This is the seventh in the Prospect's series on the 174 measures on state ballots this year.
Ever since the Affordable Care Act (ACA) passed, Republicans have been desperate for ways to gut it. They hoped the Supreme Court might do the dirty work, but the Court ruled this summer that the law was constitutional. They hoped to pass new legislation, but as long as Democrats have the White House and the Senate, that's a non-starter. So instead, for the time being, they are turning to purely symbolic acts of defiance.
Four states have ballot measures on November 6 that, if passed, would directly conflict with the ACA. In Alabama, Florida, Montana, and Wyoming, voters can ostensibly decide to ban any and all mandates that residents get health insurance. But these "bans" would exist in name only. That's because the measures would violate Obamacare, which requires that the state's residents get health insurance or pay a fine (which the Supreme Court calls a tax). These measures will have no practical impact—Article VI of the Constitution makes federal laws the "supreme law of the land"—but that’s not the point. The idea is to show just how much people dislike the law.
Of course, the ACA has a lot more to it than simply mandating that everyone be insured. The legislation is all about reducing the costs of health-care coverage by extending it to more people. The plan is for states to expand their Medicaid coverage. Those who make too much for Medicaid can get subsidized policies, and private insurers must cover those with pre-existing conditions. Kids can stay on their parents' insurance longer. The lifetime limits that left so many without options are now gone as well. There’s a lot to like if you’ve ever had a health problem.
But because Obamacare has become a rallying cry for the right, symbolic ballot measures are a great way to reinforce existing misconceptions about the law. Twenty states have already passed some form of anti-ACA legislation, and four have passed ballot measures similar to the new batch. Colorado is the only state to have rejected such an effort. Interestingly, however, little of this is coming from the grass roots. Instead, all of this year’s measures originated in state legislatures, where conservative lawmakers have a vested interest in keeping voters angry about the "government takeover" of health care.
Perhaps because these measures don't actually do much, there's been little polling. Still, logic indicates they're likely to pass. The GOP has been extremely successful in casting the law as anti-freedom and just generally evil. Still, there have been plenty of voices in opposition. In Florida, the League of Women Voters has opposed the state's measure, and in Alabama, several folks, including the editorial board of the Decatur Daily, have pointed out the costs from inevitable (and likely fruitless) court cases the measure would produce, since the state can't actually overrule the federal government.
There's one other anti-ACA measure on the ballot next Tuesday—and it's not just symbolic, but ironic to boot. Missouri has already passed a ballot measure to prohibit mandated health insurance. That wasn't sufficient, apparently. So this year the Show-Me State ballot will give voters the opportunity to prevent officials from setting up health-insurance exchanges—the marketplaces Obamacare authorizes for helping consumers choose insurance plans. It seems like another excellent chance to stick it to government overreach—except that it actually will give those federal bureaucracies more discretion. Under the ACA, if states do not create the exchanges themselves, the duty falls to the federal government. The U.S. Department of Health and Human Services is already creating a one-size-fits-all exchange model for states that don’t create their own. So if Missourians pass the measure, they'll likely be turning over state discretion to the federal government—giving it more power rather than less.
The single oddest thing about the anti-Obamacare measures is that none of them addresses the one aspect of the ACA that states do control: whether or not to expand Medicaid to cover more people. While the Supreme Court ruled that the feds do not have the power to force states to expand their Medicaid coverage, the feds will pay almost the entire cost for those states that choose to do so. Such an expansion would decrease costs for everyone by allowing more people to choose regular medical care over emergency-room vists. Mounting a ballot-measure campaign to deny such expanded coverage and refuse the savings that come with it might come across as a tad unfeeling.
But at least it would be honest.