by Katherine Howitt. This article originally appeared on the Community Catalyst blog.

As the nation begins unpacking the 2018 midterm election results, we will hear a lot from pundits framing Democratic gains in the House and gubernatorial races largely as a backlash against the bigotry, hypocrisy and lack of civility in the Trump administration. But if you take a moment and dig deeper, you’ll find another powerful motivator, something more personal and more relevant to voters’ lives that also drove the electorate in many red and purple states: Medicaid. In at least six states, voters went to the ballot box to demand accountability from policymakers who, for nearly half a decade, have ignored their cries for expanded Medicaid coverage.

Utah, Nebraska and Idaho are the three most obvious illustrations of this phenomenon. In these three states – not exactly known for their progressive populations – voters were asked for their explicit opinion on Medicaid expansion in the form of a ballot question. And in all three states, voters chose to extend Medicaid coverage to more low-income families. In Idaho, the margin wasn’t even close: over 60 percent of voters cast their ballot for expansion.

And voters in Montana were asked in a ballot question about whether or not to preserve their existing Medicaid expansion with an increase in the tobacco tax. As of the publication of this blog, the results in Montana are still being counted, but polls heading into Election Day showed voters evenly split on the measure. Montana voters’ enduring support for Medicaid must be extraordinarily frustrating to the tobacco industry, who poured a whopping $17 million into the state to defeat the measure. Since Medicaid supporters were outspent by more than 3-1, the mere fact that this race was even close is a powerful testament to how deeply Medicaid expansion has affected the lives of Montanans.

But Medicaid expansion was also implicitly on the ballot in several states where Democratic candidates’ central platform issue was expanding Medicaid. And in at least three states, voters chose new governors who support expansion – a clear expression of frustration that their voices have been ignored by leaders in their state who, year after year after year, turned away billions of federal dollars to expand coverage to low-income working families:

• In Kansas, where the Republican-led legislature passed Medicaid expansion in 2017 only to have their bill vetoed by then-Gov. Sam Brownback, voters elected Democrat Laura Kelly; her vocal support for Medicaid expansion was a prominent factor in that race.
• In Wisconsin, voters elected Democrat Tony Evers – who ran so strongly on Medicaid expansion that his first television ad in the election criticized Gov. Scott Walker for rejecting federal Medicaid expansion money.
• In Maine – where voters approved Medicaid expansion at the ballot in 2017 only to see their Gov. Paul LePage obstruct their will and refuse to implement expansion – voters overwhelmingly elected the Democratic candidate for governor, Janet Mills, who ran in part on her commitment to implement expansion. Unsurprisingly, polls showed health care and Medicaid expansion were top issues on voters’ minds in Maine.
• And in Georgia, where the gubernatorial race remains too close to call, Democratic candidate Stacey Abrams ran more centrally on Medicaid expansion than perhaps any other issue. But in a state as conservative as Georgia, the mere fact that a Democrat is close to clinching the governor’s mansion shows how deeply Abrams’ focus on Medicaid resonated with the electorate.

These results set up 2019 to be a blockbuster year for Medicaid expansion – with at least six states lined up to finally extend health care coverage to hundreds of thousands of low-income families. The results also send a clear warning to policymakers in states across the country: if you persist in opposing Medicaid and ignoring the will of your constituents, you can expect voters to hold you accountable.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.