In one yes-or-no question, Colorado voters must decide whether to embark on one of the nation's most ambitious health care experiments: Socializing the state's insurance market.
Amendment 69 would change the Colorado Constitution to create ColoradoCare - a taxpayer-funded, universal health care system that aims to drop the state's uninsured rate to zero.
The measure has garnered national attention, even if the campaign battle in Colorado has been lopsidedly against it.
Opponents have out-raised supporters of the proposed amendment by a nearly six-to-one margin, and a Magellan Strategies poll released last month showed nearly two-thirds of respondents plan to vote against it.
Leading the fight has been a well-funded, bipartisan opposition that includes insurance companies, health care providers and past-and-present politicians, including Democratic Gov. John Hickenlooper and Republican Treasurer Walker Stapleton.
Most of that money - more than $4 million so far - was raised by the group Coloradans for Coloradans, which invested heavily in television spots attacking the measure, as well as online ads and Facebook posts.
Sean Duffy, Coloradans for Coloradans spokesman, said the fundraising totals and early polling results show the proposal is flawed.
"It's risky, it's unaffordable, and it's very dangerous for the economy," he said.
Supporters, however, say Colorado Care offers a stepping stone to broader national reform. Bolstering their case are endorsements from author Noam Chomsky and former presidential candidate Bernie Sanders, whose "Medicare-for-all" platform became a rallying cry during his Democratic primary campaign.
Led by the group ColoradoCareYes, proponents have relied on donations of $100 or less in raising nearly $345,000 this year, on top of $424,000 in 2015. With less money to spend, the campaign has shied from television ads in favor of printing handouts, mailers, yard signs and bumper stickers.
"When people find out about ColoradoCare, they like it and they'll vote for it," said Owen Perkins, a ColoradoCareYES spokesman. "Our challenge has always just been to make sure people find out about it. That is a big challenge."
No other state has done what Amendment 69 proposes.
The proposal would scrap Medicaid and private insurance plans across Colorado and wrap everyone currently using that coverage onto a single health insurance plan called ColoradoCare, which would cover nearly everyone in the state.
Only Medicare, Tricare and Veterans Affairs beneficiaries would keep their current coverage. But those people would share the financial burden of helping to pay for ColoradoCare, which would be funded using a universal 10 percent payroll tax (employees would pay 3.33 percent and employers 6.67 percent). The tax is expected to generate about $25 billion during its first year of implementation.
Even then, ColoradoCare would need billions of dollars more to remain solvent.
Most of that gap would be filled using federal money that Colorado receives to fund its Medicaid program. It also would need money from the state's health insurance exchange, Connect for Health Colorado, and the subsidies offered through it.
Co-pays also may be assessed, but the program's oversight board can waive those.
The issue has met stiff Republican resistance and divided Democrats, who this summer held dueling rallies for and against the amendment.
The Board of El Paso County Commissioners unanimously opposes the measure, as do the Colorado Springs Regional Business Alliance and the Colorado Hospital Association and Planned Parenthood of the Rocky Mountains.
A Colorado Medical Society survey found physicians overwhelmingly oppose the measure. Of the 795 doctors who responded, 78 percent said they would vote "no," while 16 percent said they approve of it. Another 6 percent were unsure.
Their objections stemmed from the uncertainties surrounding Amendment 69's implementation and operation. The doctors also were concerned that projected costs would out-pace revenues and that the increased taxes would cause business to leave Colorado. Meanwhile, sicker patients from other states might flock to Colorado for care, most physicians said.
"It's just not the answer," said Alfred Gilchrist, the Colorado Medical Society's chief executive.
But physicians who backed the proposal said everyone should be given access to health care, and the current health care system cannot work while for-profit insurance companies are involved.
Sen. Irene Aguilar, D-Denver, a physician who has strongly backed the measure, said Amendment 69 can spur more preventative care and tamp down expensive emergency room visits.
"It's a public-health issue," Aguilar said, adding that "as a humanitarian, I think it's unjust to have a country that doesn't guarantee access to health care for everybody."
Analysts say predicting ColoradoCare's impact on the state's health care system would be difficult because nothing like it has been created in the United States.
Only one other state, Vermont, has tried to create a universal health care system. But the effort failed in 2014, after the state's governor said the proposal wasn't financially sustainable.
Questions over ColoradoCare's own financial viability have swirled for months.
An independent analysis in August found the proposal would likely run a deficit of $253 million during its first year, and it would fall deeper into the red each ensuing year for at least nine years. Within 10 years, the deficit could hit $7.8 billion, the analysis by the Colorado Health Institute showed. The nonprofit studies health care trends and does not take positions on ballot, policy or legislative proposals.
The bulk of those deficits would come from reduced federal funding, and analysts were skeptical the state would be granted the necessary waivers to continue receiving that money, the report said.
Proponents waved off those concerns, however, calling the analysis ill-informed and overly pessimistic.
An analysis by ColoradoCareYES claimed the measure would run a $2.6 billion surplus its first year and remain in the black for nine years.
If their predictions are wrong, and ColoradoCare is not financially viable, ColoradoCare will shut down, Perkins said.
"We could win with 90 percent of the vote, but if we don't meet those standards and earn the (federal) waivers as a result, it doesn't take off," Perkins said.
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