Medicaid expansion is back on the ballot.

Organizers in Utah submitted signatures on Monday to put an initiative expanding Medicaid on the state’s ballot in November. They got 165,000 signatures, or about 50,000 more than they needed.

State legislators are actually pushing a limited form of Medicaid expansion, but, as we covered before, the Trump administration seems unlikely to greenlight that proposal. The ballot initiative being submitted today would be a clean version of expansion.

Medicaid expansion would cover about 150,000 low-income people in Utah, one of 18 mostly Republican-led states to refuse to expand Medicaid under the Affordable Care Act. A recent poll by the Salt Lake Tribune and the University of Utah found 62 percent of Utah voters support the ballot initiative.

”People want more health care — not less,” Jonathan Schleifer, executive director of the Fairness Project, a left-leaning economic justice group that is helping support the initiative, said in a statement. “They are done with politicians who are not addressing their top concerns, and they are taking action to do something about it.”

vox-mark Sign up for the VoxCare newsletter Get our newsletter in your inbox once a week. Email (required) By signing up, you agree to our Privacy Notice and European users agree to the data transfer policy. For more newsletters, check out our newsletters page Subscribe Your subscription has been confirmed. You've been added to our list and will hear from us soon. {{error_msg}}

Last year, Maine became the first state to approve Medicaid expansion by ballot initiative, though its Republican governor is doing what he can to stop it. Utah could be the next — and signatures are being gathered in several other red states to try to finally push through Medicaid expansion.

Organizers are also hoping to put initiatives on the ballot in Idaho and Nebraska. It has been a slow grind to push the holdout states to expand Medicaid — some 4 million Americans have been left without insurance as a result — but this fall, voters will have a chance to make significant strides toward the nationwide expansion that the ACA originally envisioned.

In Idaho, organizers have an April 30 deadline to submit about 56,000 signatures. The Fairness Project told me they “will significantly exceed that number.” Medicaid expansion would cover about 62,000 people in the Potato State; a 2017 survey found that 70 percent of Idahoans said they supported closing the state’s coverage gap, though it didn’t ask about the Medicaid expansion explicitly. (Here’s a good piece from BuzzFeed’s Anne Helen Petersen about the health care politics there.)

In Nebraska, the deadline for submitting signatures for a ballot initiative is July 6; organizers said that the campaign was “on track” to gain the 85,000 signatures that they need. Medicaid expansion would cover nearly 90,000 people in the state.

(The Fairness Project is also helping to support a signature drive in Montana. The state has already expanded Medicaid, but the expansion would end in 2019 unless it is reauthorized. It has covered about 90,000 people in the state.)

The prize turkeys for Medicaid expansion will always be Texas and Florida, where serious ballot initiative campaigns have yet to be mounted. And, as we have seen in Maine, voters approving Medicaid expansion doesn’t mean things will go smoothly if there are intransigent state officials.

Still, Medicaid notched some big wins at the polls last year — in Maine and in Virginia, where Democrats won huge victories campaigning on the issue and may soon approve expansion as a result — and it will get another shot in a few months.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.