STEUBENVILLE — It was hard to find a sign supporting Issue 2 in this Eastern Ohio river town before the election. But residents received more than their share of direct mail pieces, robocalls, and an avalanche of ads about the controversial ballot question that no one can dispute went down in flames.

In fact, Issue 2 suffered the largest loss of any ballot initiate in the Buckeye State’s history, with a near 59-point margin of defeat. The measure asked voters to consider a law that would require the state to pay no more for prescription drugs than the federal Department of Veterans Affairs does.

Those who opposed it said it was a law fraught with impossibilities; it would be hard to implement, cause an enormous amount of red tape, create more bureaucracy, and in the end cost patients access and affordability.

Voters responded with skepticism and rejected it.

So, why should anyone in any other state care? Because Ohio voters were essentially the test market for a ballot initiative that the man behind the ballot, Michael Weinstein, hopes to get on several ballots ahead of next year’s mid-term elections. Already, activists in South Dakota and D.C. are pushing for similar initiatives for next November.

In short, it was the biggest political issue on the ballot in Nov. 2017 that nobody talked about nationally. It was supported by Bernie Sanders, the independent senator from Vermont who sought the Democratic presidential nomination last year, who even cut an ad for it.

That it went down in flames in Ohio with Sanders tied to it should give supporters pause. Sanders is a powerful voice in progressive circles as well as influential; his healthcare initiative Medicare for All — a government run plan that provides health care coverage for every American — is quickly becoming a national litmus test for Democrats.

“Ohioans have the opportunity this year to take on the greed of the drug companies and significantly lower the cost of prescription drugs. Corporate greed has no place in the health and wellness of you and your family,” Sanders said in a statement in support of the measure before the elections.

“At a time when we in the U.S. pay, by far, the highest prices in the world for our medicine, the rest of the country is looking for Ohio citizens to take the first step in lowering drug prices,” he added.

The man behind the initiative, Michael Weinstein, is the polarizing president of the AIDS Healthcare Foundation, or AHF, in Hollywood, a non-profit which funded (with the exception of a handful of small donations) the bulk of multi-million dollar Ohio campaign, including millions spent in the stretch for volley of aggressive digital and traditional ads as well as money on the ground to pay people to accumulate the 300,000 signatures needed to initially get the issue on the ballot.

Weinstein was also the man and the money behind a similar referendum in California in 2016 called Prop. 61 which also went down to (a much narrower) defeat. That effort also drew scrutiny into how Weinstein spends his non-profit monies, and why.

In a New York Times Magazine profile of Weinstein last spring, his organization was described as a social enterprise, explaining that “it generates most of its revenue not from grants and fund-raising but from adjacent businesses,” a model that has both insulated AHF from typical funding woes and helped it to expand at an astonishing clip.”

Since 2011, NYT magazine reported the budget has grown $300 million to more than $1.4 billion, about the size of Planned Parenthood.

Weinstein's activism in the ballot issues in both liberal California and heartland Ohio show a man who has a bottomless pit of money to spend on progressive activism and is beholden to no one but his own ideology.

Which is why the entire campaign against the ballot was about Weinstein, his shady business, and the fact that he was using money from his AIDS foundation to fund political work.

While Weinstein failed on this ballot issue in both California and Ohio, D.C. activists have until July 9, 2018 to gather the 23,000 signatures needed for the Nov. 2018 election. In South Dakota, they have already met the 13,871 threshold needed for the measure to qualify for the ballot in 2018 — the signatures just need to be validated.

Critics of the measure face the same uphill, yet successful challenge. They are largely funded by pharmaceutical companies, and voters won't necessary have the patience for the nuanced explanations of the many problems with this measure. Still, it is critical for both sides to watch how Weinstein’s activism across the country plays out, and whether he is indeed successful.