Missouri Healthcare Freedom, Proposition C (August 2010)

Voting on Healthcare Ballot Measures By state By year Not on ballot Local Measures Missouri Constitution Preamble Articles I • II • III • IV • V • VI • VII • VIII • IX • X • XI • XII • XIII

The Missouri Healthcare Freedom Act, also known as Proposition C, was on the August 3, 2010 ballot in Missouri as a legislatively referred state statute, where it was approved.

The proposed measure aimed to block the federal government from requiring people to buy health insurance and banned punishment for those without health insurance.

Backers of such measures were opposed to President Barack Obama’s new health care plans. The measure did not advocate a particular plan but measure advocates said the measure would "protect the individual’s right to make health care decisions." Opponents of the measures and some constitutional scholars said the proposals were mostly symbolic, intended to send a message of political protest, and had little chance of succeeding in court over the long run.

On May 4, 2010 the Missouri State Senate voted 26-8 in favor of referring the proposed measure to the ballot. On May 11 the House gave final approval to refer the measure to the ballot following a 108-47 vote.

Although similar measures were scheduled to appear on other 2010 statewide ballots, Missouri's Proposition C marked the first time voters had a say on blocking the federal government's 2010 health care reform.

A "yes" vote was a vote to amend current Missouri law to deny the government authority to "penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services." A "no" vote was a vote to reject the proposed referendum.

Reports out of Missouri predicted a low turnout of voters on August 3, as there were no television advertisements or debates on the matter in the low-key campaign. The Missouri Secretary of State expected a voter turnout of 24 percent.

Aftermath

Response

Shortly following the August 3 vote, ALEC board member and Missouri Senator Jane Cunningham said, "The people of Missouri sent a clear message to the President and Congress: we don't want government-mandated health care."

The Missouri measure was modeled after the American Legislative Exchange Council's (also known as ALEC) Freedom of Choice in Health Care Act, which has been introduced in several states across the country. ALEC Health Task Force Director Christie Herrera said, "Proposition C will give Missourians the ultimate exit strategy at a time when Americans are faced with an unconstitutional federal requirement to purchase health insurance."

Lt. Gov. Peter Kinder, who supported the measure being placed on the ballot, said, "What we saw in Missouri was an F-5 tornado touch down and move across all 114 counties, leaving very little left of the federal health care law. It was passed by such an overwhelming margin in every part of the state, with tens of thousands of Democrats voting for it."

Months after the vote, a majority of likely voters in Missouri continued to oppose federal health care reform, according to a poll released by Missouri Foundation for Health. The poll found 54 percent do not support the federal health care reform law. The survey for MFH was conducted in late August by polling 800 likely general election voters across Missouri. "

The Supreme Court will ultimately decide if the federal health care mandate is constitutional, said Elizabeth Price Foley, a law professor at Florida International University, who specializes in constitutional and health care law. If the Supreme Court decides in favor of the federal government, the decision will be the law of the land and residents in Missouri will be required to buy health care insurance, even though voters passed Prop C in August, she said. "Prop C is unenforceable as a legal matter, if the federal courts rule that health reform is constitutional, Foley said. "

Finance reports

According to campaign finance reports released in early September 2010 supporters, Missourians for Health Care Freedom, raised about $125,000 and spent an estimated $114,000 promoting Proposition C.

Election results

Missouri Proposition C (August 2010)
Result		Votes	Percentage
a Yes		669,847	71.07%
No		272,723	28.93%

Election results via the Missouri Secretary of State's website.

Text of measure

See also: Full text of the measure

Healthcare on the ballot in 2010

Ballot Title

The official ballot title read as:

“

Shall the Missouri Statutes be amended to: Deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services? Modify laws regarding the liquidation of certain domestic insurance companies? It is estimated this proposal will have no immediate costs or savings to state or local governmental entities. However, because of the uncertain interaction of the proposal with implementation of the federal Patient Protection and Affordable Care Act, future costs to state governmental entities are unknown.

”

Fair Ballot Language

A “yes” vote will amend Missouri law to deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services. The amendment will also modify laws regarding the liquidation of certain domestic insurance companies.

A “no” vote will not change the current Missouri law regarding private health insurance, lawful healthcare services, and the liquidation of certain domestic insurance companies.

If passed, this measure will have no impact on taxes.

Support

In May 2010 media reports said that local consultant Patrick Tuohey filed paperwork to establish a committee in support of the proposed health care freedom measure. The official group in support of Proposition C is Missourians for Health Care Freedom.

Arguments

• Sen. Jane Cunningham, a sponsor of the proposed measure, argued that the measure was about protecting personal liberties and allowing Missouri residents to choose whether to accept federal health care without any penalties. "Missourians will lose absolutely nothing if this amendment passes. They can choose the government plan or they can choose anything else they want," said Cunningham. But some lawmakers argued that the health care legislation crosses into states' rights and oversteps its own federal power. Sen. Jim Lembke said,"If the federal government is going to make all the decisions for us, why are we here?"

• In a July 25 blog post, the Citizens Commission on Human Rights of St. Louis said, "We think voting for this is a good idea because the recently passed federal Patient Protection and Affordable Care Act is laden with language and funding for the psycho/pharmaceutical industry, which has a vested interest in seeing every man, woman and child in America labeled with some mental disorder and prescribed harmful psychiatric drugs."

• Carl Bearden, executive director of United for Missouri, said, "Quite simply, United for Missouri believes that the federal health care package pushed by the president and supported by the Democratic Congress treads on states' rights. It's a mandate on individuals and states that goes beyond proscribed federal powers."

• A co-sponsor of the proposed measure, Rep. Ed Emery, said, "It’s unsustainable anyway, but it’s more quickly unsustainable if you can get out of it," of the 2010 federal health care reform. In regard to the proposed measure, Emery said, "This is the most fundamental Constitutional battle. We have, little by little, been losing the principles of federalism. This is our chance to take a stand and make America like America is supposed to be."

Donors

Senator Jane Cunningham on Prop C, Part 1, 7-17-10

According to the quarterly finance report filed July 15, Missourians for Health Care Freedom received several donations from June 18 through June 30. According to reports, the group received $22,768.07 in monetary contributions. According to the finance report, the group has had a total of $9,700 in expenditures.

Below is a chart that outlines major cash contributions to Missourians for Health Care Freedom:

Contributor	Amount
Citizens for Brad Lager	$5,000
Missourians for Goodman	$5,000
Ray Vinson, Executive for US Auto Protection	$5,000
William Canfield, retired	$5,000
Fred Sauer, Orion Investment Co.	$5,000
Missourians for Mayer	$2,500
Ron Richard 2010	$2,500

Campaign advertising

The Missourians for Health Care Freedom began running radio ads on July 26 in support of the proposed measure. According to reports, the radio ads ran during conservative talk shows and on Christian radio stations.

Tactics and strategies

In the last week prior to the August 3 primary vote, supporters held various rallies and fundraisers. On July 28, 2010 Missourians for Health Care Freedom held a fundraiser/rally at The Columns Banquet Center in St. Charles, Missouri. According to the campaign's website, attendees included Sen. Jane Cunningham, Sen. Jim Lembke, Rep. Tim Jones and Rep. Brian Nieves. Another fundraiser is scheduled for July 29 and a rally is scheduled for July 31 at the corner of Brentwood and Manchester between 12 and 2 pm.

Opposition

Opponents argued that the approved federal health care legislation was similar to a mandate, requiring lawmakers to cover treatment for autistic children - approved in March 2010 by the Missouri State Senate. In response to supporters' arguments Sen. Victor Callahan said, "Social Security per se is not in the Constitution. I don't see it in the Constitution but it appears to be on my check every two weeks."

Arguments

• Missouri Jobs with Justice was opposed to Proposition C, maintaining that Proposition C protected insurance companies instead of people. The organization released a flyer in opposition to Proposition C. It can be found here.

• On July 23, 2010 the League of Women Voters of Missouri came out in opposition to Proposition C, arguing that, "The new federal law, the Patient Protection and Affordable Care Act, provides universal coverage with access to affordable, quality care for all Americans . . . Proposition C undermines a key component of the law by allowing Missourians to opt out of buying health insurance without having to pay a penalty. League opposes this proposal."

• On July 24, 2010, the Missouri Hospital Association urged voters to consider that, "Proposition C would only reinforce a broken system." The Association suggested that Missourians should consider that it was, "unfair for Missourians who pay for health insurance to pay higher insurance premiums to cover the cost of care for those who decide not to buy insurance."

• Ruth Ehresman, the director of health and budget policy for the Missouri Budget Project, wrote in an editorial, "A 'no' vote on Proposition C will allow Missouri — and the rest of the nation — to focus on planning how to implement federal reform well and how to improve parts that might need changing. Those wishing to make political statements should be careful to not do it at the expense of the estimated 500,000 Missourians who will gain access to affordable health insurance through federal reform. Voting 'no' on Proposition C is a wise choice."

• Brian B. Zuzenak, the executive director of the Missouri Democratic Party, made the argument that the measure would change nothing and was a waste of the state's time. According to Zuzenak, “The proposition will have no legal standing, so I don’t know why there’d be a reason to focus on it. From the beginning, we’ve said it’s meaningless and unconstitutional. At best, it’s a ploy by the Republicans to get their base excited.”

• Saint Francis Medical Center president and chief executive officer Steven C. Bjelich said, "Eliminating the federal health insurance mandate will significantly reduce the number of Missourians otherwise expected to obtain coverage under the Affordable Care Act. This will have negative consequences for Missouri hospitals, because they will experience Medicare and disproportionate-share hospital payment reductions designed to fund higher levels of coverage."

Donors

The Missouri Hospital Association spent more than $400,000 sending out fliers opposing the proposed measure. Eliminating the federal health insurance mandate in Missouri would reduce the number of residents expected to obtain health coverage, according to the MHA. This would negatively hurt hospitals because they would receive lower payments designed to fund higher levels of coverage.

Campaign advertising

On July 26 opponents of the proposed measure began running radio ads calling for voters to vote "no" on Proposition C.

Tactics and strategies

Opponents of the proposed measure and supporters of the approved federal health care reform created a group on Facebook called "Vote No on Missouri Prop C." The group, however, did not list an official website. According to the group's logo, the motto read, "Protect Health Care For All Missourians: No! on Prop C."

A blog was created on blogger.com called "Vote No Prop C in Missouri." (dead link) The blog highlighted a rally, scheduled for July 29th at 5 pm. The rally was scheduled to be held in Kansas City, Missouri at the intersection of 47th street and J.C. Nichols Parkway.

Media editorial positions

Main article: Endorsements of Missouri ballot measures, 2010

Opposition

• Kansas City Star said, "Supporters are calling Proposition C on the Missouri statewide ballot the 'Health Care Freedom Act.' It more accurately could be called the 'Futile Gesture Act.' Or perhaps the 'Full Employment for Lawyers Act.' The ballot measure is an empty protest of federal health care reform, instigated by an advocacy group amply funded by health insurers and drug companies. Besides its expense in printed ballots, the measure could end up costing taxpayers plenty in legal fees. Missouri voters should say 'no' on Aug. 3."
• St. Louis Business Journal said, "This measure pits some of the largest corporations and their leadership against the largest health-care institutions (which, not so ironically, are themselves large employers) and their leadership. The corporate leaders and the political leaders who share their sentiments see requiring health-care insurance as infringing on individual freedom. The health-care leaders point to car insurance as an example of a government mandate requiring individuals to submit to the rule of the sovereign...We hope you’ll vote against Prop C."
• St. Louis Post-Dispatch said, "Proposition C is nothing but a taxpayer-funded political exercise designed to raise cash for Republican candidates, consultants and causes. No wonder they call it Prop C...they should reject the August charade and Vote No on Proposition C."

Lawsuits

See also: 2010 post-certification removal litigation

A lawsuit was filed in late June 2010 in the Cole County Circuit Court in an attempt to block Proposition C from appearing on the ballot. According to reports the lawsuit argued that the proposed measure violated the Missouri Constitution because of the way - as a legislatively referred constitutional amendment - in which it was certified for the ballot. Specifically plaintiffs cite a constitutional prohibition against bills containing multiple subjects. Originally the measure addressed procedures for "insurance companies to voluntarily dissolve. It was amended to include a section stating that people cannot be compelled to have health insurance or penalized for paying their health bills with their own money."

In reaction to the lawsuit Sen. Jim Lembke said, "...a few liberals in this state that want to settle things...in the courts, instead of allowing the people of Missouri to vote on this issue." Sen. Jane Cunningham said that the lawsuit is being pursued because opponents "know they can't win at the ballot box." However, Charles Gentry, the attorney who filed the suit argues that the suit is not about preventing voters from having a say on the measure but to protect "the referendum and ballot process."

The case was heard on July 13, 2010.

Arguments

At the July 13 hearing, attorney Chip Gentry argued that the proposed measure included multiple subjects, violating the single subject rule. "The fact that we have two questions and one box forces Missouri voters into a conundrum' and underscores the fact that lawmakers used 'logrolling' to combine multiple subjects into one bill," said Gentry. State Solicitor Jim Layton, on the other hand, said that both parts of the legislation were focused on the topic of insurance. Additionally Layton noted that voters had in the past voted on measures with several components. Specifically Layton referred to Amendment 2 in 2006 which defined and outlawed human cloning. Additionally, the measure prohibited the Missouri Legislature from denying funding to entities that performed human embryonic stem cell research.

The case was heard by Cole County Circuit Judge Paul Wilson. Wilson did not issue a ruling on July 13 but said he planned to issue one as quickly as possible. According to reports Wilson wanted to allow time for appeals and a Missouri Supreme Court decision.

Ruling: measure upheld

On Friday, July 16, Cole County Circuit Court Judge Paul Wilson dismissed the lawsuit against Proposition C. In his decision, Judge Wilson wrote that despite arguments that the measure's title was too broad, the Missouri Supreme Court had previously upheld bills that had broader titles. Additionally, Wilson noted that both parts of the proposed measure related to insurance and thus complied with the single subject rule. The changes made to the text, he noted, remained in line with the bill's original purpose.

In his decision Judge Wilson criticized the timing of the suit. He noted that the plaintiffs had more than sufficient opportunities to file a complaint prior to the lawsuit filing.

No appeal sought

In reaction to the July 16 court ruling, Jefferson City Attorney Chip Gentry announced that the plaintiffs did not plan to further pursue the case. "We thought about it and have decided not to appeal at this time; in light of the fact that ultimately what this case was about was to avoid voter confusion and the impossible choice of having two questions in one box. Even if we were successful on appeal, which we feel we would be; the ultimate remedy of actually removing that confusing language from the ballot wouldn’t happen and that the ballots simply would not be counted and would not be certified," said Gentry. In addition to bad timing, Gentry said the plaintiffs did not want to cost the state more money. Absentee ballots had already been cast and ballots had already been printed.

Despite the plaintiffs' decision not to appeal the judge's ruling, a challenge following the August election, should the measure be approved, had not been out of the question.

National lawsuit

On July 7 Lt. Gov. Peter Kinder filed a lawsuit against the federal health care bill. Kinder initially announced his intent to file a lawsuit in May 2010. According to reports, the lawsuit asserted that the federal government cannot compel people to buy a product and cannot require state officials to participate in enforcing a "federal scheme." The lawsuit was filed by Kinder and three other Missouri residents - Samantha Hill, Dale Morris and Julie Keathley. The suit was filed in U.S. District Court in Cape Girardeau. Kinder is reportedly raising private money for the lawsuit.

With United States President Barack Obama signing the passed federal health care bill into law, many states began preparing themselves to combat the health care mandates that are on the verge of taking place across the country. Some states have pending initiatives or legislative referrals for the statewide ballots, however, in other states attorney generals were joining in a national lawsuit.

Polls

See also: Polls, 2010 ballot measures

• In a July 19-21, 2010 poll conducted by Mason-Dixon Polling & Research (dead link) and commissioned by Post-Dispatch/KMOV-TV (Channel 4) a total of 300 likely Democratic primary voters and 300 likely Republican primary voters were polled on Proposition C. According to the results, 67% of Republicans said they planned to vote yes, 16% said no and 17% said they remained undecided. Of the 300 Democrats polled, 27% said yes, 48% said no and 25% said they were undecided. The margin of error was reported to be 6 percentage points. Additionally, according to reports, 61% of the total number of registered voters polled said they were opposed to the health care law passed by Congress in March 2010.

Date of Poll	Pollster	In favor (Repub.)	Opposed (Repub.)	Undecided (Repub.)	In favor (Dem.)	Opposed (Dem.)	Undecided (Dem.)
July 19-21, 2010	Mason-Dixon Polling	67%	16%	17%	27%	48%	25%

Path to the ballot

See also: Missouri legislatively referred state statutes

• In a March 3, 2010 preliminary vote, the House preapproved the measure, 113-40.

• On May 4, 2010 the Missouri State Senate voted 26-8 in favor of placing the proposed measure on the ballot.

• On May 11 the House gave final approval to refer the measure to the ballot following a 108-47 vote.

Similar measures in other states

Groups in Indiana, New Mexico, North Dakota and Wyoming are considering a similar proposal. Two of these states (North Dakota and Wyoming) allow ballot initiatives; in the other three states, the state legislature would have to vote it onto the ballot using their state's procedure for constitutional amendments.

The "Health Care Freedom" or "Health Care Choice" legislation introduced in many states since the passage of the Affordable Care Act are based on model legislation and campaigns from the American Legislative Exchange Council (ALEC). This think tank, promotes "limited government, free markets and federalism." In 2008, prior to the passage of health reform, ALEC adopted the model legislation which is mirrored by several state measures, including Missouri's August 2010 measure.

• Arizona Health Insurance Reform Amendment (2010)
• Oklahoma Health Care Freedom Amendment, State Question 756 (2010)

Indiana Health Care Freedom Act
Minnesota Health Care Freedom Act (2010)
New Mexico Health Care Freedom Act (2010)
North Dakota Health Care Freedom Act (2010)
Wyoming Health Care Freedom Act (2010)

See also

Suggest a link

• Missouri 2010 ballot measures
• 2010 ballot measures
• List of Missouri ballot measures
• History of Initiative & Referendum in Missouri

Articles

• Federal judge rules health care reform unconstitutional
• Missouri's voters approve Proposition C (updated)
• Voters head to polls in Missouri to weigh in on Prop C
• Missouri health care measure cleared for August vote, no appeal sought
• Judge to hear challenge to Missouri health care measure
• Lawsuit challenges Missouri health care measure
• Missouri House gives final approval, health care amendment to appear on ballot
• Missouri health care measure one step closer to state ballot
• Healthcare issue being fought by ballot measures

External links

• No on Prop C, Missouri Jobs with Justice (opposition)

Text and content

• HB 1764 summary
• HB 1764 full text

Additional reading

• San Francisco Chronicle, "States fight Obamacare," September 8, 2010
• FOX news, "Not a Way Around the Health Mandate, but Could Be a Way to a Public Option," September 7, 2010
• The Christian Science Monitor, "Missouri voters could rebel against Obama's health-care reform law," August 2, 2010
• Associated Press, "Mo. ballot measures tests federal health care law," July 29, 2010
• KCUR, "Challenge to Federal Health Mandate to Appear on August Ballot," July 27, 2010
• St. Louis Post-Dispatch, "Potential impact of health care measure unclear," July 23, 2010
• TPM, "Missouri Health Care Reform Foes Hope Ballot Initiative Will Start National Trend," July 21, 2010
• Politics Daily, "Missouri's Proposition C Vote: 'Health Care Freedom Act' Set to Test Obamacare," July 12, 2010
• Associated Press, "Backers get ready for vote on health care law," June 28, 2010
• The Hill, "Republicans put health reform on ballot in push to turn out conservatives," June 8, 2010
• Missourian, "A look at some of the bills passed in the Missouri General Assembly," May 14, 2010
• Insurance & Financial Advisor, "Mo. voters to get ‘ultimate voice’ on federal health reform though bill," May 12, 2010
• FOX 4, "Health Insurance Mandate To Appear On Missouri Ballot in August," May 12, 2010
• Los Angeles Times, "One nation, insured," November 16, 2009
• Missouri Voters to Have Say on Healthcare Law
• Despite Missouri, Nullification Efforts Failing Across the Country

Aftermath

• KRCG 13, "Should Missouri enforce Obama's health care law?" March 22, 2011
• The Atlantic Wire, "What Missouri Ballot Initiative Means for Health Care," August 4, 2010
• CNN Politics, "Republicans tout Missouri vote against health care law," August 4, 2010

Editorials

• Missourian, "COLUMN: Missouri's Proposition C vote yields wide range of political effect," August 18, 2010
• Columbia Daily Tribune, "Judicial Error: Approving a bogus ballot issue," July 20, 2010
• Columbia Daily Tribune, "Health reform referendum," May 26, 2010
• The Kansas City Star, "Healthcare ballot issue displays Missouri’s folly," May 20, 2010
• The Washington Times, "EDITORIAL: One million votes against Obamacare," May 12, 2010