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Last Friday Tony Messenger of the St. Louis Post-Dispatch observed that one of the reasons that Proposition C, the Missouri tenthers’ effort to sabotage the health care reform bill, is likely to pass is that there is no organized opposition. But on the other side Proposition C proponents are getting their act together. Organizations like Missourians for Health Care Freedom are mobilizing for the final push. A grim situation all around.

So you can imagine my surprise today when I received a big, glossy mailer from the Missouri Hospital Association (MHA) asking folks who might be inclined to vote for Prop C to get their facts straight. The particular fact that the MHA chose to emphasize in the mailer ought to have some resonance with those greedy and fearful little hobgoblins on the right who are so afraid that a poor person (or, horror of horrors, a poor black person) might get some of their hard-earned dollars:

But by law, Missouri’s hospitals must provide medical care in their emergency departments to anyone who is uninsured – even if they can afford health insurance. Hospitals must cover the cost of that care by charging more to patients who do have insurance.

So the question is: Should Missourians who already pay for health insurance also have to pay for those who choose not to pay?

If you think it’s acceptable that some who can afford insurance get a free ride, vote yes on Proposition C. If you think that’s unfair, you should vote no


There’s more on the MHA Website, a factsheet and a statement from the MHA President and CEO, Herb B. Kuhn, explaining why the MHA has decided to join the fight against Proposition C in such a prominent way:

The MHA Board of Trustees endorsed a voter education campaign on Proposition C because, regardless of the feelings about federal reform, Proposition C could have very real – and negative – implications for  hospitals

Negative implications like upsetting the balance of Medicare and Medicaid payments – according to Kuhn, Missouri hospitals would stand to lose somewhere in the vicinity of 500 million dollars over ten years if the individual mandate were to be revoked.  He adds:

Much will be said during the next few weeks about the individual mandate and the notion of “individual freedom.” That is a powerful and persuasive argument. There is, however, another side of the story, and that’s the notion of “fairness.” Fairness to make sure Missouri’s hard-earned Medicare and Medicaid dollars stay in the state and fairness in sharing in the cost of health coverage for all.


Many argue that since Proposition C is patently unconstitutional – it clearly conflicts with the Supremacy Clause – it can be safely ignored. Don’t think, though, that a constitutional showdown will be quick, inexpensive or pretty. If the proposition were ever allowed to go into effect, Mr. Kuhn’s statement is potent testimony to some of the potentially disastrous financial impacts. At the very least, a Proposition C victory will be used as a rallying cry to revitalize the war on the President and his health care agenda.  In this environment, the MHA’s willingness to stand on the frontline and oppose this piece of pernicious political theater with a dose of reality is more than welcome and they deserve our appreciation.