Voters in four states that heavily supported President Donald Trump in 2016 have a chance this Election Day to secure health coverage for nearly 400,000 low-income working people.

Organizers in Idaho, Nebraska and Utah successfully gathered enough signatures for petitions to put ballot initiatives in front of voters this year that would expand Medicaid eligibility to include anyone earning up to 133 percent of the federal poverty level, which is about $16,000 a year for a single person and $34,000 for a family of four. Voters in Montana, which adopted Medicaid expansion in 2015, will be able to decide whether to extend the benefit, which is set to expire in the state on July 1.

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“After piloting the strategy of expanding Medicaid via ballot initiative in Maine in 2017, we’re testing whether it can work in four states that Trump won by an average of more than 20 percentage points,” said Jonathan Schleifer, the executive director of the Fairness Project, based in Washington, D.C.

The Fairness Project is a labor-backed organization that offers financial support and logistical assistance to grassroots groups around the country promoting direct democratic action on issues like Medicaid expansion and minimum-wage increases. “Their legislatures have been an obstacle to that, and now they have a tool to actually expand Medicaid in spite of the wishes of their legislatures,” Schleifer said.

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