Bottoms first put the issue at the center of her general election campaign in June, standing outside a shuttered hospital in Commerce and promising to make more Georgians eligible for the government-funded health insurance program. On Wednesday, she said she believes bipartisan support exists for getting the policy done.

"I truly believe that support transcends party lines," Bottoms said. "I'm optimistic I will think it will get done."

Democrats will soon control both the governor's office and the state House of Representatives, but the Senate remains in Republican hands. That chamber has repeatedly blocked expansion, and its leaders have signaled skepticism about a full-scale rollout.

Georgia is one of roughly ten states that have not expanded Medicaid under the Affordable Care Act. Under the 2010 federal law, Washington covers 90% of the cost of expansion, with states picking up the rest. Supporters say expansion would extend coverage to hundreds of thousands of low-income adults and help stabilize rural hospitals that are struggling with unpaid bills and uncompensated care.

Republicans in the Senate have floated a narrower approach. Senate Majority Leader Bill Cowsert said the chamber is willing to consider conservative alternatives, but he warned against a broad expansion.

"We can't just pass a bill and then decide who's going to pay for it," Cowsert said. "We'll work with the governor and see what we can do."

Senate Republicans have pointed to Arkansas, which adopted a model using federal funds to purchase private insurance for low-income residents, as a possible template. But Democrats say that approach falls short of what Georgia needs.

"There's no path for a political question that doesn't have a health policy answer," said Harry Heiman, a professor at Georgia State University's School of Public Health. "Expansion is the policy that meets the moment."

Democrats argue the election results give them a mandate. They note that Bottoms made health care access central to her campaign, and that rural voters in particular responded to the issue.

"They were talking about it on the campaign trail, and they were talking about it in rural Georgia," said state Rep. Michelle Au, a Democrat. "Republicans didn't hear them."

Au said she believes the governor's support will be crucial. "Having a governor who supports expansion is important," she said. "But we've seen this before — there's no simple 'no' when it comes to getting it done."

Republicans, meanwhile, are pushing back. Gov. Brian Kemp, who leaves office in January, has long opposed expansion, arguing it would be too costly and that the federal government could scale back its funding commitment. Kemp's office did not respond to a request for comment.

Kemp has pointed to Georgia Pathways, a limited program that requires recipients to work or volunteer to qualify for coverage. It has enrolled far fewer people than projected and has been criticized by advocates as burdensome.

"That's not just bad policy, it's a bad deal for Georgia," said state Sen. Nan Orrock, an Atlanta Democrat. "It's a boondoggle."

Democrats also point to the recent expiration of enhanced federal subsidies under the Affordable Care Act, which has driven up premiums for hundreds of thousands of Georgians who buy coverage on the individual market. They argue that expansion would help offset those costs by covering more people through Medicaid.

"We have a real opportunity here," said state Rep. Jasmine Clark, a Democrat. "We need to focus on health care access and affordability."

Hospital officials say the stakes are urgent. Caylee Noggle, president of the Georgia Hospital Association, said rural hospitals are closing and patients are showing up in emergency rooms with untreated conditions.

"We need solutions, and we need them now," Noggle said. "We're ready to work with the governor and the legislature to find a path forward."

Bottoms has said she is willing to negotiate but will not accept a plan that leaves too many people uncovered. "I'm a Democrat, but I'm not a partisan," she said. "I'll work with anyone who wants to get this done."

The legislative session begins in January.