ATLANTA — The Georgia Senate narrowly passed a new hospital tax to fund Medicaid and balance the state budget Thursday night, pairing it with an eventual tax cut and measures meant to soften the blow for some hospitals.

The tax would amount to 1.45 percent on hospital revenues for the next three years. The estimated $216 million that it would raise each year would be used to draw down hundreds of millions more in federal money. That money — a total of nearly $870 million in state and federal funds — would be plowed back into hospitals, with those that serve the most Medicaid patients getting the largest cut.

This is key in Gov. Sonny Perdue’s 2011 state budget proposal, and without it the governor had promised disastrous Medicaid cuts for hospitals and doctors. Hospital representatives, who initially fought the new tax, acquiesced after the governor’s threat, saying those cuts would close some rural facilities and the state’s largest public hospital, Grady Memorial in Atlanta.

Even so, the tax increase was controversial among the Republican majority at the Capitol. It passed the House by a relatively comfortable margin and with largely bipartisian support. But, in the Senate, Democrats were content to let the GOP majority go it alone on approving a tax increase, even one that would benefit some of the state’s poorest hospitals.

Senate Minority Leader Robert Brown, D-Macon, said the GOP leadership had to “run and hunt Democrats” to vote for the bill, when “they can’t find us” on other major issues, such as Democrat proposals to raise other taxes and increase education funding.

In the end, Republicans paired the tax increase with an end to the state’s insurance premium tax on health-care policies in an effort to make it more palatable. That cut won’t kick in, though, unless Georgia’s economy — and thus state tax revenues — rebound enough that the state has at least $500 million in its reserve account. That fund has been nearly depleted over the last two years.

Senate leaders also attempted to merge the hospital tax with another tax cut, but were unsuccessful. That bill, called the “JOBS” Act, contains several small tax incentives for businesses that hire the unemployed. It also includes a rollback in the state’s capital gains tax, which kicks in if the state’s reserve fund builds up to at least $1 billion.

When an effort to pair this with the hospital tax failed, the Senate passed the JOBS bill on its own. The bill already had passed the House, so the Senate’s vote sends it to the governor for his signature.

The hospital tax bill, House Bill 307, will have to go back to the House for final approval because the Senate made several changes. In addition to the insurance premium tax cut, the Senate inserted language meant to give hospitals with major trauma operations a break on the tax. There are only a few of these trauma facilities in the state, and The Medical Center of Central Georgia in Macon is one of them, as is Grady Memorial in Atlanta.

Another Senate amendment allows hospitals to count their portions of the tax as a form of charity. Many hospitals are required to provide charity or indigent care because they have a special tax status that exempts them from property and other taxes.

With these amendments the hospital tax bill passed the Senate 31-15. All but three of the no votes came from Democrats.

Several Republicans addressed the Senate chamber before the vote to say that they didn’t want to vote for the bill, but they would anyway.

As Perdue has said repeatedly, it was the best course of action in a field full of bad options when it comes to balancing the budget, they said.

“This is about (helping) a woman with a child in poverty,” Senate President Pro Tem Tommie Williams, R-Lyons, said. “And this is about the aged, blind ... we’re choosing to do this because we believe you should take care of the least of these in society.”

It remains to be seen whether the Senate’s amendments will survive as the bill returns to the House for another vote, which won’t happen for at least 11 days.

The Legislature will be out of session today and next week with several major issues still to decide before they wrap up for the year.

Among them is another measure crucial to the budget and likely to be controversial in the Senate. House Bill 1055 raises numerous state licensing fees, generating another $90 million or so to help balance the budget.

That bill has passed the House and awaits action in the Senate Finance Committee.

To contact writer Travis Fain, call 361-2702.