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Last Tuesday August 3, 2010 Missouri voters overwhelmingly approved Proposition C, a ballot measure that would prohibit the state government from requiring residents to have health insurance or from penalizing them for not having coverage. The referendum – now Missouri law – is in direct conflict with the individual mandate that’s part of the Patient Protection and Affordable Care Act of 2010. The federal requirement that most citizens have health insurance or face penalties begins in 2014. Because federal law generally overrules state law, the vote was largely symbolic as a show of the Tea Party movement’s strength and of popular discontent (particularly among conservative voters) with healthcare reform.

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Missouri Opposes Federal Individual Mandate

71% of Missouri voters approved the measure while only 29% voted against it. Though turnout for the vote was low, the vast majority of those who did vote were Republicans. Analysts know this because even though Missouri’s open primaries do not require voters to register their party affiliation, many more voters took Republican ballots than Democratic ones. Republican legislators originally wanted to put Proposition C on Missouri’s November election ballot as a vote on a constitutional amendment, but to avoid a Democratic state senate filibuster they settled for a proposed law on last week’s primary ballot.

The purpose of the federal law’s individual mandate is to widen the pool of healthy individuals covered by insurers to balance out the influx of unhealthy individuals expected to enter the pool as a result of separate provisions which prohibit insurers from denying people with pre-existing medical conditions. Were there not to be an individual mandate in conjunction with eliminating denials based on pre-existing conditions, premiums would rise out of control.

Though this is nothing more than a symbolic gesture of disapproval from voters, several other states have also passed similar statutes not based on referenda, including Arizona, Georgia, Idaho, Louisiana, and Virginia. Arizona and Oklahoma voters are set to vote on state constitutional amendments to the same effect in November. In the same vein, public officials in more than twelve states (including Missouri) have filed lawsuits claiming the individual mandate violates usual federal-state relations. Defenders of the law argue the mandate falls under Congress’s power to levy taxes and regulate interstate commerce. Federal courts are expected to weigh in on the constitutionality of this issue before the individual mandate goes into effect.

A number of high powered interest groups were involved in campaigning for Proposition C. The Missouri Hospital Association was particularly vocal – to the tune of $400,000 – in warning voters that passage of the measure could increase hospital costs for treating the uninsured. The group argues that were there not to be an individual mandate, there is the potential for a massive cost-shift onto the insured to cover those visiting emergency rooms because they lack insurance. There was little opposition from grass-roots organizations or unions and consumer groups who had forcefully supported reform earlier this year.

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