This November, voters in Utah, Idaho, Nebraska, and Montana will decide whether to expand Medicaid. Expansion would place huge burdens on taxpayers while offering minimal benefits to new Medicaid enrollees.

Last year, voters in Maine became the first to put Medicaid expansion on the ballot after Republican Gov. Paul LePage refused to expand the program under Obamacare. LePage has stopped Medicaid expansion seven times, but the state’s highest court ruled that he must comply with the referendum.