08/05/10 – To Be Seen Whether Other States Follow Missouri’s Vote Against Health Reform

by Matt Sundeen

Senior Program Officer for Health Policy, The Colorado Trust

In an August 3 primary election, more than 71% of Missouri voters approved a health care ballot proposal that could foreshadow upcoming events in Colorado. Missouri's Proposition C was marketed to that state's voters as a repudiation of federal health care reform. It attacks the controversial individual mandate requirement in the new federal law by prohibiting government from penalizing citizens for failure to buy private health care insurance.

Here in Colorado, the Independence Institute submitted more than 130,000 signatures last week to the Colorado Secretary of State supporting a similar proposal for the November ballot. Currently referred to as "Initiative 45" or the "health care choice" initiative, the measure contains many of the same provisions found in Missouri's Proposition C. We probably won't know until August 20 whether the Secretary of State has determined that the Initiative 45 petition contains the roughly 76,000 valid signatures needed to make the Colorado ballot, but given the events of the last week it seems appropriate to make several points about both proposals.

First, it's historically misleading to claim that either Proposition C or Initiative 45 was drafted solely in response to federal health care reform. In fact, several conservative organizations, including the American Legislative Exchange Council, advocated for the idea well before health reform passed and even before President Obama was elected. For example, a similar measure failed on the Arizona ballot in 2008 by less than one-half of one percent of the vote.

Second, it should be noted that while both initiatives have been marketed as a response to federal health care reform, it is likely that they will not affect federal reform at all. Federal law preempts state law, so even a state constitutional amendment cannot overturn federal law.

Even so, both measures could significantly affect their respective state health care laws. In Colorado, for example, preliminary assessments are that Initiative 45 could prevent Colorado from regulating the scope of practice, because the proposal says the state cannot "deny, restrict or penalize the right or ability of any person to make or receive direct payments for lawful health care services." The initiative also could disrupt the third-party payer system, prevent the state from requiring Medicaid and CHP+ enrollees to participate in managed care and could destabilize current employer-sponsored insurance plans and drive up the price of insurance.

It may be premature to conclude that the Missouri result was a strong referendum against federal reform that presages results elsewhere. Nonetheless, at least 11 states will consider similar health care proposals in voting booths this fall.

For more information, please contact Matt Sundeen.

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