Rob Schaaf

Sunrise is just starting to break over the skies of St. Joseph, but Dr. Bob Stuber is busy under fluorescent lights, examining a patient inside the hundred-year-old building that houses the Social Welfare Board. After decades heading an internal medicine practice, working at a charity clinic is a big change for Stuber. But it’s not the only post-retirement shift for a doctor who voted Republican for most of his 75 years.

For more than a year, Secretary Kathleen Sebelius and others at the U.S. Department of Health and Human Services have been courting states to take part in setting up and running a health insurance exchange. But Missouri, home of an enthusiastic governor and opposing legislature, keeps sending mixed messages. Now, with Friday’s deadline looming for states to commit to joining the feds in setting up an exchange, it appears as though HHS will be flying solo in the Show-Me state.

Efforts to establish a prescription drug monitoring program in Missouri are making a comeback this year. But there’s a twist: the main opponent of establishing such a program is now sponsoring legislation.

This fall, voters in Missouri will face a number of decisions: picking state and congressional representatives, the President.  But also on the ballot will be a measure that like two years ago, has to do with the federal health law.