JACKSON, Miss. (AP) — The first serious effort by Mississippi’s Republican-led Legislature to expand Medicaid appeared to be crumbling Thursday as leaders argued over whether to let voters decide the issue.

Under pressure during the final days of a four-month session, House and Senate negotiators released a proposal Monday to authorize Medicaid coverage for tens of thousands more low-income people, but it included a work requirement.

House Democrats balked before the plan could come up for a vote, saying it was Medicaid expansion in name only because the federal government has blocked several states from having such mandates.

Mississippi is one of the poorest states and has some of the worst health outcomes. Some business leaders, clergy members and health advocates are lobbying for Mississippi to join 40 other states in expanding Medicaid as allowed under the health overhaul law signed by then-President Barack Obama in 2010.