Missouri voters, the first in the nation to cast judgment on federal health care reform, overwhelmingly approved a ballot measure that prohibits the government from requiring people to buy health insurance.
In Tuesday’s vote, 71 percent voted yes and 29 percent voted no. The lopsided vote sent a message to Washington, but its impact on the new federal law remains murky.
The measure, titled Proposition C, prohibits governments from forcing individuals and businesses to purchase health insurance and from fining those who refuse to buy coverage. Similar measures are on the Nov. 2 ballot in Arizona and Oklahoma. A Florida initiative is up in the air after a state judge ordered it off the ballot, a decision that is being appealed. Legislatures in five other states—Virginia, Idaho, Utah, Georgia and Louisiana—have passed legislation that, like the Missouri proposition, forbids requiring health insurance for residents.
Richard Cauchi, health program director for the nonpartisan National Conference of State Legislatures, said the state actions would primarily affect individual state health care efforts, such as the reforms under way in Massachusetts.
“A state can use its state law to set policy for its own internal operation,” Cauchi said. “They cannot overrule something that is in federal law.”
Where state and federal law might overlap is the big area of uncertainty, he said.
“How that’s going to play out in terms of the federal law is really not known,” Cauchi said, noting that the federal health insurance mandate doesn’t go into effect until 2014. “No one knows what the ultimate outcome will be.”
Already, Virginia’s attorney general has cited its state ban on mandatory insurance in his legal challenge to the federal health care law. Earlier this week, a federal judge refused to throw out the suit. Missouri and 21 other states have filed similar challenges to the federal law; these legal actions are separate from the state ballot and legislative measures.
While the practical impact of the state law changes may not be felt for months or years, the political impact could be felt sooner.
Opponents of the federal health care law said passage of ballot measures like Missouri’s are a demonstration of public antipathy toward the law. Conservative Republicans pushed for the Missouri measure as a protest against what they said was overreaching by the federal government. Democrats in the Missouri legislature agreed not to block the measure, so long as it was on the ballot in the August primary, when turnout is traditionally low, and not on the November ballot.
Low turnout was coupled with competitive races on the Republican side that spurred more GOP voters to the polls. This led some observers, including Cheryl Matheis, senior vice president for health strategy at AARP, to downplay the significance of the vote.
While AARP supports the federal health care law, it did not take a position on the Missouri ballot initiative. “These are things the courts are going to determine,” said Matheis.
She said she didn’t think the Missouri vote would have much impact, citing the low turnout and ballot wording that was designed to appeal to opponents of federal health care.
AARP has been busy answering questions about health care reform by providing information on AARP.org and meeting with members and the public. Matheis said AARP officials are seeing a big difference in members’ attitudes toward health care reform from the heat of the debate earlier this year.
“I think you’re seeing a turn in the attitude of the public,” she said. “They’re not going to accept someone’s knee-jerk description anymore. Give me the facts and let me make my own decision.”
There was little debate over Proposition C in the months leading up to the primary. The Republican Party supported Proposition C, and state chairman David Cole urged voters to “protect our state from the worst parts of the Democrats’ overbearing health care bill.”
In recent weeks, the Missouri Hospital Association spent some $200,000 on fliers in opposition, according to the St. Louis Post-Dispatch. The association said hospitals could lose millions of dollars if they had to pick up the tab for uninsured patients.
Tim Poor is a freelance writer in St. Louis.