PORTLAND, Maine — Voters on Tuesday overwhelmingly approved a state ballot question to expand Medicaid under the Affordable Care Act, the signature health bill of former President Barack Obama.
The referendum represented the first time since the federal law took effect that a measure to make the health insurance program for low-income people more accessible had been put in front of US voters. Some 11 million people in 31 states have gotten Medicaid coverage under the ACA, also known as Obamacare.
Voters also rejected a ballot question that would have created a third casino in the state, while former Manchester, N.H., alderman Joyce Craig won the Manchester mayor’s race, defeating a four-term incumbent.
The Medicaid vote in Maine was a rebuke of Republican Governor Paul LePage, who vetoed five different attempts by the state Legislature to expand the program. It follows repeated failures by President Trump and his fellow Republicans in Congress to repeal 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.
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.
LePage 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.
Mainers For Health Care, which supports expansion, touted the proposal as a ‘‘commonsense 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.
Backers of Medicaid expansion in Idaho and Utah have started similar efforts to get the question on the 2018 ballots in their own states.
The casino ballot question was written in such a way that only gambling entrepreneur Shawn Scott’s company could run it. It would have been located at a yet-to-be-determined spot in the southern part of the state.
Supporters of the proposal said it would prove to be a windfall for schools, jobs, and the economy.
Opponents peppered traffic medians with signs decrying it as a ‘‘wicked shady deal.’’ Critics included LePage.
During this campaign, the Maine ethics commission imposed a record $500,000 in fines against four pro-casino committees for missing deadlines for filing disclosures that accurately reflected who was funding the campaign.
Existing casinos are in Oxford and Bangor.
In the Manchester, N.H., mayor’s race, Craig, a Democrat, beat Republican Mayor Ted Gatsas in the race to lead New Hampshire’s largest city.
Senators Jeanne Shaheen and Senator Maggie Hassan praised Craig’s election. Shaheen said she ‘‘adds to New Hampshire’s outstanding legacy of electing strong woman leaders.’’
It was a rematch of the 2015 election, in which Gatsas defeated Craig by 54 votes. This time, Craig won with 10,861 votes to 9,290 for Gatsas.
Craig advocated citywide campaign finance reform; encouraging and recommending diverse and experienced appointments to city boards; and adding open dialogue at Board of Mayor and Alderman meetings once a month.