In a major defeat to the administration of President Donald Trump, voters in the purple state of Maine decided Tuesday to expand access to the Medicaid program under the Affordable Care Act, also known as Obamacare. This made the state first in the United States to decide on the healthcare issue by referendum, reports said.

Maine became the 32nd state to agree to expand Medicaid to around 80,000 low-income residents and it also represented a major setback for Republican Gov. Paul LePage, also an ally of Trump.

LePage vetoed a bipartisan legislative deal to expand Medicaid under Obamacare at least five times. Since Republicans took control of Washington this year, they have done everything possible to repeal Obamacare with proposals that would have drastically cut Medicaid, the Washington Post reported.

Expansion of Medicaid in Maine could also help progressives get voters in other states such as Alaska and Idaho to do the same. 

"This will send a clear signal to where the rest of the country is on health care," said Jonathan Schleifer, executive director of the Fairness Project, a not-for-profit involved in expanding Medicaid services in Maine through the Maine Medicaid Expansion Initiative in 2017, according to the Post.

Meanwhile, Twitter users expressed joy on the expansion of Medicaid in the state. Several users congratulated the voters who could make this possible by voting in favor of Obamacare, while some criticized LePage for allying with Trump.

Medicaid expansion is a controversial topic in states where Republicans are in control of the state legislatures. Out of the 18 states that have not expanded their programs under Obamacare, all but Virginia and North Carolina are led by a Republican governor. Louisiana was the last state before Maine to agree to expand Medicaid about two years ago. It was done after Democrat John Bel Edwards was sworn in as governor and signed an executive order on his second day in office, according to Politico.

Kellie Dupree working with the Ballot Initiative Strategy Center — liberal American advocacy organization that helps progressive groups strategize ballot initiatives — said expanding Medicaid can be a tough sell as it requires taxpayer money.

"We'll wait to see how these policies shape up," she said, the Post reported.

Under Obamacare, the federal government takes up the responsibility for paying at least 90 percent of the expansion's costs. Washington would pay 94 percent of the Maine Medicaid expansion costs in 2018, with the cost falling to 90 percent by 2021.

In Maine's case, despite the Obamacare voting, the state legislature could try to block it or make some changes. However, Democrats hold a majority in the Maine House and Republicans control the state Senate, hence the Obamacare passage through referendum might not have changes. Moreover, state lawmakers have already repeatedly supported expanding the program, according to Politico.

The next step after the Maine ballot measure is the state has to submit a plan accounting for the expansion to the Department of Health and Human Services within 90 days.