Oklahoma became the first state to expand Medicaid coverage under Obamacare to tens of thousands of low-income adults during the coronavirus pandemic on Tuesday.

The vote, which narrowly passed with 50.5% support, undermines the Trump administration’s plan to cap Medicaid spending. Oklahoma is the fifth state to break with Republican leaders’ wishes in blocking Medicaid expansion. Missouri will also hold a similar vote in the coming months.

The coronavirus pandemic was likely the determining factor in the narrow vote, as Oklahoma has reported more than 14,000 cases and nearly 400 deaths. Additionally, the average number of new cases in Oklahoma has more than doubled in the past month, with the state reporting a record 585 new infections on Tuesday.

At least 200,000 Oklahoman adults will be newly eligible for the program, but enrollment could increase if the state’s unemployment rate continues to climb.

Former presidential candidate Pete Buttigieg said the win is “proof that Americans are often ahead of their elected politicians.”

“Great news out of Oklahoma as voters insist on Medicaid expansion,” Buttigieg tweeted. “It’s proof that Americans are often ahead of their elected politicians, and that even in very conservative areas, real progress is possible on life-and-death issues like health care.”

Rep. Ted Lieu (D-California) congratulated the voters’ decision, but noted that the deeply red state, which hasn’t voted for a Democratic presidential candidate since 1964, is favoring a candidate that may undermine their healthcare.

“Congratulations to Oklahoma for passing Medicaid expansion!” Lieu tweeted. “Also, your regular reminder that the [Trump] Administration is suing to eliminate the federal law that guarantees health care coverage for Americans with pre-existing conditions.”

North Carolina Gov. Roy Cooper (D) was quick to use the news to urge his state to support a similar initiative.

“The people of the red state of Oklahoma know that Medicaid Expansion insures working families and saves lives,” Cooper wrote. “Past time for legislators to make NC the 39th state to do this.”