While Democrats were struggling to enact a major health-care reform bill in Washington on Tuesday, the Missouri House moved in the opposite direction by approving a proposed constitutional amendment against a federal mandate for universal insurance.

The House's joint resolution, approved by a bipartisan vote of 109-46, says no law or rule will compel a person, employer or health-care provider "to participate in any health-care system." The provision is a reaction to Democrats' health-care reform bill in Washington.

A similar proposal could be taken up for Senate debate within the next two weeks, say backers. The goal is to put a proposed amendment on the ballot this fall. The ballot language might read this way: "Shall the Missouri Constitution be amended as follows: That government may neither penalize citizens for refusing to purchase private health insurance, nor infringe upon a citizen's right to offer or accept direct payment for lawful health care services. This section shall permit courts to enforce contracts volunatrily entered, and the General Assembly to regulate the health insurance industry."

Political stand or political theater?

Proponents will try to build momentum from Tuesday's vote during a rally today at the state capitol. Among those expected to attend is Annette Read of Chesterfield, founder of a 1,500-member group called I Heard the People Say. The group's website says the group needs to show Senate President Pro Tem Charlie Shields, R-Kansas City, that "we will not let one man stand in the way of standing up to the federal government regarding our health care."

The rally is expected to draw members from Read's group, along with people from the Tea Party, Show Me Patriots and Concerned Women for America, among others. 

"It's a collaborative effort," Read (right) says. "We have enough rules and regulations for the rest of our lives, and we don't want any more. That really is the bottom line. We just strongly disagree with potential federal health mandates coming down the pike."

Bob Quinn, executive director of the Missouri Association for Social Welfare, in Jefferson City, says he's disturbed by the "underlying notion that the state has some sort of constitutional enforceable right to place itself between the decisions of the elected federal Congress" and the public. "That notion was settled when Lee surrendered to Grant at Appomattox," he says.

Quinn (right) added that proponents have a point when they say that this is an "unusual situation where the federal government is going to mandate that individual citizens buy a product," health insurance. But he says the federal government also has a case for expanding health care and that Missouri would be the loser if it enacts the proposed amendment.

"It's going to cost us. We're just absolutely broke. We don't have money to keep lights on at the capitol. But we're going to be investing money defending all sorts of lawsuits" that would grow out of the proposed amendment.

Proponents note the bipartisan nature of Wednesday's vote. Democrats supporting it included Rep. Ron Casey, D-Crystal City. He says he voted for it because "unfunded federal mandates irk me. If you're going to mandate that we do it, then send us the money and let us do it." In addition, he says he's concerned that "we'll have to cut $500 million out of the state budget because we have to be fiscally responsible. I want to send a message to Washington that they need to get their financial house in order."

On the other hand, he says the resolution is "a lot to do about nothing. It doesn't affect anything Washington is going to do; it's just sending a message."

He laughed when asked whether his vote was really about his race for re-election this fall. He said, "I'd be lying to you" if he said no to the question. But he added that his position was consistent, in keeping with his views about unfunded mandates from the days he served as a commissioner in Jefferson County.

Rep. Jeanne Kirkson, D-Webster Groves, said if she had to sum up Tuesday's House action in two words, "I would call it political theater. We were all over the place in the debate about federalism and state's rights. One of the sad things is that the whole effect of federal health-care reform is to create a big enough financial pool to require people to purchase private insurance."

Without the pool, she says, insurers couldn't be required to cover pre-existing conditions.

"By saying we're not going to participate or make it optional defeats the whole purpose. If we're going to continue down the road of private health insurance, we have to have mandatory participation."

Bill goes to Senate

Sen. Joan Bray, D-University City, definitely thinks action on the joint resolutions is a waste of time.

"This is really a dumb thing to do. For one thing, Congress doesn't care what the General Assembly thinks. We should be talking about substantive matters that we can have an impact on."

In the Senate on Tuesday afternoon, lawmakers took up a Bray-inspired proposal for setting up a committee to look at efficiencies and economies of scale in all the various health-care plans in Missouri. The issue didn't come up for a vote. During the discussion, Bray (right) said she had forgotten to include the state's prison system on her list of agencies whose health systems should be reviewed with an eye toward saving money.

"It sort of hit me in the face that prisoners, people who broke the law, have a constitutional right to health care. I don't have a problem with prisoners having health care. What I do have a problem with is that (some of) the rest of us don't. I do believe every American should have health care and to put something in the constitution that limits the right to health care is absolutely shameful, wrongheaded and misguided."

Bray says the proposal will have a tougher time winning approval in the Senate. Sen. Scott Rupp, R-Wentzville, agrees, saying "you know the liberal Democratic senators will fight this and we'll do everything hat we can to break down that filibustering and get it passed. It is difficult, but it can be done."

Rupp says the House took the appropriate action, pointing to the 2,200 people who showed up in St. Charles County last Wednesday for a rally to oppose president's health-care proposal.

"Constituents would definitely like to see the health-care freedom proposal pass and definitely oppose what the federal government is trying to force through," Rupp (right) says. "What (the Democrats' proposal) is basically saying is that the federal government passes this thing and says you have to take this coverage, and this is what it has to look like, and you have to pay these fines and fees if you do not do it. We as Missourians are saying we have a solemn right not to be forced into these types of medical contracts."

Misconceptions about bill 

The chief backer of the proposed Freedom of Choice in Health Care Act in the Senate is Jane Cunningham, R-Chesterfield. She says opponents have mischaracterized what the proposal would do.

"We're getting people educated, but the misconceptions are still out there. They have called the bill an opt-out bill, in other words opting out of the federal mandate, opting out of the public option. That's absolutely false."

She says the bill "preserves and protects the rights that people have right now. What it does is expand their options, not limit them. If someone wanted to choose the public option, choose the health-care exchange, under my legislation, they are perfectly able to do that."

She adds that there would be no constitutional conflict because her bill contains the same language of a bill that will be placed on the ballot in Arizona this fall. According to Cunningham (right), Medicare and Medicaid officials have told Arizona that its proposal "would not impact any federal funds." She says that means no Missouri health programs, "no safety net programs or Medicaid would be impacted. So we're safe from that."

On March 5, Virginia enacted the health freedom legislation. Similar bills are pending in 33 states, including Missouri and excluding Illinois.