Missouri sets up challenge to federal health care law

COLUMBIA | Missouri law now contains a direct challenge to the federal health care law passed earlier this year.

Primary voters approved Proposition C by a wide margin Tuesday, giving Missourians the power under state law to ignore government requirements to buy health insurance and nullifying penalties for failing to do so.

Just over 71 percent favored the ballot question, with 29 percent in opposition, according to unofficial final results.

The measure is intended to invalidate in Missouri a key element of the federal health care law passed by Congress and signed by President Barack Obama in March. That law requires individuals to purchase health insurance beginning in 2014.

Tuesday’s vote was the first statewide referendum in the nation to test an aspect of the health care law. Similar questions will be on November ballots in Oklahoma, Arizona and Florida.

The proposition’s success was bolstered by a heavily Republican turnout in a relatively low-turnout primary. In the U.S. Senate race, for example, Republican candidates received almost 65 percent of the votes cast.

Proposition C was sponsored in the General Assembly and strongly supported by Republicans. Many of its chief critics have been Democrats.

Supporters have couched the law as a defense of Missourians’ right to make their own health care choices.

With Tuesday’s victory, voters did two things, said state Sen. Jane Cunningham, a St. Louis County Republican. They protected their rights and signaled their displeasure with Congress and Obama.

“The Show-Me State just picked up a megaphone and sent a message like you wouldn’t believe to Washington, D.C., to stay out of our health care decisions,” said Cunningham, who carried the ballot measure in the Senate.

Critics, meanwhile, argue that the measure is more likely meaningless because courts have generally found that federal law overrules state law. They emphasized that it was foremost a political statement.

But it could have real consequences for consumers, Missouri Hospital Association spokesman Dave Dillon said. The association opposed the proposition because allowing people not to purchase insurance could pile more costs onto hospitals for care for the uninsured — costs that eventually would be passed on to those with insurance.

“The passage of Prop C has potential to impact the costs for all Missourians,” Dillon said. “But that depends on whether the courts decide that this is something that’s valid or not.”

Proponents countered that the law will put meaningful restrictions on how Missouri’s state government carries out aspects of the federal law. And at the very least, they suggested, it could provide the basis for a legal challenge against the federal law.

The measure may have been confusing to voters who viewed the ballot question as a referendum on the federal health care law as a whole, since a “yes” vote on the ballot indicated opposition to the federal law, while a “no” vote could be interpreted as support for health care reform.

Kansas City resident Angela Augur said someone had warned her ahead of time that the ballot measure might be confusing. Since she was forewarned, she didn’t have a problem voting.

Betsy Sharp Lynch of Kansas City said the question was a little confusing at first glance. But once you took the time to read it, it was pretty easy to understand, she said.

The law goes into effect immediately.

The Star’s Tony Rizzo contributed to this report. To reach Jason Noble, call 573-634-3565 or send e-mail to jnoble@kcstar.com.

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