JEFFERSON CITY — Missouri lawmakers are preparing a second salvo over the federal health care law. The most recent push comes after the state became the first to use a referendum to challenge the federal law's requirement that most people eventually get health insurance.
A measure proposed in the Missouri Senate would amend the state constitution to bar governments from requiring people to have health insurance and from penalizing them for paying their own medical bills. It follows on a nearly identical state law approved overwhelmingly by voters in August 2010. Lawmakers are expected to renew their focus on health care during the annual legislative session that starts Wednesday.
Sen. Jane Cunningham, a leading supporter of the state law, said the new constitutional amendment will strengthen those protections and shield Missouri residents from being forced to buy something they do not want.
"The federal government will mandate, require that Americans buy a product against their will. That is just wrong. It's not American. It's not freedom," said Cunningham, R-Chesterfield. "So it's a fundamental correction and protection of Missourians against the federal government."
Missouri's health insurance law — and the proposed constitutional amendment — clash with the federal health care overhaul's requirement that most Americans have health insurance or face penalties starting in 2014. The courts likely will need to decide whether the federal or state law prevails, and federal statutes generally have trumped state measures.
Nonetheless, several states have approved similar laws targeting the individual insurance mandate and most states have at least considered legislation. Missouri's measure was the first to appear on the ballot and passed with 71 percent of the vote. Two states now have constitutional amendments, and Arizona has both a state law and a constitutional amendment.
The individual insurance mandate has been one of the most controversial provisions of the federal health care overhaul signed into law in March 2010. The mandate is meant to broaden the pool of healthy people covered by insurers and thereby hold down premiums that otherwise would rise because of separate elements keeping companies from denying coverage to people with pre-existing conditions. Legal challenges also have been filed, and the U.S. Supreme Court has scheduled five hours of oral arguments.
Opponents of the proposed constitutional amendment contend Missouri lawmakers are more concerned with politics than policy. They say state legislation is unlikely to overturn the federal health care law or block Missouri from complying.
"It seems that the majority party in Missouri wants to continue to run against the president and what they call Obamacare, and they are finding it fertile political ground," said Amy Smoucha, a health care organizer for the group Missouri Jobs with Justice. Smoucha added: "Political motivations appear to be trumping problem-solving."
Missouri lawmakers considered a constitutional amendment in 2010 but settled on a state statute so Senate Democrats would permit a vote. Still, the Missouri House passed a constitutional amendment aimed at the individual insurance mandate, though it did not win final legislative approval.
House Speaker Steven Tilley, R-Perryville, said he would consider a second crack at a constitutional amendment but does not consider it a priority.
Lawmakers also have expressed concern about a portion of the federal health care law dealing with health insurance exchanges that will allow people to shop for insurance through an online marketplace. Missouri insurance officials dropped plans this fall to spend federal money for the computer technology needed to prepare a state-run exchange after objections from some Republican senators.
A measure proposed in the Senate would bar the establishment of a state-based health insurance exchange without approval from the legislature or the voters. Sen. Rob Schaaf, R-St. Joseph, said setting up an exchange could have significant implications and demands input from lawmakers or the electorate.
"Just because the federal government says jump doesn't mean we have to say how high," Schaaf said. "We are a sovereign state and determining how insurance is delivered is our prerogative, not the federal government's."
Under the federal health care law, states have until 2014 to either set up their own insurance exchanges or have their online marketplace run for them by the federal government. Sen. Joe Keaveny said it seems some legislators want to avoid supporting any piece of the federal health care law, no matter what.
"We can make a much better system than to have someone come in from the federal government and create a totally autonomous system," said Keaveny, D-St. Louis.