HARRISBURG — “Able-bodied” adults enrolled in Medicaid would have to work at least 20 hours a week, look for a job or participate in job training under a bill passed Tuesday by the Pennsylvania House of Representatives.

The Republican-controlled chamber voted 115-80 for a bill that would require state officials to seek federal approval for a work requirement. All but five Republicans and just four Democrats voted to send it to the state Senate.

The list of exceptions includes people enrolled in high school full-time or receiving long-term disability benefits, those under age 19 or older than 64, pregnant women, prisoners and residents of mental health institutions.

“The goal of this bill is one we all share — to help individuals rise up out of poverty and achieve independence from government aid,” said the measure’s prime sponsor, Rep. Matthew Dowling, R-Fayette.

Opponents said many recipients already are working and the bill would set up a costly bureaucracy that could be difficult to navigate.

“Having this legislation pass will tie up people, and some of them will lose their health care,” said Rep. Leanne Krueger-Braneky, D-Delaware. “I want less bureaucracy, not more, and I’m certainly not in favor of creating more red tape.”

Democratic Gov. Tom Wolf vetoed a bill last fall that contained a similar requirement. The bill the House voted on Tuesday was drafted to get federal approval under an announcement by the Trump Administration in January that it would permit such work requirements.

Wolf spokesman J.J. Abbott called the vote part of a House Republican effort “to gut Medicaid and kick people off their health insurance, while also spending hundreds of millions of taxpayer dollars to create unnecessary red tape and bureaucracy.”

Abbott challenged the bill’s use of the term “able-bodied,” saying the proposal would require work from people who are chronically ill or caring for the chronically ill.

Wolf’s human services secretary, Teresa Miller, estimates the bill will cost some $800 million to implement in its first year.

The nonpartisan Kaiser Family Foundation says just three states — Arkansas, Indiana and Kentucky — have Medicaid work requirements, while seven others have requests pending before the federal government.

U.S. Sen. Bob Casey joined more than two dozen fellow Democrats in a January letter that questioned the legality of the work requirements, arguing they “contradict the plain text and purpose” of relevant federal law.

Medicaid, originally designed for poor families and the severely disabled, has become the country’s largest government health insurance program, helping 1 in 5 people.