Four traditionally conservative states had Medicaid expansion measures on the ballot Tuesday night, with three voting to approve the proposal.
Voters in three historically Republican states voted to expand Medicaid, joining 34 other states and the District of Columbia, while one state defeated the measure in a close race.
Nebraska, Idaho, and Utah passed ballot initiatives to expand Medicaid coverage, a provision offered under the ACA that Republican governors and state legislatures had resisted embracing in recent years.
Last year, however, voters in Maine approved a Medicaid expansion measure, the first time Medicaid expansion had been passed by ballot initiative.
In approving Medicaid expansion, an additional 300,000 people are expected to receive healthcare coverage.
Nebraska's Medicaid expansion, which passed by a 53% to 47% margin, is expected to extend coverage to another 90,000 people, and received an endorsement from the Omaha World-Herald editorial board prior to election day.
Medicaid expansion was approved by a 61% to 39% vote in Idaho after having been one of the most talked about political items of the year. Nearly 62,000 Idahoans are expected to be added to the program, which should delight some rural hospitals who view it as a financial lifeline, and outgoing Gov. Bruce Otter, a Republican, who blessed the proposal last week.
Utah's opportunity to expand Medicaid will effect the most residents of the four states who had it on the ballot. By approving a 0.15% increase to the state's sales tax, excluding groceries, Utah voted by a 54% to 46% margin to expand coverage to 150,000 residents.
Related: Medicaid Work Requirements Aren't on the Ballot, But Their Proponents Are
Medicaid expansion did not finish the night without a loss though, as Montana voters defeated the measure with a 55% to 45% vote.
The state legislature had approved Medicaid expansion in 2015 but instituted a legislative sunset for the end of 2018.
Also attached to the Medicaid expansion issue, the most expensive ballot measure in Montana's history, was a potential tobacco tax hike to fund the program for 100,000 people.
Related: Healthcare Winners and Losers from Election Night 2018
Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.
Idaho, Utah, and Nebraska all voted to expand Medicaid, joining Maine as the only states to do so by ballot initiative.
More than 300,000 residents across those states are likely to receive extended Medicaid coverage as a result of expansion.
Montana, however, voted down the proposal, which had been attached to a proposed tobacco tax hike.