By Kimberlee Kruesi, Associated Press

BOISE, Idaho (AP) — Idaho is joining a handful of states where health advocates are hoping to bypass lawmakers who have refused to expand Medicaid and take the issue directly to voters through a ballot initiative.

"It seemed like a time for change," Luke Mayville, co-founder of Reclaim Idaho, a group leading the ballot initiative effort, said Monday.

"We wanted to get involved in the 2018 election and Medicaid expansion was a no-brainer."

Reclaim Idaho submitted the ballot initiative paperwork to the secretary of state's office last week. The proposal must now be vetted by the attorney general's office before supporters can start collecting signatures to get it on the 2018 November ballot.

The group would need at least 48,000 signatures to make the ballot.

The battle over whether to expand Medicaid has traditionally taken place inside state legislatures since former President Barack Obama's health care reform law was enacted in 2010. But after years of opposition from Republican state lawmakers, activists are seeking a new approach.

Voters in Maine will decide Nov. 7 whether to approve a referendum requiring the state to apply for Medicaid expansion for adults under 65 with incomes at or below 138 percent of the federal poverty line. And last month, health care groups in Utah announced they would also seek a ballot initiative to expand Medicaid.

So far, no state has successfully expanded Medicaid eligibility through a ballot initiative. Montana supporters attempted to do so in 2014, but they failed to collect enough valid signatures from registered voters.

Under the Affordable Care Act, the U.S. government pays at least 90 percent of the cost of expanding Medicaid while states picked up the rest. In total, 31 states have expanded their program.

Yet despite the savings promoted by Medicaid expansion supporters, Idaho lawmakers have long refused to consider the idea while also failing to come up with a solution to provide health coverage to the estimated 78,000 Idahoans who currently don't qualify for Medicaid or make too much for a subsidy.

The primary argument against expansion has been that accepting federal dollars only comes with regulatory burdens that do not help lower the growing costs of medical care. Instead, Idaho Republicans have floated a variety of modest health care solutions to improve medical access to the state's poorest residents. Those ideas have largely failed to take hold.

Mayville says the idea of using a ballot initiative was inspired after he and others spent the summer traveling in a bright green 1977 Dodge camper across the state talking to Idahoans about health care. He added that in every rural community they visited, people not only sympathized with the need to expand Medicaid, but also had stories about struggling to pay for health care.

Reclaim Idaho then worked with former Democratic Sen. Dan Schmidt, ousted from his legislative seat in 2016 after being one of the Statehouse's strongest proponents for Medicaid expansion, to write the initiative. Mayville says Reclaim Idaho's initiative is largely derived from Schmidt's 2016 Medicaid expansion bill that failed in the Legislature.

"We can't wait another year or two," Mayville said. "We can never be sure what Congress will or will not do, but we have reason to believe Congress is not going to repeal Medicaid expansion. It's time to move forward on this."

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