Boise, Idaho • Of all the decisions Idaho voters are making on election day, the decision on whether to expand Medicaid to more low-income Idahoans might be the one that hits closest to home for many.
The citizen initiative called Proposition 2 would expand Medicaid coverage to potentially more than 60,000 low-income adults across the state. Those residents are dubbed the "gap population," people who make too much to qualify for Medicaid in its current form but don't earn enough to get subsidized health insurance coverage under the state health insurance exchange.
Those living in the gap can find themselves with no way to get medical care except for emergency room settings, and the costs of those hospital visits often fall on hospitals, local municipalities and the state.
The Medicaid measure is one of several high-profile items before Idahoans on Tuesday's ballot, including a governor's race, a schools superintendent contest and other measures.
Proponents of Proposition 2 say that expanding Medicaid coverage to that impoverished but uninsured population would ultimately drive down state health costs by reducing the costs of indigent care borne by local governments and health care facilities. The Medicaid expansion would be primarily covered by federal tax dollars, although the state would also have to kick in a portion of funding. Still, proponents say the state would also save money because it would allow working low-income Idahoans to be healthier, able to contribute to the economy and care for their families.
But opponents say Medicaid expansion would be bad for the state and it could pull state money from other needs like education and infrastructure. They also argue that allowing able-bodied low-income adults to access Medicaid would serve as a financial shortcut for some rather than expecting them to come up with ways to cover their own health care costs.
Voters in Idaho aren't the only residents to be considering Medicaid expansion election day. Nebraska and Utah have similar ballot initiatives, and an initiative in Montana seeks to raise a tobacco tax to keep funding a Medicaid expansion that is set to expire.
Another ballot initiative, Proposition 1, is also drawing voters. Proposition 1 would legalize historical instant horse racing terminals, slot-like betting machines that allow players to place bets based on horse races that happened in the past. The machines have had a contentious past in Idaho, with lawmakers first approving them in 2013 after proponents said the machines would raise money needed to help keep the struggling horse racing industry alive.
But lawmakers made that decision mostly sight unseen. Once they realized the machines included slot machine-like features - including videos of rolling wheels with cherries, diamonds and other more traditional slot-machine images - some lawmakers had second thoughts.
In 2015, lawmakers repealed the instant horse racing law, and though Gov. C.L. "Butch" Otter vetoed the repeal, he missed the veto deadline and the veto didn't survive a court challenge.
That's when proponents of horse racing and the instant racing terminals launched an effort to bring them back through a ballot initiative. Proposition 1 seeks to legalize historical horse race betting at race tracks where the state has already allowed live or simulcast racing.
Proponents have said the revenue from instant racing is needed to keep Idaho's horse-racing industry alive. The initiative calls for 90 cents of every dollar wagered to go toward bettors' winnings. Nine cents from every dollar would go toward expenses, races purses and profits. And a penny of each dollar would also go to the Idaho Racing Commission, to be split between public schools and other programs.
Opponents, meanwhile, contend Proposition 1 is actually about casino-style gambling rather than horse racing, and that struggling private businesses shouldn't get special exceptions to the law designed simply to keep them afloat.
Both Proposition 1 and 2 in Idaho had to reach a high bar just to make it to the ballot. That's because Gov. C.L. "Butch" Otter signed legislation in 2013 toughening the requirements for citizen initiatives and referendum measures to qualify for a statewide ballot. The move came after Idaho voters used initiatives to ditch unpopular school reform efforts the Legislature had approved the previous year.
The tougher rules meant that instead of needing signatures 6 percent of registered voters to qualify a measure for the ballot, proponents now had to get signatures from 6 percent of the registered voters (at least 56,000 people) in at least 18 of Idaho's 35 legislative districts.
The enthusiasm appeared to carry through in early voting on both initiatives.
David Lopez, a Boise software engineering, said Medicaid expansion was his priority on the ballot.
"I want it more accessible for people. That's the most important thing by far," Lopez said after casting a ballot during early voting at Boise City Hall last week.
Terence Lamanna, a retired Boise resident, said Proposition 1 is the biggest issue on the ballot for him this year.
“I’m a big horse racing fan,” Lamanna said, saying the historical horse racing terminals are needed to keep the industry alive.