Missouri voters on Tuesday approved an expansion of Medicaid eligibility under the Affordable Care Act, a change that is expected to benefit about 230,000 low-income residents.

It is the sixth Republican-led state to approve the Obama-era measure, with 53% of the vote. The results come just weeks after Oklahoma narrowly passed the program, underscoring the effects the coronavirus pandemic and unemployment crisis has had on traditionally Republican states.

The ballot measure adds Medicaid expansion into the state’s constitution, effectively preventing opponents of the bill to add restrictions to the program, such as premiums and work requirements.

Republican Gov. Mike Parson had opposed the ballot measure, arguing that it was too expensive for the state. Some proponents of the bill had accused Parson of attempting to undermine the ballot measure by including it on the primary ballot, rather than the general election ballot in which turnout is expected to be higher. Parson denied any political motivation in scheduling the measure.

State Auditor and gubernatorial candidate Nicole Galloway tweeted that Parson “has spent years fighting alongside special interests against that very vote — but the people have spoken.”

“Today, Missouri voted to extend healthcare to over 230,000 Missourians by voting #YesOn2 and expanding Medicaid,” she tweeted. “[Parson] has spent years fighting alongside special interests against that very vote — but the people have spoken. And they’ll have more to say on November 3rd.”

The passage of the bill comes as Missouri faces a sharp increase in coronavirus cases, reporting over 55,000 cases and more than 1,300 deaths. Amid the pandemic, Missouri has experienced a rise in Medicaid enrollment by 9% between February and May.

“Quite frankly, Missourians are sick and tired of not getting their fair share. They pay their taxes, they’ve seen now 37 other states use that money to expand access to health care. Meanwhile, our economy’s clearly ailing here,” Jack Cardetti, the campaign’s spokesperson, said last week.

The ballot measure requires Missouri to expand Medicaid by next July and notify the federal government by March 1.