Missouri Voters Poised To Reject Health Care Reform, Start Legal Challenges

Missouri Republicans today are preparing to celebrate the success of their ballot initiative on health care reform, which asks Missourians whether they want to roll back a critical element of the new law despite significant questions about the constitutionality of doing so.

But opponents of Prop C, the Republican-engineered ballot measure dubbed the “Health Care Freedom Act” that has more political significance than legal precedent behind it, number just in the hundreds and have scant help from the state’s Democrats or even Gov. Jay Nixon. The teenage leader of the opposition, in fact, is managing a Facebook campaign against the ballot measure in between his job making sandwiches at Subway.TPM recently detailed the anti-health care measure up for a vote today, a proposition which will give Missourians the chance to say no to the federal law’s provision that mandates individuals have insurance coverage by changing state statutes. After several interviews with state political activists and partisans from both sides, it seems all-but-certain the measure will pass today. Backers expect the measure to face a legal injunction and set up a court challenge similar to the one facing Virginia, where lawmakers earlier this year passed similar legislation that survived its first court challenge yesterday. More than 15 other states are pursuing similar legal challenges to the health care law, which became an issue during Elena Kagan’s confirmation hearings.

Missouri’s ballot initiative is the first time, however, that voters themselves will have the opportunity to reject health care reform. It is all the more likely to pass today because the statewide Republican primaries also on the ballot today are competitive — meaning that conservatives opposed to health care are sure to turn out.

“There isn’t a real groundswell of organizations against it, at least not publicly. There just isn’t anything similar to the major effort they’ve got on the pro side,” Missouri Hospital Association spokesman Dave Dillon told TPM in an interview.

Health Care for America Now said the large grassroots organization didn’t get involved because the ballot measure has no teeth.

“The Missouri vote was nothing more than a Republican straw poll with no legal force, and it certainly wasn’t about health care. If we thought this was about the new law, we would have run a campaign against it. But it wasn’t, so we didn’t,” said HCAN Executive Director Ethan Rome.

The most heated race on today’s primary ballot is for the Republican nomination for Senate. Rep. Roy Blunt (R-MO) is widely expected to capture the nod to challenge Robin Carnahan (D) for retiring Sen. Kit Bond’s seat. But it’s won’t have happened without effort on his part. The tea party is mad at him, and Blunt’s 17 primary challengers who say he’s not a real conservative probably have something to do with him recently endorsing Prop C as a way to halt “ObamaCare.”

Other Republicans on the ballot in Congressional races are pushing the effort, and hope it can boost voter turnout and enthusiasm in the lead up to what will be a major battleground election this fall.

Kansas City resident Caleb Files, 18, has made it his mission to try and defeat Prop C today. While juggling his job as a manager at Subway, Files has spent nearly $1,000 of his own money to organize rallies via Facebook. He earned several stories in the local press but conceded with the higher Republican turnout expected today, the measure is likely to pass and end up before the Supreme Court.

“If that happens it’s a waste of taxpayer dollars. We’re trying to protect health care for all Missourians,” Files told TPM in an interview. “The law is the law and now Missouri is trying to make their own laws against it.”

Files noted Nixon staying out of the issue, adding, “We haven’t seen any outpouring of support.”

TPM asked several large organizations who spent big on health care reform at the national level, receiving no response as to why they aren’t involved in Missouri and what they will do when this passes.

A spokeswoman for Gov. Nixon told TPM that the Democrat “hasn’t waded into the fray” on the ballot measure. Nixon’s view “is that the new federal health care plan is the law of the land, approved by Congress and signed by the president, and it’s his job to make sure that the citizens of Missouri get the most benefit from it,” said spokeswoman Christine Bertelson.

While he supports the law on those grounds, Nixon is, after all, one of the six Democratic governors who didn’t sign a bland letter stating support for health care reform last fall. Nixon did not want his Democratic attorney general joining the states challenging the federal government over health care reform, so Lt. Gov. Peter Kinder (R) said he would go out on his own with a lawsuit against the health care reform legislation.

For its part, the Missouri Hospital Association has sent mailers to several hundred thousand primary voters across the state with the goal of informing them about how the measure could cost the state big bucks, but isn’t clearly opposing Prop C. (Update: It’s a $400,000 campaign, more than proponents are spending.)

See the mailers in full here and here. The thrust of the argument is that, without a mandate, state hospitals and health care providers will have to pick up the tab for the uninsured. Below is an example of what they are telling voters:

Dillon said the Missouri Hospital Association estimates the state could lose $2.5 billion, based on figures provided by the Congressional Budget Office. He said the hospitals could suffer and premiums could go up.

Supporters of Prop C hope that the heartland will then be the first real test of health care reform. They believe that, no matter what, their case will end up being decided by the court. And, given the early election while other states are holding fall health care referendum votes, they want to be the pioneers.

If it passes today, Prop C would amend state statutes to deny the federal government the authority to penalize people for not buying health insurance. Among those states with similar ballot initiatives this fall are Arizona, Florida and Indiana — all of which also have high-profile Senate races.

“After months of saying NO to Washington, Missouri voters have something to say YES to,” boosters say.

The proposition’s official spokesmen have partisan ties. GOP pollster and political consultant Patrick Tuohey is treasurer of Missourians for Health Care Freedom. He’s used his state politics journal, the Missouri Record, to champion the proposition.

[Ed. note: This story was edited after publication.]