With many Republican politicians at the state level refusing to have anything to do with Obamacare, some groups are now starting to look toward the ballot initiative process as a way to circumvent their opposition to the Medicaid expansion provision. After the Montana legislature failed to approve an expansion several groups are now planning a ballot initiative campaign. From the Missoulian:

A coalition of labor, health and advocacy groups took the first step Wednesday toward putting a voter initiative on the 2014 ballot to expand Medicaid coverage to 70,000 low-income Montanans.

The groups created a ballot committee called Healthy Montana Initiative, which will lead an effort to qualify the initiative for the ballot and campaign for its passage. [...]

The coalition behind the initiative includes AARP Montana; the Montana Nurses Association; MEA-MFT, which is the state’s largest labor union; the Montana AFL-CIO; the Montana Primary Care Association; and the Association of Montana Public Health Officials.

Given the makeup of the coalition it is likely the campaign will gather enough signatures to qualify for the ballot. All it takes is enough money and/or volunteers.

This could be a very interesting initiative fight. While Obamacare as a whole remains unpopular and poorly understood, Medicaid is a very popular program and the Medicaid expansion provision in the Affordable Care Act has broad support.

There are several well-financed ideological groups that may have a reason to spend big to get voters to reject anything related to Obamacare, but there doesn’t seem to be any groups that would financially benefit from its defeat. On the other hand, not only will it have the support of many liberal groups, but also having more Medicaid patients would financially help local hospitals and pharmacies.

This initiative may even end up serving as an important national proxy fight. If voters in Montana overwhelmingly back expansion, it could put pressure on Republican officials in other states to accept expansion.

At the very least, this is another sign that the Affordable Care Act is set to be a significant issue in the 2014 election at federal and local levels.