When President Trump rolled out his plan to block grant Medicaid expansion under the Affordable Care Act in January, his executive order was met with vocal opposition as a backdoor plan for reducing access to health care.

He did find one eager taker, though, who was willing to move his veiled attempt to cut benefits forward. Oklahoma’s Gov. Kevin Stitt flew to Washington to participate in the rollout and pledged to be the first adopter of the new block grant approach. If the effort had been successful, other states would have eventually followed.

Fortunately, a campaign was already well underway to fully expand Medicaid in Oklahoma — a state that voted for Trump by 65.3 percent in 2016. As part of The Fairness Project’s plan to expand health care everywhere, the organization had already worked with in-state partners to craft a constitutional amendment that would protect Medicaid expansion and prevent future attempts to reduce health care coverage.

Language for the measure required the state to provide Oklahomans who receive Medicaid under the Affordable Care Act the same benefits received by other Medicaid recipients, effectively closing the door on the governor’s efforts to implement work requirements, co-pays, premiums, or make health care cuts under Trump’s block grant plan. The amendment also took a more flexible waiver process away from the governor.

Last week, Stitt acknowledged as much when he officially withdrew Oklahoma’s waiver request to the federal government to block grant Medicaid expansion. With help from The Fairness Project, Oklahoma voters approved the constitutional amendment by 6,000 votes earlier this summer.

“Not only did we win healthcare for 200,000 Oklahomans, we effectively put an end to Trump’s plan to block grant Medicaid before it could ever begin,” said Jonathan Schleifer, executive director of The Fairness Project. “That’s the power that ballot measures have when done right. They allow us to go into the deepest of red states and win progressive policies that change lives and protect all of us.”

The ballot language marked a departure from the 2017 and 2018 Medicaid expansion campaigns that The Fairness Project led. In 2018, lawmakers in Idaho and Utah tried to overturn the will of voters by implementing work requirements and other restrictions. In 2017, the governor in Maine fought against the expansion in courts for more than a year before it was eventually implemented.

“It took a big fight to protect those measures, and we wanted to avoid that in Oklahoma and Missouri this year. We are constantly learning and evolving, and that’s one of the reasons why we have the track record we do.”

The Fairness Project has now won 18 of its 19 campaigns, delivering healthcare, wage increases, and paid leave to more than 15 million Americans in the last four years.

Related: New York Times: How Progressives Flipped the Script on Medicaid Expansion