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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

Updated 17 mins ago - Politics & Policy

Smaller than expected "Justice for J6" rally met with large police presence

Police officers watch as demonstrators gather for the "Justice for J6" rally in Washington, D.C., on Sept. 18, 2021. Photo: Andrew Caballero-Reynolds/AFP via Getty Images

A few hundred demonstrators were met by a heavy law enforcement presence on Saturday at the "Justice for J6" rally outside the fenced-off U.S. Capitol, AP reports.

The latest: About 400 to 450 people were inside the protest area, excluding law enforcement, U.S. Capitol Police said.

DHS to increase deportation flights to Haiti from Del Rio

Migrants walk across the Rio Grande River carrying supplies back to a makeshift encampment under the international bridge between Del Rio, Texas, and Acuña, Mexico. Officials are struggling to provide food, water, shelter and sanitation, forcing migrants to cross the Rio Grande several times per day for basic necessities. Photo: Jordan Vonderhaar via Getty Images

The Department of Homeland Security on Saturday announced plans to ramp up deportation flights to Haiti out of the small Texas border town Del Rio, starting as soon as Sunday.

Why it matters: Reports have emerged of more than 10,000 migrants, primarily from Haiti, crowded in a temporary camp under the international bridge in Del Rio. Hoping to find refuge in the United States, they've had to bear with filthy conditions and the scorching sun for days, per an NBC News affiliate.

4 hours ago - World

Pope Francis urges bishops to listen to survivors of sexual abuse

Pope Francis rides his Pope mobile through a crowd of pilgrims before holding an open-air mass on September 15, 2021 in Sastin, Slovakia. Photo: Sean Gallup/Getty Images

Pope Francis on Saturday urged European bishops to listen to survivors of clergy sexual abuse, saying "these important discussions truly touch the future of the church," AP reports.

Driving the news: Francis spoke in a video message to Central and Eastern European bishops who are convening in Poland for a four-day child protection conference beginning on Sunday.