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

Supreme Court Justice Ruth Bader Ginsburg dies at 87

Ruth Bader Ginsburg. Photo: Tom Brenner/Getty Images

Justice Ruth Bader Ginsburg has died of metastatic pancreatic cancer at age 87, the Supreme Court announced Friday evening.

Why it matters: Ginsburg had suffered from serious health issues over the past few years. Her death sets up a fight over filling a Supreme Court seat with less than 50 days until the election.

NYT: White House drug price negotiations broke down over $100 "Trump Cards"

President Trump with Mark Meadows, his chief of staff, on Sept. 3 at Andrews Air Force Base in Maryland. Photo: Mandel Ngan/AFP via Getty Images

Negotiations on a deal between the White House and pharmaceutical industry to lower drug prices broke down last month after Mark Meadows, the president's chief of staff, insisted that drugmakers pay for $100 cash cards to be mailed to seniors before the election, according to the New York Times.

Why it matters: Some of the drug companies feared that in agreeing to the prescription cards — reportedly dubbed "Trump Cards" by some in the pharmaceutical industry — they would boost Trump's political standing weeks ahead of Election Day with voters over 65, a group that is crucial to the president's reelection bid, per the Times.

In photos: Virginians line up for hours on first day of early voting

Photo: Andrew Caballero-Reynolds/AFP via Getty Images

In some parts of Virginia, people waited in line up to four hours to cast their ballots on the first day of early voting, according to the Washington Post.

The big picture: The COVID-19 pandemic seems to already have an impact on how people cast their votes this election season. As many as 80 million Americans are expected to vote early, by mail or in person, Tom Bonier, CEO of TargetSmart, a Democratic political data firm, told Axios in August.