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Missouri voters become the first to reject key federal health reform provisions

On the heels of the first district court ruling validating legal challenges to the Patient Protection and Affordable Care Act, (PPACA), Missouri’s primary election drew nearly 939,000 votes on Proposition C, a ballot initiative relating to federal health care reform. The measure, which was approved by over 71 percent of votes cast, read:

“Shall the Missouri Statutes be amended to:

  • Deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services?
  • Modify laws regarding the liquidation of certain domestic insurance companies?”

The initiative conflicts with key provisions of the new PPACA which requires individuals to obtain health insurance or pay fines by 2014.

“The people of Missouri sent a clear message to the President and Congress: we don’t want government-mandated health care,” said Missouri Senator Jane Cunningham, board member of the American Legislative Exchange Council (ALEC) and lead sponsor of the referendum. “Each individual vote on this proposition was an individual voice expressing frustration and disappointment with our federal government — we just hope the leadership in Washington hears this majority’s voice,” she added.

The ballot issue stems from the state’s “health care freedom” law ( H. 1764), passed on May 11, 2010. Among its provisions, the law provides that:

  • laws or rules may not compel individuals, employers or health care providers to participate in a health care system;
  • individuals and employers may pay directly for lawful health care services, and providers may accept direct payment for such services without penalty or fine; and
  • subject to reasonable and necessary rules that do not substantially limit an individual’s options, the purchase or sale of health insurance in private health care systems may not be prohibited by law or rule.

The effective date of the freedom law was contingent on voter approval of the measure, which it has now overwhelmingly received. Missouri is the first of four states to put this issue to its voters — Arizona, Florida and Oklahoma will conduct similar referendums in November. While the votes are symbolic of public opinion, it is the courts that will likely determine the fate of the federal health care reform law.