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Quentin Young on the individual mandate, Missouri and more...

Health & Medicine Policy Research Group (HMPRG)
August 5, 2010

Quentin Young on the individual mandate, Missouri, and a rebuttal of the RNCC's MichaelSteele

Read the article on Medpage Today

MissouriVotes Against Healthcare Reform Mandate

By Joyce Frieden, News Editor, MedPageToday
Published: August 04, 2010

Missouri residents have voted for a measure exempting residents of the statefrom the "individual mandate" provision of the new healthcare reform law.

The mandate, part of the Patient Protection and Affordable Care Act signedby President Obama on March 23, requires all individuals to purchase healthinsurance or pay a penalty beginning in 2014.

The vote in Tuesday's statewide election was 71% to 29% in favor ofProposition C, which asked "Shall the Missouri Statutes be amended to:

  • Deny the government authority to penalize citizens for refusing to purchaseprivate health insurance or infringe upon the right to offer or accept directpayment for lawful healthcare services?
  • Modify laws regarding the liquidation of certain domestic insurancecompanies?"

The ballot went on to explain that "it is estimated this proposal will haveno immediate costs or savings to state or local governmental entities. However,because of the uncertain interaction of the proposal with implementation of thefederal Patient Protection and Affordable Care Act, future costs to stategovernmental entities are unknown."

Although the vote of 667,680 to 271,102 was considered a "landslide" by themeasure's supporters, only about 20% of registered voters weighed in on thequestion.

That's only slightly higher than the typical turnout in August specialelections, according to Missouri newspapers. Voters were also asked to decideprimary races for the Senate and the House of Representatives.

There is also a question about whether the Proposition C vote is enforceable,since federal law usually preempts state law.

Legal issues aside, Republican officials were elated by the victory.

"By rejecting ObamaCare with nearly three-quarters of the vote in a criticalswing state, Missouri sent a clear message to Democrats and the Obamaadministration that government-run healthcare is a gross over-reach of thefederal government that needs to be repealed and replaced," Republican NationalCommittee chairman Michael Steele said in a statement.

"Last night's decisive vote against a key provision of ObamaCare, arguablythe cornerstone of the Obama presidency, shows how completely detached theDemocrat agenda is from the American electorate," Steele said.

But other groups heard a different message.

"The vote in Missouri ... shows that people do not want to have their healthbenefits linked to penalties and fines, but would much prefer a rational systemof finance that covers everybody in a comprehensive way, as Medicare alreadydoes for persons over 65," Quentin Young, MD, national coordinator of Physiciansfor a National Health Program, which favors a single-payer system, said in ane-mail to MedPage Today.

"It's possible to oppose the newly enacted mandate to purchase private healthinsurance while retaining some of the desirable reforms embedded in thelegislation, [such as] no exclusions for preexisting conditions, no rescissions,and no lifetime caps on claims," Young wrote. "However, serious reform of ourdesperately troubled health system is contingent on the enactment ofsingle-payer, an improved Medicare for all."

Measures similar to Proposition C will be on the ballot in Arizona andOklahoma in November. A proposal scheduled to appear on Florida's ballot wasnixed by a circuit court judge in that state because a proposed ballot summarycontained misleading information.