In a key step toward half a million uninsured people around the state receiving health care coverage, Medicaid expansion passed overwhelmingly Wednesday, clearing the first of two votes in the North Carolina Senate.

“It protects patient choice and access to affordable health care,” said Republican Sen. Ralph Hise of Spruce Pine, a former opponent of Medicaid expansion who has since reversed course and helped write the expansion bill.

The final vote in the Senate won’t happen until Thursday, but the outcome is not in question following Wednesday’s lopsided 44-2 vote in favor. The fate of Medicaid expansion is less certain in the House of Representatives, however, where it will head once it formally passes through the Senate.

But supporters on Wednesday were not focused as much on the future challenges as they were on the historic vote in the Senate — which signaled a change in opinion from GOP leaders that Democrats have been pushing for for a decade.

“Even though it took 10 years, y’all are there,” Greensboro Democratic Sen. Gladys Robinson said. “Praise the Lord.”

Before the vote Durham Sen. Mike Woodard opened the session with a prayer that pointedly focused on the parable of the road to Damascus, in which a villain, Saul, changes his ways and becomes Paul, one of Christianity’s most revered early figures.

“What we are getting ready to do here is monumental,” Woodard said later during the floor debate, moments before the votes were cast.

Hise said that for him and many other Republicans, their minds changed because of a combination of issues. The law is on more stable footing federally, after Republicans in Washington failed to repeal the Affordable Care Act. At the local level, the state’s Medicaid system is on better financial footing. The state could stand to receive $1.5 billion from the federal government in exchange for expanding Medicaid. And a number of regulatory reforms that Republicans have chased for years are tacked onto the bill as well.

Senate leader Phil Berger said he changed his mind for many of those reasons, but also because he feels it’s simply the right thing to do to expand coverage. He pointed to an example given by fellow Republican Sen. Kevin Corbin, who works in health insurance and spoke about a single mom with two kids, making around $25,000 a year, who’d be considered too wealthy to qualify for Medicaid now, unless expansion is approved.

“That’s one thing my perspective has changed on,” Berger said.

Berger doesn’t often speak for or against bills before the Senate, but he said he thought it was important to do so Wednesday, given his previous — and vocal — opposition to Medicaid expansion. And he wrapped up his speech acknowledging that the bill faces a less certain fate in the House, urging senators to work to convince their colleagues in the other chamber to have the same about-face.

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