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Celebration breaks out in Maine after a ballot measure to expand Medicaid passes. Photo: Robert F. Bukaty / AP

Democrats were over the moon Tuesday when Maine became the first state to adopt the Affordable Care Act's Medicaid program through a ballot initiative. Buoyed by that success, advocates are already looking ahead to similar ballot measures in other states.

  • There are 18 states that haven't expanded Medicaid.
  • Supporters are already collecting signatures to get Medicaid referendums on the ballot next year in Idaho and Utah.
  • Advocates said Nebraska and Missouri are also potential candidates for Maine-style ballot questions, but serious efforts aren't under way yet in those states.

Reality check: There are limits to how far that strategy can take them. Some of the biggest and most politically important states on that list — the ones that would be the biggest coups for expansion supporters — are bad candidates for referendums like Maine's, according to Jonathan Schleifer, executive director of the Fairness Project, which works on progressive ballot initiatives.

  • Expanding Medicaid in Texas and Florida, for example, would add millions of people to the ACA's coverage rolls — advancing the law's core mission and helping to secure it politically.
  • But both make referendums difficult, Schleifer said. Texas' legislature has a lot of power to undo successful initiatives, and Florida requires 60% support for a measure to pass. And the Fairness Project tries to focus on fights it can win.

The bottom line: The pro-expansion effort will largely remain a grind through state legislatures. On that front, advocates have their eyes on Kansas, North Carolina and Virginia. They're also hoping Georgia and Tennessee could come into play down the road.

  • Ballot initiatives are expensive, resource-intensive and politically risky, said Katherine Howitt, associate policy director at the advocacy group Community Catalyst. (Good luck getting a state legislature to pass a policy if it fails as a referendum.)
  • So, as exciting as Maine was for liberals, it might be most helpful as an argument to state legislators that expansion is popular.
  • "If there's a path to doing it legislatively, that might be preferable," Howitt said.

Go deeper

Dave Lawler, author of World
53 mins ago - World

Oxford and AstraZeneca's vaccine won't just go to rich countries

Waiting, in New Delhi. Photo: Jewel Samad/AFP via Getty Images

While the 95% efficacy rates for the Moderna and Pfizer/BioNTech vaccines are great news for the U.S. and Europe, Monday's announcement from Oxford and AstraZeneca may be far more significant for the rest of the world.

Why it matters: Oxford and AstraZeneca plan to distribute their vaccine at cost (around $3-4 per dose), and have already committed to providing over 1 billion doses to the developing world. The price tags are higher for the Pfizer ($20) and Moderna ($32-37) vaccines.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Eniola Odetunde/Axios

  1. Vaccines: Key information about the effective COVID-19 vaccines — Oxford University's 90%-effective vaccine.
  2. Health: U.S. coronavirus hospitalizations keep breaking recordsWhy we're numb to 250,000 coronavirus deaths — Americans line up for testing ahead of Thanksgiving.
  3. Travel: Air travel's COVID-created future — Over 1 million U.S. travelers flew on Friday, despite calls to avoid holiday travel.
  4. World: England to impose stricter regional systemU.S. coronavirus hotspots far outpacing Europe's — Portugal to ban domestic travel for national holidays.
  5. Economy: The biggest pandemic labor market drags.
  6. Sports: Coronavirus precautions leave college basketball schedule in flux.

Biden transition names first Cabinet nominees

Biden with John Kerry. Photo: Justin Sullivan/Getty Images

President-elect Joe Biden on Monday unveiled his nominations for top national security positions in his administration, tapping former Secretary of State John Kerry as his climate czar and former deputy national security adviser Avril Haines as director of national intelligence.

Why it matters: Haines, if confirmed, would make history as the first woman to oversee the U.S. intelligence community. Biden also plans to nominate Alejandro Mayorkas to become the first Latino secretary of the Department of Homeland Security.