Potential impact of health care measure unclear

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buy this photo Missouri will be the first of several states — Arizona, Florida and Oklahoma are the others — to hold what amounts to a voter litmus test on President Barack Obama's health care plan. Here, he is shown July 13 at the White House. (Ron Sachs-Pool/Getty Images)

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JEFFERSON CITY • Missouri voters have a chance on Aug. 3 to weigh in on the hottest political topic of the year: the new federal health care law narrowly passed by Congress in March.

On paper, the vote seeks to change state law so that the federal government can't require an individual to buy health insurance. In reality, experts say the end result will be mostly symbolic, as the U.S. Constitution gives clear priority to federal laws over state laws.

But that doesn't mean that the vote isn't full of political meaning.

"I think it will be marketed as a referendum on President Obama," said George Connor, chairman of the political science department at Missouri State University.

Missouri will be the first of several states — Arizona, Florida and Oklahoma are the others — to hold what amounts to a voter litmus test on the president's health care plan, and that makes the vote an important part of the midterm election strategy of the Republicans pushing it.

"What people will hear if Proposition C passes is that the people of Missouri voted against President Obama's health care plan," said Patrick Tuohey, campaign manager for Missourians for Health Care Freedom, one of the groups supporting the ballot initiative. "Come Aug. 4, that's how it's going to be presented."

There is little doubt in Missouri political circles that Proposition C is going to pass.

The initiative has no organized opposition. The largest turnout among the two major parties on primary day is expected to be among Republicans, who have more hotly contested primaries, including the race for state auditor and a crowded field in the 7th Congressional District race.

Democrats, who opposed the measure in legislative debates earlier this year and persuaded Republicans to keep it off the November general election ballot, are largely steering clear of the matter on the campaign stump. The Missouri Democratic Party did release a statement calling the initiative "a meaningless and unconstitutional political ploy."

"Proposition C probably doesn't accomplish anything," said state Sen. Jolie Justus, D-Kansas City.

If it passes, legal experts and observers agree, the proposition will likely be challenged quickly, quite possibly by the federal government, said Richard Reuben, a law professor at the University of Missouri School of Law.

The key issue for the courts, Reuben said, would be whether the state law was in direct conflict with federal law.

Supporters of the measure in the Missouri Legislature said they expected a legal battle when they passed the bill placing Proposition C on the ballot.

"It's setting up a constitutional showdown," said state Rep. Tim Jones, R-Eureka.

Indeed, much like the lawsuits filed by several states against the new federal health care law, the ultimate goal is twofold: first, to find a case that makes it to the U.S. Supreme Court to further define the relationship between states' rights and federal power; and second, to foment political opposition to the health care law.

In Missouri, the narrative in favor of Proposition C fits hand in hand with the arguments made by Lt. Gov. Peter Kinder in his lawsuit challenging some of the same aspects of the new federal law.

The proposition already survived one legal challenge just to make the ballot. A Jefferson City lawyer argued that the measure was unconstitutional in that it included two issues. Besides the health insurance mandate, voters will be asked to change a law regarding the liquidation of insurance companies that go out of business. A judge ruled that both issues are related to insurance, and therefore, the proposition is constitutional.

Proponents of the proposition argue that health care choices should be left to individuals.

But seeking that end through a statewide vote that contradicts federal law will ultimately not work, many legal and political experts agree.

"Any attempt by a state to opt out will be in violation of the Supremacy Clause" of the Constitution, said Connor, the political science professor.

Tuohey concedes the political repercussions of Proposition C are more significant than any legal ones. But, he said, politics can be a powerful force that can lead to an effective repeal of the federal law.

He points to the Real ID bill passed in 2005 by Congress that created some national standards for drivers licenses and other forms of state identification. There has been so much political opposition to the law that it has yet to be implemented, and Congress is considering changes.

Randy Barnett, professor of constitutional law at Georgetown University Law School, said the national debate over medical marijuana shows how state politics can affect federal policy.

Over the last decade, he said, several states have enacted laws allowing for the sales of medical marijuana, even though such sales contradict federal law. The Obama administration has reacted to the strength of the movement by deciding to allow the state laws to continue in force.

"It's a real-world example of how these state initiatives can change the politics and ultimately the enforcement," said Barnett, who took one of the landmark medical marijuana cases to the Supreme Court.

Some of the mandates in the federal health care law won't take effect for several years. So the political opposition is unlikely to die down anytime soon.

Conservatives hope to create a national groundswell of opposition to Obama's health care overhaul, and Missouri's vote — constitutional or not — is part of that strategy, Tuohey said.

"Ultimately," he said, "all of this is political."

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