LEE’S SUMMIT, Mo. – A health care initiative on the Nov. 6 statewide ballot is either a valid check on government authority or a legally questionable effort that could hamstring state workers and sock taxpayers with litigation costs.

Those were the widely divergent views expressed Tuesday by initiative supporter Mark Siettmann, a Republican staffer in the General Assembly, and opponent Andrea Routh, executive director of the Missouri Health Advocacy Alliance. About 40 people attended the debate sponsored by the Lee’s Summit Chamber of Commerce.

Known as Proposition E, the ballot initiative could restrict state and local officials from helping develop an online marketplace where individuals and small businesses could shop for health insurance. The exchange, federal officials say, would create a large pool of customers that private insurers would compete to cover at affordable prices.

“At the very least,” Siettmann said, “it’s good that we have on the ballot the right for Missourians to look at this issue directly.”

But if the initiative passes, supporters could find they shot themselves in the feet, Routh said, because it would mean a larger role for the federal government in setting the rules and managing the exchange.

“People who didn’t want the federal government telling them what to do,” she said, “are about to have the federal government telling them what to do.”

The exchange has become a Missouri flashpoint between supporters and opponents of the Affordable Care Act, commonly known as Obamacare. The health reform law calls for the establishment of state-based exchanges by Jan. 1, 2014.

In states that choose not to set up an exchange - as it appears Missouri might - the default option is one created and managed by the federal government.

Proposition E, which the General Assembly placed on the ballot, would prohibit public officials with some exceptions from assisting in establishment of an exchange.

The initiative would block Gov. Jay Nixon, a Democrat, from creating an exchange administratively, said Siettmann, chief of staff for state Sen. Will Kraus, a Lee’s Summit Republican.

“It is not partisan,” said Siettmann, who appeared as a private citizen, not as a representative of Kraus’ office. “It is just that this governor believes that his administrative powers are greater than the powers of the Legislature, and this is why this is on the ballot.”

Two key events helped fuel legislators’ support for the initiative, Siettmann said.

The first came in August 2010, when voters, more than three to one, approved another ballot initiative that sought to exempt Missouri residents from the Affordable Care Act’s requirement that most people who can afford health insurance must purchase it or pay a penalty. The health reform law included subsidies to help low- and moderate-income individuals buy coverage.

The second came in September 2011, when a group of Republican state senators halted a hearing on health insurance exchanges and rushed to stop a Department of Insurance panel from accepting $21 million in federal planning funds for an exchange.

Taken together, Siettmann said, the events demonstrated Missourians’ opposition to the Affordable Care Act’s mandates and the willingness of the Nixon administration to ignore that public sentiment in implementing the law.

But Routh said that the language of the proposition was so vague it likely would lead to legal challenges that would end up costing taxpayers.

One section, for instance, would prohibit public officials from “providing assistance or resources” related to establishment of a federally facilitated exchange unless required by state statute or federal law.

Routh said the wording of the proposition already has state employees wondering how far they can go in working with federal officials to implement an exchange, which means the state is missing out on an opportunity to tailor the exchange to the needs of Missouri residents.

“We are putting (state workers) in a really rough position,” she said. “But mostly, we are making it tough for our citizens to be well served by the federal exchange that is going to come down the pike.”

The Health Care Foundation of Greater Kansas City is proud to partner with the Kansas Health Institute news service to provide weekly health stories about health and policy issues impacting the greater Kansas City region. This News Service is an editorially independent program of the Kansas Health Institute and the Health Care Foundation of Greater Kansas City and is committed to objective coverage of health issues.