PORTLAND (AP) — Voters in Maine are headed to the polls Tuesday to decide if they want to join 31 other states and expand Medicaid under former President Barack Obama’s Affordable Care Act.

It’s the first time since the law took effect that the expansion question has been put before voters.

The ballot measure comes after Maine’s Republican governor vetoed five attempts to expand the program. It also acts as a bookend to a year in which President Donald Trump and congressional Republicans tried and failed repeatedly to repeal Obama’s law.

Activists on both sides of the issue are looking at the initiative as a sort of national referendum on one of the key pillars of the law. Roughly 11 million people nationwide have gained coverage through the expansion of Medicaid.

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