Missouri could become first state to challenge new health care law

Voters will choose whether to nullify a provision of the law with Proposition C on the ballot Tuesday.

With their vote on Proposition C tomorrow, Missouri voters will decide whether the state will become the first to challenge the federal health care overhaul through a ballot measure.

After a trial debating the constitutionality of including a health care measure on the primary ballot, Cole County Circuit Judge Paul Wilson upheld the inclusion of the measure in July. Earlier this year, Missouri legislature passed the Health Care Freedom Act, which created Proposition C and gives voters the opportunity to oppose a portion of the new federal health care law, the requirement that most people obtain insurance or pay a tax penalty.

Missouri will be the first state to hold a referendum concerning the federal health care bill. If passed, Proposition C could exempt Missouri residents from the federal requirement to own health insurance by 2014, but, because the proposition would directly conflict with the federal law, it could be challenged in court as a violation of the U.S. Constitution's supremacy clause.

State Sen. Jane Cunningham, R-Chesterfield, sponsored the Health Care Freedom Act and expects the ballot measure to pass. She said the federal health care measure violates the U.S. Constitution.

“Never before in our nation has the government told Americans just because they reside in this country they will have to buy a product with their own money against their will,” Cunningham said. “I think it is unconstitutional.”

Several states’ attorneys general have filed lawsuits opposing that provision of the federal bill. Missouri is not among them, but Lt. Gov. Peter Kinder filed a similar lawsuit as a private citizen on July 7.

“This lawsuit challenges those provisions of the federal health care law which actually reduce Missourians’ access to affordable health care and which violate our United States and Missouri state constitutions,” Kinder said in a statement when he filed the suit.

Missouri Attorney General Chris Koster has requested the court either dismiss or clarify parts of Kinder’s lawsuit, claiming he appears to be violating state law by suing on behalf of the state, a duty state law permits only to the attorney general.

Under the federal health care bill passed in March, parents are able to claim their children up to age 26 as dependants on their health insurance policy. Although the requirement will not officially take place until the fall, about 66 percent of licensed health insurance companies, including MU’s student health insurance provider Aetna, have already begun allowing adult children to remain on their parents’ policies, according to the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP).

DIFP spokesman Travis Ford said the age 26 provision was created with college students in mind, because many graduate and take first jobs that do not offer health insurance. He said the provision will not be affected if Prop C passes.

“Of the uninsured in the United States, the largest portion is young adults,” Ford said. “The intent was to try and get these young adults covered.”

MU does not require students to have health insurance, but the university offers the Student Accident and Sickness Insurance Plan for about $2,000 per year through Aetna Student Health. This voluntary option covers treatments at facilities other than the Student Health Center and is in addition to the pre-paid student health fee.

Graduate students may be eligible for a subsidy from the Graduate School if they meet certain criteria such as holding an assistantship or fellowship, said Karen Gruen, coordinator of the Graduate Medical Insurance Subsidy Program. All international students are required to be insured.

Aetna Student Health spokesman Ethan Slavin said students do not to be very worried about losing their health insurance, even if Prop C passes.

“At this point, there are still many areas of the health care reform legislation that are still being finalized and addressed, including how the legislation will impact student health plans,” Slavin said.

If Proposition C were to fail, the free MU medical student-run venture MedZou Community Health Clinic would have to re-evaluate its services. The clinic currently serves only patients who are uninsured or are waiting for insurance coverage to begin.

According to the U.S. Government Accountability Office, more than 4.5 million college students nationwide are uninsured. MedZou Community Outreach director Alicia Ludden said because the federal bill is not slated to go into full effect until 2014, the clinic is not yet fully aware of what lies in the future.

“Actually we haven't seen many changes yet because the bill doesn't fully go into effect until 2014,” Ludden said. “Hopefully, when the bill does go into effect there should be less of a need for MedZou. However, my sense is that there will always be a need for free clinics. For example, homeless individuals have very limited access to health care and almost never have health insurance. MedZou could serve this population.”

Conversely, Cunningham believes the federal bill will force more people to be uninsured, leading them to health options such as MedZou.

“Health insurance mandates from the federal government are forcing businesses to do the opposite of the federally expressed goals of universal coverage,” Cunningham said. “My expectation is that the increased premiums will result in more uninsured citizens - the opposite of what the Obama administration hopes will happen.”

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