CONCORDIA — The vote may turn out to be little more than symbolic. Other pressing problems continue to vex the country, such as strengthening the economy and figuring out what to do about illegal immigration.
But as Sen. Claire McCaskill traversed rural Missouri on Tuesday for a series of town hall meetings during Congress' August recess, the federal health care overhaul remained a target of angry voters. About half the questions from the 50 constituents at the day's first stop in Concordia concerned health care reform.
McCaskill told the audience that the Aug. 3 referendum in which Missourians decisively approved a state measure to bar the federal government from requiring health insurance would likely do little to change that provision.
She also defended her vote in favor of President Barack Obama's health care plan as difficult and unpopular, but necessary.
"It's hard to get anything done without making some people mad," she said. "Overall, as time goes on, and people learn how this bill will be implemented, and learn that what they've heard is not true in regards to parts of this bill, I may be wrong, but I believe it will become more and more accepted by the people I work for.
"It wasn't easy for me voting for the bill knowing how unpopular it was. But I honestly believe it was the right thing to do."
The session was billed as an open forum, and McCaskill's brief opening remarks dealt with deficit spending and "promoting fiscal responsibility." Yet her staff was sure to pass out a two-page fact sheet titled "Health Care Reform: Myth and Facts" to those in attendance.
One week ago, 71 percent of Missouri primary voters backed a ballot measure, Proposition C, which challenges the federal requirement that nearly everyone have health insurance — and penalizes those who do not — starting in 2014.
The Aug. 3 referendum was helped by a high Republican turnout. In Missouri's open primaries, voters don't have to register their party affiliation. But far more people picked Republican ballots than Democratic ones.
Since federal law generally supersedes state law, the vote might ultimately have more impact on other states considering similar proposals than on Missouri residents. The Missouri vote was seen as warning to Washington and the Democrats, in particular, as they seek to maintain their majorities in Congress after November's midterm election.
"The rest of the country was looking at us. I don't think it will stop in Missouri," said forum participant Kerry Blevins of Knob Noster, who works for a welding supply company and voted in favor of Proposition C.
McCaskill, who is in her first term and faces re-election in 2012, acknowledged concern about the ballot measure's potential political cost.
"I'm not deaf, dumb and blind," she told The Associated Press after the morning session. "I'm sure there will be some political ramifications."
While public passions remain inflamed, the required insurance provision and other aspects of the health care overhaul could ultimately be decided in the courtroom. Federal courts are expected to rule on the plan's constitutionality well before the insurance requirement takes effect.