Voters in Red state’s overrule their leaders an choose to expand Obamacare…

Deeply conservative Oklahoma narrowly approved a ballot initiative Tuesday to expand Medicaid to nearly 200,000 low-income adults, the first state to do so in the midst of the coronavirus pandemic.

The vote to expand the Affordable Care Act’s reach once again put voters, many of them conservative, at odds with Republican leaders, who have worked to block it or invalidate it. Five states — Maine, Utah, Idaho, Nebraska, and now Oklahoma — have used ballot initiatives to expand Medicaid after their Republican governors refused to do so.

Oklahoma pushed the G.O.P. over a notable threshold: Most congressional Republicans now represent Medicaid-expansion states. The vote also came at a striking moment, less than a week after the Trump administration asked the Supreme Court to overturn the entirety of Obamacare — including Medicaid expansion.

“What we saw last night was Medicaid expansion triumph over party and ideology,” said Jonathan Schleifer, executive director of the Fairness Project, which has helped organize all the Medicaid votes. “Oklahoma voted for Medicaid expansion even as Trump is doubling down on repeal.”

Medicaid expansion could spread further into Republican-controlled states this year, as they weigh how to cover the many unemployed Americans expected to lose health insurance along with their jobs. Missouri voters will decide on a ballot initiative at the state’s August primary. If it passes, it will expand Obamacare coverage to 217,000 low-income people.

Some Wyoming legislators recently took a fresh look at the program, too, as they watched job losses mount. “I’ve voted against it about 10 times, never voted for it,” said the state’s House speaker, Steve Harshman, a Republican. “Now I’m thinking of our work force. We’re a mineral and oil kind of state. That’s a lot of able-bodied adults in a lot of industries who will probably need some coverage.”

Mr. Harshman voted in May to have a legislative committee study the topic, but he does not expect any action until the body’s next session begins in January.

Medicaid expansion has proved an especially resilient part of the health care law, despite early challenges. The program, which provides coverage to Americans earning less than 133 percent of the federal poverty line (about $16,970 for an individual), was initially meant to serve all 50 states.

But in a 2012 ruling, the Supreme Court declared that states could decline to participate. The program began in 2014 with about half of the states, mostly run by Democratic governors.

That figure has grown to 37 states and the District of Columbia, as more Republican-controlled states have signed on. Many academic studies have found that the program increases enrollees’ access to medical care. A more limited body of research shows that the program also reduces mortality rates….

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