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SALEM, Ore. (AP) — It wasn’t only Democratic-leaning counties in Oregon that voted to impose a tax on hospitals and health insurers to pay for Medicaid for low-income residents — several counties that voted for Donald Trump also helped propel the ballot measure to resounding “yes” vote.

As president, Trump endorsed Republican bills to repeal the Affordable Care Act’s expansion of Medicaid. Oregon did the opposite on Tuesday when it expanded funding of Medicaid, making up for a drop in the federal government’s share and covering more children.

Every Democratic-leaning county in Oregon said “yes” to Measure 101. But so did eight counties that had voted overwhelmingly for Trump in 2016, according to an analysis of data from the secretary of state’s office.

Among those counties are Tillamook and Columbia in the northwest corner of Oregon. They are called “pivot counties” because they voted for Democratic presidential candidate Barack Obama in 2008 and 2012, and then went for Trump, according to Ballotpedia, which tracks elections nationwide.

Gov. Kate Brown, a Democrat who had urged voters to vote “yes” in the special election, said politicians everywhere should take note. It was the first ballot measure to be held in America this year, according to Ballotpedia.

“Across the country we are seeing a wave, and elected officials and candidates should really pay attention to what’s happening,” Brown told The Associated Press. “Clearly, voters care a lot about this issue, and they care a lot about making sure people have access to health care.”

Opponents of the measure said insurers and health-care providers would shift the extra cost onto customers, although insurance increases are limited to 1.5 percent.

Nineteen heavily Republican counties in Oregon did vote against the Medicaid-funding measure, some by a wide margin and some narrowly.

Wallowa County, which covers the forested mountains of northeast Oregon, went for Trump over Hillary Clinton by a more than two-to-one margin. But it rejected Measure 101 by only 45 votes out of 2,589 ballots cast.

Brendon Kinzel, a social worker from Medford, was one of 35,550 people who voted for Measure 101 in Jackson County. It passed there, with 58 percent in favor. In 2016, most Jackson County voters had voted for Trump.

Kinzel said he voted for Trump because he wanted an outsider in Washington, but has soured on the president because of what he sees as flip-flops, including health care.

As a candidate, Trump had originally said he would not cut Social Security, Medicare, or Medicaid. Later he backed off his Medicaid promise.

“As long as it means children have health insurance and have access to affordable health coverage, I am for that. If they’re going to raise premiums, I don’t mind them doing that,” Kinzel said.

The 0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums and on managed care organizations tax on hospitals and insurers had already been approved by the Legislature and signed by Brown in 2017. But three Republican lawmakers, arguing that the costs would be shifted to consumers, gathered enough signatures for a referendum.

Rep. Julie Parrish, one of the three, attributed the referendum’s defeat in part to “special interests” in favor of the measure outspending opponents by 40 to one.

If voters had said no to Measure 101, thereby eliminating or delaying the taxes, it would have caused a drop of $210 million to $320 million in state revenue, resulting in a possible reduction of $630 million to $960 million or more in federal Medicaid matching funds, officials had said.

“If it had gone down, we would have spent probably every moment of the February session tackling how we would meet this financial challenge,” Brown said.


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