ANNAPOLIS, Md. (AP) — The Maryland House approved a measure on Friday to enable people to buy health insurance through the state’s health care exchange regardless of their immigration status, with the approval of a federal waiver.

The House voted 101-34 for the bill, which now goes to the Senate, where similar legislation is under consideration.

The measure would require the Maryland Health Benefit Exchange to submit a federal waiver application by July 1, 2025, to implement the program. The waiver is needed because of federal restrictions on undocumented immigrants using the marketplace. Washington state received such a waiver from the Centers for Medicare and Medicaid Services in late 2022. The program in Maryland could start as early as 2026, if a waiver is granted.

Maryland’s health care exchange was created during the 2011 legislative session to provide a marketplace for people and small businesses to purchase affordable health coverage. Through the Maryland Health Connection, Maryland residents can shop for health insurance plans and compare rates.

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Since Maryland created its health care exchange through the federal Affordable Care Act and expanded Medicaid, the state has cut the number of uninsured residents by more than 50%, from about 756,000 to about 350,000, or about 6% of the state’s population, said Del. Joseline Pena-Melnyk, who chairs the House Health and Government Operations Committee.

Of the state’s remaining uninsured, about 256,000 of them are undocumented immigrants, Pena-Melnyk said. She pointed out that undocumented immigrants who sign up for health insurance through the exchange work in the state, pay taxes in the state and will pay for the plans.

“It’s preventive medicine, cheaper when it’s preventive, and it helps all of us. This is not free, not free, not free,” Pena-Melnyk said for emphasis.

But Del. Mark Fisher, a Calvert County Republican, contended that Maryland residents who are U.S. citizens often have long wait times to get doctor’s appointments, and he questioned why the state should expand health insurance coverage through the state’s exchange to people who aren’t citizens.

“The term health equity is meaningless if you can’t get access to a doctor, absolutely nonsense, and that’s the experience that we’re having throughout the state, and certainly in Calvert County,” Fisher said. “I just do not understand why folks believe that when you are a citizen of the United States that you should get into a queue behind folks who are not citizens of the United States.”

But Pena-Melnyk said the measure would help everyone because when people without health insurance need care, they end up going to emergency rooms where medical costs are higher.

“It saves us a lot of money, because guess what? Hospitals last year spent anywhere between $120 million and $150 million in uncompensated care,” Pena-Melnyk, a Prince George’s County Democrat, said during the debate Friday, while also noting that Maryland has the worst emergency room waiting times in the nation.