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A ballot initiative that would have continued funding Montana鈥檚 Medicaid expansion beyond June 2019 has failed. But advocates say they鈥檒l continue to push for money to keep the expansion going after that financial sunset.

鈥淲e now turn our attention to the legislature to maintain Montana鈥檚 bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,鈥澛犅爁rom Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure.

The initiative,聽, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren鈥檛 in yet, but聽聽to defeat the initiative. That鈥檚 more than twice as much cash as supporters were able to muster.

Most of the money in favor of I-185 came from the Montana Hospital Association. 鈥淚鈥檓 definitely disappointed that big money can have such an outsized influence on our political process,鈥� said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish.

The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren鈥檛 currently taxed in Montana.

Part of the expected $74 million in additional tax revenue would have funded continuation of聽聽in Montana.

Unless state lawmakers vote to continue funding the Medicaid expansion, it鈥檚 set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act.

In September,聽that if the Medicaid initiative failed, 鈥渨e鈥檙e going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.鈥�

Republican State Rep.聽, who opposed I-185, disagrees with Bullock鈥檚 position. 鈥淚 think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.鈥�

Ballance, who didn鈥檛 receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products.

鈥淣o one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,鈥� she said. 鈥淚 think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.鈥�

Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won鈥檛 qualify.

In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge.

North Valley Hospital鈥檚 Cohen said he hopes Montana will pass a tobacco tax hike someday. 鈥淲e all know how devastating tobacco is to our families, our friends and our communities,鈥� Cohen said. 鈥淎nd I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.鈥�

This story is part of a partnership that includes , and Kaiser Health News. Montana Public Radio鈥檚 Edward O鈥橞rien contributed to the story.