A majority of those polled in Missouri are in favor of a measure that would deny the federal government the authority to punish citizens for refusing to purchase private health insurance. Seventy-one percent were in favor of the measure.

This is the first such voting referendum in the country, and many commentators have suggested that the vote reflects a nationwide rejection of the Affordable Care Act, which is implementing health care reform measures. The referendum is one of many challenges to the Affordable Care Act and the minimum coverage provision, which mandates that in 2014 all Americans must purchase or obtain health care coverage or face a penalty. Several state legislators have introduced bills similar to the referendum, to prohibit citizens from being compelled to participate in a health care system. Some states attorneys general have filed challenges to the law. Most recently, Virginia's lawsuit was given the go-ahead to proceed.

The effect of the law is likely to be more about public opinion and political grist for upcoming elections than actually preventing the implementation of the Affordable Care Act. Federal law generally preempts state law, but the Obama administration might face some difficulty in maintaining public support.

Stewart Jay, professor of law and the William L. Dwyer Chair in Law at the University of Washington School of Law in Seattle, WA, told DOTmed via email,
"The vote is irrelevant to the constitutionality of the individual mandate in the health care act. If the federal law is upheld, I believe it will be, then under the Supremacy Clause of the Constitution states cannot refuse to abide by its terms. Individuals also cannot refuse to obey a federal law that is otherwise constitutional merely because they disagree with it. The vote, in other words, is purely a political act and has no legal significance."

Polls on health reform from the Kaiser Family Foundation have consistently found that the country continues to be divided on health reform law in general, but support for many individual elements of the law remain strong--such as bipartisan support for the health insurance exchanges. The individual mandate has been the least popular measure, according to Kaiser's surveys.

According to Kaiser's latest tracking poll, unfavorable opinions of the health reform law have decreased. One particular issue raised by the poll is concerning seniors' knowledge of the specific provisions in the law affecting them. Around half the seniors polled were aware of provisions such as addressing the Medicare Part D doughnut hole, but only a third were aware that the Affordable Care Act will provide Medicare co-pays and deductibles for certain preventive services. In addition, half of the seniors were under the false impression that the act has provisions that will cut some universal Medicare benefits, and a little over a third have a false impression that the Act will create so-called "death panels" making end-of-life decisions for those on Medicare.

The Kaiser polls can be found here and here.

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