In November, Nebraska residents will get to decide whether or not more people should qualify for public health insurance. Should voters decide to expand Medicaid under the Affordable Care Act (ACA), roughly 90,000 low-income residents will gain health coverage.

The months-long grassroots campaign to get Medicaid expansion on the November ballot succeeded after activists and volunteers with the Insure the Good Life coalition collected more than 133,000 signatures from the state’s registered voters, surpassing the required amount. And on Friday, state officials officially verified the signatures, clearing the initiative.

Nebraska now joins Idaho and Utah, where voters will also decide in November whether to expand Medicaid eligibility to people earning up to 133 percent of the federal poverty level, or roughly $16,000 for one person. Montana voters will also decide if the state should re-authorize Medicaid expansion using a tax on tobacco products to pay for it, after expanding in 2015.

The ACA provision became optional after the Supreme Court ruled in 2012 that states don’t have to expand Medicaid. As of now, 14 states have chosen not to give health insurance to more people (and three states are considering expansion), even though the federal government paid for 100 percent of costs associated with it until 2016, and despite the fact that the insurance program helps a lot of people, particularly those who need addiction treatment.


Nebraska lawmakers have rejected the popular policy for years, and now some are trying to block the ballot initiative. Two Republicans recently filed a lawsuit seeking to prevent the issue from going before voters, claiming Medicaid expansion will have a negative impact on property taxes and will alter existing coverage benefits. This week, a judge said she’ll soon decide whether the measure is “invalid and legally insufficient” as the plaintiffs purport. Legal experts are doubtful the lawsuit will stick.

“The allegations upon which their standing is based are undermined, if not contradicted, by the facts associated with Medicaid expansion,” Director of Health Policy for the National Health Law Program (NHeLP) Leonardo Cuello told ThinkProgress. (NHeLP recently won a Medicaid-related lawsuit in court.)

Lawsuits and lawmakers are also holding up Medicaid expansion implementation in Maine, where residents voted to give more health care to more people last November. The executive director with the Fairness Project, a national group working with local activists and funding all these local ballot initiatives, said these tactics are meant to interfere with voters’ wishes.

“Because these initiatives are so popular with voters, it’s very hard for opponents to take them on at the ballot box, so what we see is that they rely upon their lawyers on the front end and tail end to try to take down these initiatives. And when their lawyers can’t do it, they often turn to their lobbyists,” said the Fairness Project’s Jonathan Schleifer.

While Nebraska Gov. Pete Ricketts, who’s up for re-election, doesn’t support Medicaid expansion, arguing “[w]e cannot trust the Federal Government’s long-term financial commitment to state programs,” he said he won’t interfere with the campaign to expand. Alternatively his Democratic opponent, state Sen. Bob Krist, supports it.


This November will be a big moment for Medicaid, and activists in other states that haven’t expanded are closely watching to see what happens, just as those in Nebraska did when Maine voters set a precedent last November, Schleifer told ThinkProgress. And the Fairness Project will support future initiatives where there’s a lot of enthusiasm from residents.

“If we can win in these four states in 2018 — and we can — we can really win anywhere,” said Schleifer.