Voters in four red states will decide Tuesday whether to expand Medicaid to thousands of low-income adults, potentially circumventing GOP legislators who for years have blocked one of ObamaCare's key provisions.

Ballot initiatives in Idaho, Montana, Nebraska and Utah aim to bring those states in line with the 32 that have already embraced Medicaid expansion.

Winning margins on Election Day would also increase the odds for similar ballot campaigns in the other 14 states where policymakers — often Republicans — have rejected expansion.

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“If Medicaid expansion wins in these states, it can win anywhere,” said Jonathan Schleifer, executive director of The Fairness Project, a Washington-based advocacy group backed by SEIU United Healthcare Workers West that has spent millions of dollars supporting expansion.

The ballot measures would expand Medicaid eligibility to those making 138 percent of the federal poverty level — which is about $17,000 for an individual and $25,000 for a family of four.

In all, 325,000 people would become eligible for Medicaid if voters approve the initiatives in Idaho, Utah and Nebraska.

Montana residents will decide whether the temporary Medicaid expansion approved by state lawmakers in 2015 should be permanent. If it fails, expansion ends next year.

More than 90,000 people were enrolled in Montana’s expanded Medicaid program at the beginning of this year.

Supporters are feeling confident ahead of Nov. 6, noting that polls have consistently shown health care as a dominating issue this election cycle.

In Utah, where state legislators have rejected a full expansion of Medicaid for years, backing for the initiative has polled around 60 percent, said RyLee Curtis, the campaign manager for Utah Decides Healthcare.

“Before, we would never use the word ‘Medicaid’ out loud if we could help it,” she said. “But over the years, people increasingly understood what Medicaid expansion is and all the good it can do for beneficiaries and the states that expand.”

The campaigns to expand Medicaid have been buoyed by financial contributions from The Fairness Project, other like-minded organizations and wealthy donors.

Utah Decides Healthcare has received $3.2 million in contributions this year, as of Oct. 25, according to state campaign finance disclosures. Almost $1 million of that amount came last month, and half of it was from The Fairness Project.

Financial support at those levels has made it challenging for opponents.

The Utah chapter of Americans For Prosperity is running the only organized fight against the measure, said Heather Williamson, state chapter director.

“It’s been difficult,” she said, while remaining optimistic about the prospects for Tuesday’s vote. “I think we’re closing the margins.”

Americans for Prosperity, which is funded by the Koch network, opposes Medicaid expansion, saying it adds more strain to an already expensive government program.

In many other states that expanded, Williamson said, the number of people who get added to the Medicaid rolls exceeds initial estimates.

“Taxpayers are forced to foot the bill to cover them,” she said.

For example, initial estimates in Montana put enrollment at 70,000. At the beginning of this year, more than 90,000 were receiving Medicaid.

But expansion can be a financially attractive proposition for states since the federal government picks up about 90 percent of the cost for expansion enrollees.

In Utah, that works out to be about $800 million a year footed by the federal government. The state’s $90 million tab is paid for by a 0.15 percent sales tax on nonfood items.

In Montana, a permanent expansion would be funded by higher taxes on tobacco products. Consequently, the main opposition to expansion is coming from the tobacco industry, which has spent $17 million against the measure, making it the most expensive ballot campaign in state history.

Those ad dollars appear to be paying off. A poll released Wednesday by Montana State University found 41.4 percent of voters in favor of expansion and 40.8 percent opposed, with 17.3 percent undecided.

In Idaho, 70 percent of voters support expansion, according to an Idaho Politics Weekly poll released last month.

Supporters there turned to a ballot initiative after years of failing to get expansion through the Republican state legislature.

The campaign received a boost this past week when Gov. Butch Otter (R) endorsed expansion.

There is no public polling on the topic in Nebraska.

If all of four measures pass, that would bring the total of states with expanded Medicaid programs to 36.

About 12 million Americans have already gained coverage under Medicaid expansion, and the prospects for more states to expand coverage would increase significantly if Democrats win governor races in Wisconsin, Florida, Georgia, Kansas and South Dakota.