Maine used ballot initiative to expand Medicaid, despite GOP opposition—and these states could, too

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On Nov. 7, Maine voters approved Question 2 in a 59-41 landslide, making it the first state to expand Medicaid under Obamacare via ballot initiative, joining the ranks of 31 states and D.C. with expansion. Republican Gov. Paul LePage has steadfastly opposed this policy to provide low-income residents with health insurance under Medicaid, and Republicans across the U.S. have long stymied Democratic legislators’ efforts to pass it. But Maine was able to circumvent GOP opposition thanks to the ballot initiative process, and another nine of the remaining states could also do it this way, as shown on the map at the top of this post (see a bigger version here).

Including Maine, states that have expanded coverage thus far account for 62 percent of the 50-state population. The states that haven’t expanded coverage include 25 percent of the population in states without the availability of initiatives, but 13 percent of people live in states that do. Although that number may not sound like much, it includes 1 in 8 Americans and major states like Florida. Crucially, initiative states like Mississippi are disproportionately lower-income and have high uninsured rates, meaning the impact of expansion would go much further there than some of the richer blue states that already passed expansion.

Gerrymandering, voter suppression, and the Republican lean of many key red states have given Republicans historic dominance of state legislatures, making expansion impossible in many of the remaining states without the initiative process like Texas and North Carolina. However, as Maine’s successful election contest demonstrates, voters in states with initiatives can take things into their own hands to provide health insurance to the most vulnerable of the uninsured population.

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