JEFFERSON CITY — Missourians were delivering a political message Tuesday about the new federal health care law championed by President Barack Obama. Whether their vote on a ballot measure could carry any legal effect was far less certain.
In a first-of-its-kind referendum, Missouri voters were deciding on a ballot proposal attempting to defy a key element of a new federal law requiring most people to have health insurance.
If it passes as expected, the Missouri measure could send a troublesome signal from a historical swing-state about the most high-profile accomplishment of Obama and the Democratic-led Congress.
Were the ballot measure to fail, it could signify a stunning setback for Republicans who have tried to make the federal health overhaul a central part of the midterm elections.
The proposed Missouri law would prohibit governments from requiring people to have health insurance or from penalizing them for paying health bills entirely with their own money. That would clash with a requirement of the new federal law that most Americans have health insurance or face penalties starting in 2014.
The courts likely would have to decide which law prevails. But generally, federal laws supersede those in states — making the legal effect of Missouri's measure doubtful.
"It may have some rhetorical or symbolic significance," said Allen Rostron, a constitutional law professor at the University of Missouri-Kansas City. But "if the federal law is valid, then this essentially amounts to a non-legally binding expression of dissent by the state of Missouri."
The intent of the federal health insurance requirement is to broaden the pool healthy people covered by insurers, thus holding down premiums that otherwise would rise because of separate provisions prohibiting insurers from denying coverage to people with poor health or pre-existing conditions.
The insurance requirement has been one of the most contentious parts of the new federal law.
Opponents have pushed for defiant state laws to supplement their lawsuits contending that Congress overstepped its authority under the Constitution's Commerce Clause by requiring citizens to buy health insurance.
Laws similar to Missouri's proposal already have been enacted — without statewide votes — in Arizona, Georgia, Idaho, Louisiana and Virginia. Similar measures are to appear as state constitutional amendments on the November ballot in Arizona and Oklahoma.
On Monday, a federal judge said a Virginia lawsuit challenging the federal health care law could move forward. Among other things, the judge said the Virginia attorney general had a right to defend a state law exempting residents from the federal coverage mandate.
In Missouri, the campaign for a similar law has been led by Republican lawmakers and some activists who have been involved in the tea party movement. A specially created campaign committee raised about $100,000 to run radio ads and print yard signs.
There was little organized opposition. But the Missouri Hospital Association spent more than $400,000 to mail brochures to hundreds of thousands of homes. The fliers said hospitals could incur costs of about $50 million annually in treating the uninsured if the Missouri ballot measure passed and successfully exempted people from the insurance mandate.