In the next few days, the U.S. Supreme Court will rule on the constitutionality of the federal health care law. Even if the court upholds the law, one key component will be under fire here in Missouri come November. On the ballot will be a measure targeting the law's required online marketplaces, or health insurance exchanges, where individuals and small businesses can buy plans.
Missouri is one of fifteen states to have made no progress so far toward setting up a federally-mandated exchange.
If it's up to Missouri House Majority Leader Tim Jones, the state never will set one up.
"We know that the citizens of the state of Missouri do not want the federal health care law, the Obamacare law, or anything related to it."
Jones, a Republican, spoke on the final day of session last month in favor of Senate Bill 464. The bill prohibits the creation and operation of a health exchange in Missouri unless the legislature or voters approve it, and prohibits the governor from creating one through executive order. The bill passed during those final hours of session, and will now be up for a popular vote in November.
Senator Rob Schaaf, a Republican from St. Joseph, sponsored the measure.
"A health insurance exchange is a major policy decision and it should require the input of the legislature. I mean, that's my concern for filing this bill."
Schaaf said Governor Jay Nixon, a Democrat, previously went behind the legislature's back in trying to set up an exchange. His administration applied for and received a federal grant last year to start setting up the technical infrastructure for an exchange, including updating the state's old Medicaid computer system. The administration channeled the funds to a quasi-government body that wasn't subject to legislative oversight.
"I was inflamed and decided to offer up this bill," said Schaaf.
Schaaf said he wants to further ensure nothing happens without the legislature being on board. That's why included in his ballot measure is the ability for people to sue any state agency or worker involved in any exchange activity.
Some people worry about this.
"I have a concern that that bill hanging out there will have a chilling effect," said Andrea Routh, director of the consumer group, the Missouri Health Advocacy Alliance. Routh said the ballot measure itself, even before it's voted on, could cause Missouri to fall behind on preparing for an exchange in 2014. State workers might not do anything for fear of being sued, even though a lot has to happen for the exchange to be ready.
"It can really work well for families if we do it right, but doing it right takes planning, and time, and if we're waiting for the last minute, there is the potential it may not be that workable for people."
If the measure does pass in November, it could be declared unconstitutional. But even so, Ken Warren, a political scientist at St. Louis University, says having it on the November ballot is a gain for Republicans.
"They used opposition to Obamacare to win elections in 2010 and they will try to do the same in 2012."
So far, 15 states have established exchanges, two have opted not to, and the rest are somewhere in between. Under the Affordable Care Act, if a state does not set up an exchange, the federal government will do so.
But that's up in the air -- along with the rest of the health law, pending a Supreme Court ruling.
Answers on that will be coming very soon, as soon as tomorrow … or later next week.