Republicans who think the American public is clamoring to repeal or roll back the Affordable Care Act have another think coming.

Voters in Maine overwhelmingly enacted Medicaid expansion for their state Tuesday, overturning a string of five successive vetoes by their right-wing governor, Paul LePage. The vote was roughly 60%-40%. Maine thus becomes the 33rd state (including the District of Columbia) to expand Medicaid under the Affordable Care Act, the first to do so during the Trump administration, and the first to do so by ballot initiative.

Expect more of the same in other states where the Republican political establishment has blocked expansion, including Utah and Kansas. LePage, by the way, has said he’ll refuse to implement the policy mandated by Maine’s voters, but he’s sure to face a fight over his position.

The Maine result, which will bring health coverage to an estimated 80,000 residents, has other national reverberations. The state’s senior Sen. Susan Collins, a Republican, has been a steadfast opponent of GOP efforts to repeal the ACA in Congress. She also has expressed distaste for the House GOP’s idea to fold an Obamacare rollback into its tax cut measure. The vote back home will only strengthen her resolve; the chance she will change her mind now has to be counted at less than zero.

Verma shed crocodile tears over the fact that the federal match rate of Medicaid expansion costs is more than 90%, compared to the national average of about 63% for traditional Medicaid. “If the match rate is a reflection of the value we place on caring for our neediest citizens, this is backwards,” she told her audience.

One can’t argue with that. But here’s a solution Verma apparently hasn’t considered: Cover all Medicaid spending at more than 90%. That would show that we value caring for our neediest citizens very highly indeed.

What is Verma’s answer? It’s to place more obstacles in the way of Americans seeking coverage under Medicaid. She signaled that the Trump administration will be much more accommodating to states asking to impose work requirements and other mandates on Medicaid applicants. Typically for the Trump administration, she concealed this intention behind the phrase “community engagement requirements.”

Let’s be clear: As administrator of the Centers for Medicare and Medicaid Services, it’s not Verma’s job to manage the labor force participation rate, the figure she cited to justify work requirements for Medicaid. Her job is to maximize coverage, not place roadblocks in the way of enrollment. For her to advocate work requirements for Medicaid is nothing short of a dereliction of duty.

Not only that, it’s a reflection of profound ignorance about the Medicaid population. The fact is that most people eligible for expanded Medicaid already are working. Most of the rest can’t work even if they want to—29% are caring for family members at home, 18% are going to school, 17% are ill or disabled, 10% are retired and 20% can’t find work. Verma’s chatter about “community engagement” is window dressing for her real intention, which is to cut people out of Medicaid.

Verma’s speech indicates that the Trump administration isn’t letting up one bit in its campaign to undermine the Affordable Care Act any way it can. But Tuesday’s election results suggest that the ground is shifting under its feet. Americans like having insurance coverage, and increasingly they see resistance to Medicaid expansion negatively. Trump should take note.

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Trump’s Medicaid chief attacked her own program on the very day it scored a huge win at the polls