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“There’s been this vacuum of leadership, and in places where voters can take matters into their own hands, they’re doing it,” said Kelly Hall, executive director of the Fairness Project, which has worked to support minimum wage and Medicaid expansion initiatives across the country.

Ballot referendums are a particularly useful tool in states where a gap exists between what voters want and what their state legislatures are doing, said Kelly Hall, executive director of the Fairness Project, an organization that worked with the abortion rights ballot campaigns in Vermont and Michigan.

“Citizens took matters into their own hands to pass Medicaid expansion via ballot measure, showing us once again that if politicians won’t do their job, their constituents will step up and do it for them,” said Kelly Hall, executive director of the Fairness Project, an advocacy group that helped lead the ballot initiative.

Amendment D in South Dakota, which will expand healthcare coverage through Medicaid to residents earning less than $19,000 per year, also gained approval. The campaign’s pitch — which was backed by the Fairness Project, an organization that supports a handful of ballot initiatives across the country — was that federal tax dollars.

“Nebraska proves to the nation that a $15 minimum wage is not a coastal elite priority,” said Kelly Hall, executive director of the Fairness Project, which helped draft the language for the Nebraska measure. “It’s an absolutely necessity everywhere.”

Since 2014, groups such as the Fairness Project have been supporting ballot initiatives to expand Medicaid in states where the legislatures have repeatedly rejected the idea.

Just 17 states have the ability to amend their state constitutions by citizen-led ballot initiatives, explained Kelly Hall, the director of the group Fairness Project. Of that group of states, Hall said she’s eyeing the places where abortion rights are already greatly restricted — like Dakotas, Arkansas, Arizona, Ohio and Missouri.

South Dakota becomes the seventh state where voters have forced an expansion of the government health care program that insures low-income people. “Citizens have taken matters into their own hands,” said Kelly Hall, executive director of the Fairness Project, which backed the initiative.