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“Attacks, through state legislatures, on the ballot measure process have been pretty consistent and pretty aggressive for the last several (election) cycles,” said Kelly Hall, executive director of the Fairness Project, which has helped pass progressive measures in red states.

“This argument about rural hospital closures has been an incredibly compelling argument to voters,” said Kelly Hall, the executive director of the Fairness Project, a national nonprofit that has successfully pushed ballot measures to expand Medicaid in seven states.

In recent years, the ballot initiative process has seen many traditional progressive policy ideas pass, even in red or purple states. According to the Fairness Project, a nonprofit organization that helps support progressive ballot measures, dozens of initiatives have passed with bipartisan support in recent years

“I call these bills ‘death by a thousand cuts,’” said Kelly Hall, the executive director of the progressive ballot initiative group The Fairness Project. “When you hear about each one in isolation, they seem like not that big a deal. But taken together, they have an exclusionary effect on people’s participation in democracy.”