Maine voters on Tuesday approved a measure allowing them to join 31 other states in expanding Medicaid under the Affordable Care Act, the signature health bill of former President Barack Obama.

The referendum represented the first time since the law took effect that the question of expansion had been put in front of U.S. voters.

Some 11 million people in the country have gotten coverage through the expansion of Medicaid, a health insurance program for low income people.

The vote in Maine was a rebuke of Republican Gov. Paul LePage, who vetoed five different attempts by the state Legislature to expand the program. It follows repeated failures by President Donald Trump and his fellow Republicans in Congress to repeal Obama's law.

"This is an exciting night in Maine, but also an exciting night for the country," said David Farmer, spokesman for pro-expansion Mainers For Health Care. "Voters have made it clear they want more health care, not less."

For supporters and opponents of "Obamacare," Maine's question took on the form of a referendum on one of the most important pieces of the Affordable Care Act. And it was taking place in a politically charged atmosphere with GOP efforts to undermine, or repeal, the health overhaul.

Here in the nation's Northeast corner, the issue was personal to many in a rural state that has the nation's oldest population and the region's lowest wages.

Passage of the proposal would mean an estimated 70,000 people in Maine would gain health coverage. About 268,000 people currently receive Medicaid in the state.

Maine's governor blamed an earlier Medicaid expansion for increasing state hospital debt, and he opposes giving able-bodied people more access to Medicaid.

LePage often summarizes his argument by saying: "Free is expensive to somebody." He also warned that he would have to divert $54 million from other programs — for the elderly, disabled and children — to pay for the state's share of the expansion once it's fully implemented.

LePage's office didn't immediately respond to a request for comment.

Mainers For Health Care touted the proposal as a "common sense move" to ensure health care coverage for more people. Maine's hospitals also supported the Medicaid expansion and say charity care costs them over $100 million annually.

The initiative's supporters have reported spending about $2 million on their campaign, with hundreds of thousands of dollars coming from out-of-state groups. By comparison, the lead political action committee established to oppose the measure has spent a bit less than $300,000.

This may not be the last state vote.

Backers of Medicaid expansion in Idaho and Utah have started similar efforts to get the question on the 2018 ballots in their own states. If it passes in Maine, some 70,000 people would gain health coverage.