Health care reform was not really on the ballot in Missouri. AP Photo
As expected, Missouri voters passed Proposition C by a large margin today. The measure passed by a 71% to 29% margin. Headlines from various national outlets like The New York Times declared that Missouri had voted down the national health care law. Republicans within the state called the measure a "wake-up call" for the federal government, and a clear sign that Missourians reject the national health care reform.
However, the actual language of Proposition C never referred to health care reform. Instead, the very complicated, multi-pronged measure referred to the individual mandate and liquidation of health insurance companies. Basically, Missouri voters were asked whether they want to give government the authority to mandate individuals to buy health insurance.
The national health care reform law certainly does include an individual mandate, but it also includes much more. The individual mandate arguably was the least popular provision of the health care reform package (death panels do not qualify since they are fictional). Popular provisions of the bill included the banning of pre-existing condition exclusions and rescissions. Before health care reform, insurance companies could exclude sick children on the basis of pre-existing conditions. Under some very wordy insurance contracts, companies could actually take coverage away from a person after the person got sick. The health care reform law bans these practices, but Missouri voters were not asked to vote on these provisions.
Essentially, Missouri voters were asked if they liked the worst part of health care reform, while not being asked about the favorable part of reform. The problem with this is that it skews the results. It would be like asking someone with a toothache whether they wanted their tooth pulled:
Question: "Do you want your tooth pulled?"
Question: "Do you want your tooth pulled if it rids you of your toothache?
In order to include the provision banning pre-existing conditions, the health care reform package practically had to include the individual mandate. If the ban on pre-existing exclusions was passed without the individual mandate, then every American would be wise to stop paying premiums, wait until they get sick, and then purchase the best health insurance policy they could find. Under that scenario, insurance companies would have no choice but to cover the person. To reference the analogy above, in order to rid ourselves of the toothache of pre-existing exclusions, we had to accept the painful procedure of a tooth extraction.
Missourians were not presented with the complete package. They were not asked whether they approved of health care reform. They were not asked whether they would accept the individual mandate in exchange for the benefits of health care reform. Instead, they were asked just about the individual mandate. Why? The proposition was carefully crafted by a Republican-controlled legislature in Missouri anxious to capitalize on the conservative backlash against reform. The legislature wanted an overwhelming result for the measure to help them energize their base and fundraise in the future.
Imagine, for example, if the tables were turned and Democrats controlled the legislature in Missouri. Suppose Democrats put a "Proposition D" on the ballot, which asked voters if they favored "Giving the government the authority to ban the practice of pre-existing condition exclusions in health insurance companies." Furthermore, suppose the measure passed by a large margin as polls suggest. Would it really be accurate to say Missouri voters approved of health care reform because they approved of one provision?
Lest this sound like sour grapes, there are some definitive positive effects for conservatives. The measure did pass by an overwhelming margin. Democrats blame this on higher voter turnout in the Republican primary as compared to the Democratic primary. The argument is that GOP primary voters basically passed the measure. That argument ignores the fact that Republicans made the effort to actually show up. The "intensity gap" between Republicans and Democrats appears wider than ever. Approximately 314,000 Democrats came out to vote in the Democratic primary for U.S. senator in Missouri. In comparison, some 575,000 came out to vote in the Republican primary. If voter turnout stays that way, in November the Democratic nominee Robin Carnahan will not stand a chance against Rep. Roy Blunt. The Proposition C victory also shows that conservatives still are winning the messaging war on health care reform.
Legally, the passage of the law has little significance. The state of Missouri, along with many other states, was alreadly planning on challenging the federal law before Proposition C was passed. The passage of Proposition C does not change their plans, and it will not strengthen their lawsuit. If they succeed in their lawsuit, then Proposition C will prevail. If they fail, then Proposition C will be superseded by federal law under the Supremacy Clause of the United States Constitution.
Politically, the passage of the measure is yet another sign that Missouri is becoming more and more of a "red state" in the country. Even though President Obama won the electoral college by a large margin, Senator McCain managed to win Missouri's 11 electoral votes. Missouri previously was seen as a bellwether state which could correctly predict presidential winners, but that pattern did not follow in 2008. With the passage of Proposition C, Missouri becomes known as the first state to publicly vote against one part of the health care reform law. In a sense, Missouri will be challenging health care reform, much like Arizona is challenging federal immigration policy. Missouri's legislature was dominated by Democrats for decades, but now Republicans have a strong grip on the General Assembly and can use that power to pass measures like Proposition C. The state that brought us President Harry S. Truman (who ironically favored a more liberal version of universal health care coverage) has now turned into a symbol of anti-Obama backlash.