JEFFERSON CITY — Missouri is poised to become the first state to put a new federal health insurance mandate to a vote of its residents.
The Missouri House gave final approval Tuesday to a measure that will appear on the Aug. 2 ballot stating that people and employers cannot be compelled to have health insurance nor penalized for paying for health care out of their own pocketbooks.
The referendum seeks to defy a federal health care law signed earlier this year by President Barack Obama that requires most Americans to have health insurance or face fines beginning in 2014. But the legal impact of the state measure is questionable, because courts generally have held that federal laws trump those in states.
Conservative lawmakers in about four-fifths of the states have proposed measures attempting to let people opt out of the federal health insurance mandate. The measures have kept alive a potent political issue as hundreds of federal and state lawmakers seek re-election this year.
Laws have already have been enacted in Arizona, Idaho and Virginia, and proposed state constitutional amendments are to appear on the November ballot in Arizona, Florida and Oklahoma, according to the American Legislative Exchange Council, a nonprofit group that promotes limited government and helped coordinate some of the state measures.
Missouri's vote will occur the same day as its primary elections and will be the first such state referendum since passage of the federal health care law in March.
"People are wanting to speak out. They've been holding tea parties and town hall meetings and speaking out in that way, but this will be official," said Bev Ehlen, the state director of Concerned Women of America.
Ehlen helped organize hundreds of tea party activists who repeatedly rallied at the Missouri Capitol this year in support of a proposed constitutional amendment rejecting the federal health insurance mandate. Democratic senators stalled that measure, relenting last week only after Republicans agreed to scale it back to a proposed law and place it on the ballot in August instead of November.
Senators passed the measure 26-8 last week. The House passed it 108-47 Tuesday, with 22 Democrats joining majority party Republicans in support of it. Because lawmakers referred the measure to the ballot, it will bypass the desk of Democratic Gov. Jay Nixon.
Some Democratic lawmakers denounced the ballot measure as a political ploy with little practical policy effect.
It "seems to be a straight shot at Obama," said Rep. John Burnett, D-Kansas City.
Added House Minority Leader Paul LeVota, D-Independence: "This is clearly, simply an election year stunt."
Republican lawmakers contended that the federal government overreached its constitutional authority by requiring citizens to purchase a particular product — in this case, health insurance.
The ballot measure "does set up the showdown — the constitutional challenge — that we've been asking for this whole session," said Rep. Tim Jones, R-Eureka.
The federal health insurance mandate includes exemptions for lower-income people. But the intent of the mandate is to expand the pool of people paying insurance premiums, thus offsetting the higher costs of insuring those with preexisting conditions or other health risks. Under the federal law, businesses with more than 50 employees also could face fees beginning in 2014 if the government ends up subsidizing their workers' health insurance coverage.
At least 18 states have sued seeking to overturn the federal health care law.
Although Missouri's Democratic attorney general has not joined those lawsuits, Republican Lt. Gov. Peter Kinder has said he will file his own lawsuit challenging the federal health care law. Kinder praised Missouri lawmakers for sending the health insurance mandate to the ballot.
"I believe that the voters of Missouri will overwhelmingly support this referendum on the August ballot and stand up against this infringement on their personal freedoms," Kinder said in a written statement.