Challenge to Federal Health Mandate to Appear on August Ballot

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Since President Obama enacted a major federal health law in March, several groups have attempted to challenge its provisions through lawsuits and state legislation. A week from today, Missouri voters will take to the polls in the country's first popular vote on the issue. But as KCUR's Elana Gordon reports, the impact of Proposition C is uncertain.

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You remember the health care debate...

"No obama-care! No obama-care!..."

Last August, opponents of the federal law took to chanting at this local event featuring Congressman Emanuel Cleaver.

Still, months later, Congress approved the legislation, and several provisions are already taking effect. Favorable views of the law nationwide have increased according to a June Kaiser Health Tracking Poll.

But resistance remains.

Members of several dozen state legislatures have introduced bills that either limit or oppose certain aspects of the federal reform. Lawsuits challenging the health overhaul are being heard in Michigan and Virginia right now.

In Missouri, State Senator Jane Cunningham sponsored a bill that directly opposes any federal mandate requiring the purchase of insurance or the payment of a fine.

"I don't want the government to tell me what I have to buy," says Cunningham. "It's my health care. It's my physicians. I want to choose it just like I do other products, not the government to force me to do something against my own will with my own money."

The state legislature approved Cunningham's bill and scheduled it for a popular vote on next week's ballot.

'Proposition C' - as it's listed - would change state law. It's similar to a failed proposal that appeared on Arizona's ballot back in 2008, and directly conflicts with a central part of the federal health care overhaul which requires most people to have health insurance or face fines by 2014.

Missouri's August 3rd election marks the first popularity vote on such a measure since the federal legislation passed this year. Arizona, Florida, and Oklahoma all have similar initiatives on their November ballots.

Andrea Routh, director of the consumer group, Missouri Health Advocacy Alliance, says she's disappointed it's being considered here.

"Understandably, none of us like to be told we have to do something," Routh says. "But in the private insurance market place, to have these reforms around preexisting exclusions and that you're not rated higher on your policy because you have some pre-existing condition, you need to have everyone in the system."

Routh says spreading the risk over such a large pool of people in the individual market allows such reforms to work and keep costs down.

In addition to opposing a federal mandate, Proposition C contains another provision. It would modify laws for liquidating insurance companies. The Missouri Department of Insurance says this is a technical matter, unrelated to federal reform.

The ballot measure has already survived one legal challenge related to the two-part nature of the proposal. But expect more challenges if it passes.

Richard Reuben is a law professor at the University of Missouri, Columbia. He says federal law typically supersedes states in a case like this.

"In a very nonpartisan black letter law kind of way, what should happen on the insurance coverage issue is that the U.S. Supreme Court should rule that these state initiatives, including Missouri's, are in direct conflict with it [the federal law]," says Reuben. "Congress intended to occupy the field, therefore they are pre-empted under the supremacy clause of the U.S. Constitution."

The coming court battle could be expensive. But political science professor Ken Warren from St. Louis University says even if Republicans lose on Prop C....they win.

"You know, it's a rallying cry by more conservative Missouri voters against Obama and against Democratic candidates."

Local organizers of campaign efforts in support of Proposition C say its significance extends beyond local politics and could impact federal health policies. And, they say they'll leave it to the courts to decide, if and when it gets to that point, on the constitutionality of such a measure.

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