Is Medicaid “insurance” or is it “welfare”?

The battle taking place in Maine right now over this semantic question could determine whether the state becomes the first in the nation to adopt Obamacare’s Medicaid expansion by popular vote.

Mainers have until Friday to weigh in on the exact wording of a ballot initiative, which if it passes would allow Maine to join the 30-plus states that have expanded Medicaid under the Affordable Care Act.

Conservative groups and state Republicans, led by Maine’s firebrand Gov. Paul LePage (R), are pushing for the Medicaid expansion to be characterized on the ballot as welfare in the hopes that people will then vote it down.

“It’s free health care paid for by the taxpayers, and it’s got to be said that way,” LePage told talk radio hosts at WGAN last Thursday. “It’s pure welfare. If you don’t want to call it welfare, call it an entitlement.”

In the same interview, LePage threatened to sue the secretary of state if the final ballot language calls the Medicaid expansion “insurance.”

“I’m going to challenge that,” he vowed.

To get the measure on the 2017 ballot, organizers had to fan out across the state last fall and collect more than 60,000 valid signatures. After the public comment period closes on September 1, Secretary of State Matthew Dunlap (D) has to release the final language based on that feedback within 10 days. If the initiative passes this November, an estimated 70,000 low-income residents under the age of 65 would gain health coverage. As in other states that have expanded Medicaid, the federal government would pick up the vast majority of the tab, though the state will be responsible for some of the cost.

Since Congress passed the ACA in 2010, Maine’s legislature has voted to expand Medicaid five times, and each time LePage killed the effort with his veto pen. Now, LePage is campaigning against the ballot initiative from his bully pulpit.

“It’s going to kill this state,” he told another local talk radio show.

One of LePage’s former economic advisers, Michael Hersey, formed the not-so-subtly named “Welfare to Work” PAC to lead the campaign to defeat the expansion measure—after labeling it welfare on the ballot.

“They’re trying to turn the question itself into political advocacy,” said David Farmer, the communications director of Mainers for Health Care, which is campaigning in favor of the Medicaid expansion. “The right wing has successfully turned ‘welfare’ into an inflammatory word, going all the way back to Ronald Reagan and his welfare queen story. They push the idea that welfare is people getting something they do not deserve. People also generally think of welfare as a cash-type benefit. But Medicaid is not a cash program. Medicaid pays your provider just like my insurance pays my provider.”

Though white people are by far the biggest beneficiaries of U.S. government safety net programs, invoking the specter of minorities on the dole has long been a racial dog whistle. In 2014, an outside attack ad targeting the Democrat challenging LePage for the governor’s seat asked: “Should your taxes pay welfare benefits to illegal immigrants?” The governor of one of the nation’s whitest states, LePage has played into these fears and stereotypes by blaming immigrants and people of color for the state’s rate of drug trafficking and crime, explicitly labeling them “the enemy.”

LePage’s allies have echoed his message that Medicaid expansion will benefit undeserving immigrants.

The Maine Heritage Policy Center, one of the conservative groups mobilizing against the Medicaid expansion, has written repeatedly that it will lead to “non-citizens” obtaining free health care, even though the expansion changes nothing about Medicaid’s eligibility rules apart from raising the income level slightly above the federal poverty line. The Maine Heritage Policy Center is currently petitioning the secretary of state to describe the Medicaid expansion initiative as “welfare” instead of “insurance.”

Farmer noted to TPM, however, that Maine’s Department of Health and Human Services lists MaineCare, its Medicaid program, as a health insurance program.

“It’s not reasonable to argue that Medicaid is not insurance. It’s purely political,” he said. “When the federal government calculates the uninsured in the country, Medicaid counts as insurance. This is just a messaging opportunity and an effort to try to take what is a bipartisan issue and make it partisan.”

The vote on the Medicaid expansion will come at a time when Maine’s electorate is particularly fired up about health care, and about Medicaid in particular.

This spring and summer, Maine voters furiously lobbied Sen. Susan Collins (R-ME) to oppose a slate of bills that would have repealed the Affordable Care Act and gutted Medicaid. Their efforts paid off when she became the deciding vote—along with Sens. Lisa Murkowski (R-AK) and John McCain (R-AZ) to kill the legislation.

When she landed back in Maine after that vote, she got a hero’s welcome.

“I got off the plane, and there was a large group of outbound passengers, none of whom I happened to know, and spontaneously some of them started applauding, and then virtually all of them started to applaud,” she described to CNN. “It was just amazing.”

No matter what the final wording on the ballot ends up being, pro-expansion organizers like Farmer see the state’s outsized involvement in the national health care fight as a sign of things to come on the local level, and think other states could follow Maine’s example.

“Maine people were activated on a level none of us had ever seen before,” he told TPM. “I think this vote [to expand Medicaid], if we’re successful, will reinforce to a national audience that people do support affordable access to health and will go to the ballot box for it.”