by the state GOP.
But debate over the expansion hasn't been entirely partisan, particularly in the Senate, where some Republicans have suggested they'd like to consider possible models for tapping into the federal Medicaid expansion dollars.
Voting against the Medicaid expansion in the House committee were Reps. Scott Simon, R-Abita Springs, chairman of the committee; Richard Burford, R-Stonewall; Lance Harris, R-Alexandria; Kenny Havard, R-Jackson; Bob Hensgens, R-Abbeville; Frank Hoffmann, R-West Monroe; Jay Morris, R-Monroe; Rogers Pope, R-Denham Springs; Julie Stokes, R-Metairie; Lenar Whitney, R-Houma; and Tom Willmott, R-Kenner.
Voting for the Medicaid expansion were Reps. Andy Anders, D-Vidalia; Regina Barrow, D-Baton Rouge; Kenny Cox, D-Natchitoches; A.B. Franklin, D-Lake Charles; Dorothy Sue Hill, D-Dry Creek; Katrina Jackson, D-Monroe; Bernard LeBas, D-Ville Platte; and Patrick Williams, D-Shreveport.