IT'S WHAT ELECTORATES DEMAND OF GOVERNMENT:

Based on publicly available national polling data, voters do, in fact, want to help struggling families: According to the non-partisan Kaiser Family Foundation health tracking poll released in November, about three quarters of the American public--including 77 percent of the population living in non-expansion states--holds a favorable view of the Affordable Care Act provision that grants states the option to expand Medicaid. In those same states, KFF found that 59 percent of the population would be in favor of expanding Medicaid to cover more low-income Americans, while 34 percent said they would like to see their state leave its existing Medicaid coverage unchanged.

In a 2012 ruling, the U.S. Supreme Court handed a victory to the Affordable Care Act when it upheld the constitutionality of the law's individual mandate, which stipulates that most people must maintain a minimum level of health insurance coverage. A majority of the court also decided that the ACA's mandatory Medicaid expansion was unconstitutional, effectively leaving it up to the states to decide whether or not to opt to expand coverage.

But while 36 states and Washington, D.C., have adopted Obamacare's Medicaid expansion, some red states have continued to eschew the increased coverage proposals.

With 4.7 million uninsured, Texas boasts the most people under the age of 65 without medical insurance out of any state, according to a report released by the Urban Institute in December. And in Georgia, newly minted Republican Governor Brian Kemp continues to decry Medicaid as "a failed government program," despite the fact that 73 percent of the state's population supports an expansion. Both states are legally ineligible to put Medicaid expansion to voters by way of a ballot initiative, meaning that Republican wins during the 2018 mid-terms all but ensure that the possibility has stalled for the foreseeable future.

Conversely, in states like Maine and Wisconsin, Democratic victories in November have bolstered the prospects of health-care expansion in a big way. In Wisconsin, Republican Governor Scott Walker was recently ousted by Democrat Tony Evers, who ran a campaign centered around passing Medicaid expansion. And in Maine, an approved initiative to expand health-care access that had been held hostage by Republican Governor Paul LePage will now likely see the light of day under the tenure of newly elected Democrat Janet Mills.

In the remaining six states eligible to put Medicaid expansion on the ballot in 2020--Florida, Mississippi, Missouri, Oklahoma, South Dakota, and Wyoming--there's still hope for reform.

Bridget McCandless, president and chief executive officer of Health Forward in Kansas City, Missouri, says her organization has tangled with the state's Republican-led general assembly for years without luck. She called the passage of ballot initiatives in three red states last fall "an opportunity for advocates in the state of Missouri to understand that there was an opportunity to expand Medicaid in this state."

Although Schleifer could not disclose which states the Fairness Project plans to target in 2020, he says the group is currently "evaluating the viability" of campaigns in all six states eligible for ballot initiatives. McCandless confirmed in an interview with Pacific Standard that her organization has been working with the Fairness Project in order to collect preliminary data on the popularity of a potential ballot initiative to expand Medicaid in the Missouri.

"I think when you put Medicaid expansion to the people in an initiative petition, you see voters make decisions less on political reasons and more on human issues," McCandless says. "Being healthy or well isn't a red or blue issue, it's about taking care of our neighbors and making sure as many people as possible can access the care that they need."

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