Missouri to Vote on Health Law
By KEVIN SACK
Published: July 31, 2010
ST. CHARLES, Mo. — For all its symbolic import, the first plebiscite on the Obama health care law, to be held Tuesday in Missouri, seems likely to be a low-turnout affair among an electorate dominated by Republican primary voters and conservative activists.
State Senators Jim Lembke and Jane Cunningham watching a commercial for Proposition C at a fund-raiser last week.
Missouri is the first of at least three states with ballot measures this year aimed at nullifying the federal health care law by invalidating its keystone provision, the requirement that most people obtain insurance or pay a tax penalty. A recent statewide poll in Missouri found that not even likely Democratic voters could muster a majority against the proposition.
The referendum on the measure, known as Proposition C, is seen as an organizational test for the Tea Party and like-minded conservatives in a swing state that President Obama lost narrowly in 2008 and that has since moved measurably away from him.
But the campaign has been a low-key affair, with no television advertising, debates or celebrity Facebook endorsements. Leading Democrats, from Mr. Obama to Gov. Jay Nixon, have kept their distance, seeing little to be gained by contesting what strategists dismiss as a Republican straw poll with a foregone conclusion.
The most competitive elections in Tuesday’s primary are on the Republican side, meaning turnout should be higher among those with natural sympathies for Proposition C. There are 291 Republicans competing for state and federal office, compared with 208 Democrats.
The Missouri secretary of state, Robin Carnahan, who is herself expected to coast to the Democratic nomination for United States Senate, predicted that only 24 percent of voters would turn out.
Of 20 Missourians interviewed at random in St. Louis last week, only five knew that there was a primary on Tuesday, much less a referendum on the health care law.
“Really, there is?” said Jeff R. Swaney, 53, a lawyer from Chesterfield, a St. Louis suburb. “I wasn’t even aware it was on the ballot. I haven’t seen any commercials.”
Supporters of Proposition C are hoping for a substantial victory that will convey a message of discontent with expansive federal government and rally other states and candidates to press the issue through the fall campaign.
“This is a throw-down by the states, saying, ‘Not in our state, you don’t,’ ” State Senator Jim Lembke, a Republican, said at a rally for the proposition here on Wednesday. “This health care thing is just a vehicle, a vehicle for the debate about what is the role of the federal government and what is the role of the states.”
No grass-roots organization has formed to oppose the measure, and the unions and consumer groups that lobbied for the federal health care law have steered clear. Mr. Obama did not take time to denounce Proposition C when he visited Missouri in early June.
“The proposition will have no legal standing, so I don’t know why there’d be a reason to focus on it,” said Brian B. Zuzenak, executive director of the Missouri Democratic Party. “From the beginning, we’ve said it’s meaningless and unconstitutional. At best, it’s a ploy by the Republicans to get their base excited.”
Comparable measures have already been enacted by legislatures in five states — Arizona, Georgia, Idaho, Louisiana and Virginia — according to the American Legislative Exchange Council, a conservative group that is pushing the initiatives. Arizona and Oklahoma are scheduled to vote in the November general election on state constitutional amendments to nullify the insurance requirement. A judge in Florida tossed a similar constitutional amendment off that state’s ballot last week, sayings its language was too overtly political.
The nullification laws are expected to have little immediate practical impact, because the insurance requirement does not take effect until 2014. And by then, the federal courts are likely to have had much to say about whether the new health care law is constitutional, and thus beyond the reach of state efforts to invalidate it.
Elected officials in 22 states, almost all Republicans, have filed lawsuits challenging the so-called individual insurance mandate. Among them, Virginia has made a direct claim that the federal law conflicts with its own 2010 statute, which asserts that residents of the commonwealth cannot be compelled to obtain health insurance.
The most recent lawsuit was filed individually by Missouri’s lieutenant governor, Peter D. Kinder, a Republican who acted without the support of Governor Nixon.
In the Missouri referendum, voters will be asked whether state law — not the State Constitution — should be amended to “deny the government authority to penalize citizens for refusing to purchase private insurance or infringe upon the right to offer or accept direct payment for lawful health care services.”
In May, Republican legislators, who control both houses, cut a deal with Democrats to put the question on the ballot. The Democrats agreed not to filibuster if the referendum was held during the August primary rather than the November general election, said State Senator Jane Cunningham, a Republican who sponsored the bill. With an open seat for the Senate on the line, the Democrats did not want to encourage heavy turnout among conservatives in November.
The legislation passed each chamber comfortably, winning a number of Democratic votes. By addressing the issue as a statutory ballot measure, the lawmakers managed to bypass Mr. Nixon, whose signature would otherwise be needed.
A spokesman for Mr. Nixon declined to reveal how the governor would vote on the referendum. The governor acknowledges that the health care law is not popular in his state, but has said he will work to maximize its benefits for Missouri. “This isn’t about protest,” he said recently. “It’s about progress.”
Support for the proposition is being rallied by Missourians for Health Care Freedom, which formed as an outgrowth of the legislative debate. The group raised $75,000 as of July 24, enough for radio advertising, yard signs and get-out-the-vote telephone banks, but not enough for television commercials.
“Do you think Washington knows what’s best for you and your family?” asks the group’s radio ad, which is playing on Christian and conservative talk stations.
The referendum is supported by the Missouri State Medical Association. The only organized opposition — beyond a Facebook page — has been mounted by the Missouri Hospital Association, which has spent more than $400,000 to send mailings to hundreds of thousands of homes, according to financial disclosure reports. The brochures warn that approval of Proposition C could burden hospitals, and their insured patients, with the cost of uncompensated care for people without health coverage.
“There’s an argument that a vote for Proposition C is a vote in support of freeloaders,” said David M. Dillon, a spokesman for the hospital association.
Mr. Dillon said there was no corresponding get-out-the-vote operation.
“I don’t even have someone I can direct people to,” he said. “There really isn’t an organized opposition. Frankly, we don’t want it perceived that we’re opposing it. But we certainly want people to understand that their choice has some implications.”
A version of this article appeared in print on August 1, 2010, on page A14 of the New York edition.
