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“Ballot measures have been a lifeline to working people in red and purple states, allowing them to make change even when politicians fail to represent their interests. Legislators are trying to systematically take that power away,” Kelly Hall, of the Fairness Project, a nonprofit organization that helps advance citizen-led ballot initiatives, said.

In 16 of the 23 states that allow ballot measures, Republican lawmakers are trying to make it more difficult for voters to get voter referendums on the ballot, says Kelly Hall of the Fairness Project, which has been tracking ballot measure laws.

“Expanding Medicaid anywhere protects it everywhere, which is now what we’re seeing today,” said Kelly Hall, executive director of the Fairness Project, the nonprofit that organized the constitutional amendment campaigns. She noted that her group expected the expansions would broaden support for the program in Washington.

Kelly Hall, executive director of the Fairness Project, a union-back advocacy group that campaigns for progressive ballot initiatives, told Salon that even though the situation looks dire, the fact that 41 states have made Medicaid expansion a key part of their healthcare system gives residents there a way to fight back.

The Fairness Project, which supported abortion ballot measures in five states last cycle, is launching a talent-retention program in hopes of remaining on the offensive in 2025. The goal, the group’s executive director said, is to keep campaign leaders active in the off-year and avoid the brain drain among ballot measure campaigners.