In a 25-14 vote, Kansas state senators voted for the state to take part in the Affordable Care Act’s Medicaid expansion, which provides coverage for millions of low-income Americans throughout the country. That follows the Kansas state House of Representatives’ similar green light for the program last week. If enacted – an unlikely proposition since Republican Gov. Sam Brownback has expressed deep skepticism about Medicaid expansion – it’s expected to extend health coverage to about 150,000 poor Kansas residents.

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The fact that so many moderate Republicans joined with a unified Democratic caucus to pass the measure underscores the new reality of health care reform following the American Health Care Act’s (AHCA) collapse in the House of Representatives last week.

That bill, also known as Trumpcare, failed after growing opposition from both conservative GOP lawmakers who didn’t think it went far enough to dismantle Obamacare as well as more moderate elected officials who feared the legislation’s increasingly rightward trajectory – including massive cuts to Medicaid, which has covered millions in red states and blue states alike.

Traditionally conservative rural states have much to gain from the Medicaid expansion considering the financial stresses that a large number of uninsured people have on hospitals in these regions. That’s part of the reason why rural medical services provider LifePoint Health saw shares spike considerably following Republican leadership’s decision to pull the AHCA from consideration. The Kansas Hospital Association had warned that more hospitals could be forced to shutter without Medicaid expansion.