Medicaid expansion is on the ballot in four key states

Voters in four states will decide on Tuesday whether to expand Medicaid coverage to hundreds of thousands of low-income Americans.

If successful, these ballot initiatives in Idaho, Montana, Nebraska, and Utah could expand coverage to about 300,000 low-income Americans.

They will also be a crucial test of whether conservative states are ready to embrace a large plank of the Affordable Care Act.

In a way, this is what experts have long predicted for Medicaid expansion: Once President Barack Obama left office, the program would become less polarizing, and red states would be more open to participating in the program.

States also seem more confident pursuing Medicaid expansion now than they would have a year ago, when Republican repeal plans could have ended the program entirely or significantly cut its funding.

Below are live results for each Medicaid ballot initiative, as well as a bit more context around the contest.

Medicaid expansion would cover about 92,000 low-income people in Idaho, according to recent data from research firm Avalere Health.

Early polling from Boise State University finds that three-quarters of Idahoans support the initiative.

Outgoing Idaho Gov. Butch Otter, a Republican, gave the Medicaid expansion ballot initiative a last-minute boost in late October, when he officially endorsed the proposal.

Montana voters are facing a slightly different question on their ballot: whether to have the state continue participating in Medicaid expansion.

Montana already expanded its Medicaid program in 2015, and about 129,000 low-income Montanans have gained coverage since then.

But Montana’s Legislature only funded the program for four years. And, in July 2019, Medicaid expansion would end without a reauthorization of funds. This ballot initiative is essentially trying to get ahead of a possible reauthorization fight, and continue the expansion with a popular vote.

The Montana Medicaid ballot initiative has drawn fierce opposition from the tobacco industry, which opposes the measure because it would be financed with a new cigarette tax. Altria Client Services, which represents tobacco company Philip Morris, has spent $12 million opposing the Medicaid ballot.

Still, recent polling from Montana State University showed that most Montanans supported the measure.

Nebraska’s Medicaid expansion ballot could expand coverage to estimated 97,000 low-income Americans.

The state hospital association has been a strong supporter of Medicaid expansion, and with good reason: More people with Medicaid means fewer uninsured patients showing up at their doors.

The ballot initiative effort in Nebraska is led by the Appleseed Foundation, a local nonprofit.

Most polling data shows the Utah ballot initiative having a good shot at success, even among conservative-leaning voters.

One Salt Lake Tribune poll, for example, finds that 54 percent of Utahans support Medicaid expansion — including 52 percent of voters who describe themselves as “somewhat conservative.”

An estimated 134,000 low-income Utahans would gain coverage if the ballot passes.

Utah Gov. Gary Herbert opposes the ballot initiative because he believes it is too expensive.