JEFFERSON CITY, Mo. (AP) — A dayslong filibuster in the Missouri Senate ended Thursday after a Republican faction allowed a vote on a more than $4 billion Medicaid program they had been holding hostage.

Senators gave initial approval in a voice vote to a bill that will renew a longstanding tax on hospitals and other medical providers. The measure needs a second vote of approval in the Senate.

Money from the tax is used to draw down $2.9 billion in federal funding, which is then given to providers to care for low-income residents on Medicaid health care.

The vote came after members of the Freedom Caucus, a GOP faction, on Tuesday began blocking any work from getting done on the Senate floor. They took shifts stalling two nights in a row by reading books about former President Ronald Reagan and going through the proposed state budget line by line.

The Freedom Caucus had been leveraging the tax to pressure Senate Republican leaders to pass a bill kicking Planned Parenthood off the state’s Medicaid program, which the chamber did last month.

The House last week sent the measure to Republican Gov. Mike Parson, who is expected to sign it.

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On Tuesday, the Freedom Caucus used the hospital tax again to demand that Parson sign the Planned Parenthood defunding bill and that the Legislature pass a proposed constitutional amendment to raise the bar for passing future amendments.

The hope is that raising the vote threshold to amend the constitution would hypothetically make it harder for voters to pass a pending abortion rights amendment this fall.

Republican lawmakers have said raising the bar for amending the constitution is a top priority.

GOP senators only managed to pass the proposal after negotiations with Senate Democrats to strip other election-related language, which House Republicans want, from the proposal.

Senate Majority Lear Cindy O’Laughlin said in a Facebook post Wednesday she plans to bring the measure on constitutional amendments up for debate May 6.

Both the Freedom Caucus and Republican Senate leaders are claiming victory in the extended standoff.

The Freedom Caucus said in a statement they formed a coalition with 18 senators — enough to force a vote without support from Democrats — in support of passing the constitutional amendment.

Other Senate Republicans said the advancement of the crucial hospital tax represents a defeat for the Freedom Caucus.

“What you saw today was the majority of the majority party all sticking together saying we know we have a duty to govern in this state, and we’re going to do whatever we need to do that,” Senate Appropriations Committee Chairman Lincoln Hough told the Missouri Independent.

The last time a Missouri Senate filibuster lasted so long was in 2016, when Democrats stood to protest proposed protections for those who cite their faith in denying services such as flowers or cakes for same-sex weddings.

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