A new poll from the Kaiser Family Foundation shows that a majority of people in states that have not yet expanded Medicaid want the program extended to include low-income adults.

Three states passed Medicaid expansion in the 2018 midterm elections, leaving just 14 states that have not yet expanded the state-run healthcare program. A poll released Nov. 29 by the nonpartisan healthcare organization shows that 59% of people living in nonexpansion states want Medicaid expanded to low-income adults in their state.

Furthermore, the poll found that 51% of people in nonexpansion states feel that if the governor or state government does not expand the program, voters should be able to — a tactic that was used by three states in November.

Idaho, Nebraska and Utah passed Medicaid expansion in the 2018 midterm elections through ballot initiatives, bringing the total number of expansion states to 36 plus the District of Columbia. After pro-expansion advocates unsuccessfully battled over expansion with Republican-controlled state legislatures for years, grassroots organizations in each state successfully petitioned to have expansion initiatives on the ballot for the midterms.

Not every state can use this strategy, however. Of the remaining nonexpansion states, only six would be able to use ballot initiatives: Florida, Oklahoma, Mississippi, Missouri, South Dakota and Wyoming.

Medicaid expansion is a provision in the Patient Protection and Affordable Care Act that allows states to increase Medicaid coverage for those who make an annual income up to 138% of the federal poverty level. The federal poverty level for 2018 is $12,140 for an individual and $25,100 for a family of four. Medicaid expansion extends coverage to individuals with an annual income of $16,753 and a family of four with an income of $34,638.

While voters from both parties have supported expansion in traditionally Republican states, the remaining states that allow ballot initiatives would still have to overcome a political divide around the issue. According to Kaiser's poll, 84% of Democrats and Democratic-leaning independents in nonexpansion states support expansion, compared to 65% of Republicans and Republican-leaning independents that want the Medicaid program to stay the same.

All of the remaining nonexpansion states have historically leaned Republican.

Implementing expansion in these remaining states could see hundreds of thousands of people gain Medicaid eligibility, and can in turn drop the states' uninsured rates. Virginia passed expansion in May, and an estimated 400,000 people could receive coverage once the initiative is put in place. And Idaho, Nebraska and Utah — which will have to work with Republican-controlled legislatures to implement expansion — could see nearly 300,000 people gain coverage.

The election of Democratic, pro-expansion governors in Kansas, Maine and Wisconsin in this year's midterms could also lead to another 300,000 gaining Medicaid eligibility.

The large increases in states' Medicaid population is one key point of contention for expansion opponents. Medicaid is typically one of the largest pieces of a state's budget, and opponents say opening up enrollment will require cutting to other portions, like education and transportation.

However, the federal government covers more than 90% of expansion costs because of a provision in the ACA. Nevertheless, opponents say expansion is still too expensive.

"While it sounds great to get free federal dollars, the reality is that many states are already having other important state priorities like education and transportation spending squeezed out by Medicaid," said the Goldwater Institute's Naomi Lopez Bauman in October. Bauman is director of health policy for the Phoenix-based conservative think tank.