In August 2010 when Missouri voters passed by a nearly 3-1 margin Proposition "C" to reject the must-buy insurance aspect of the nation's Affordable Care Act, they came down on the wrong side of Thursday's ruling by the U.S. Supreme Court.
The 5-4 decision with the court's Chief Justice John Roberts writing the opinion, found the requirement to carry health insurance to be Constitutional, describing it as a tax.
But in legal circles, the notion is federal healthcare reforms trump Missouri's Prop "C" opposition to ACA.
"Residents in Missouri will be required to buy health care insurance, even though voters passed Prop C in August (2010), according to Elizabeth Price Foley, a law professor at Florida International University quoted on ballotpedia.
"Prop C is unenforceable as a legal matter, if the federal courts rule that health reform is constitutional," Foley said—which the high court did, Thursday.
Some have likened the federal mandate to the requirement for car insurance.
Others, including the majority of Missouri voters in the 2010 approval of Prop "C" believe the requirement is infringement on personal choice.
State Sen. Jane Cunningham, R-Chesterfield, was one of the sponsors of the legislation to reject the federal mandate, and get Prop "C" on the ballot.
"The citizens of the Show-Me State don't want Washington involved in their health care decisions," Cunningham said at the time, according to ballotpedia.
However, the healthcare law provides subsidies in the form of tax breaks to help qualifying individuals with the cost of insurance. There is a monetary penalty for not carrying health insurance.
Under the federal health insurance law, states are also required to facilitate the creation of pools, or exchanges, that people can join to find an affordable policy.
Louisiana Gov. Bobby Jindal said Friday he refused to set up the exchanges in the state.
Another aspect of the heath insurance reforms include the option to keep young adults on a parent's health insurance policy through age 26.
Cunningham has since been essentially re-districted out of the state legislature, based on the 2010 U.S. Census results, and did not file for re-election in 2012.
Missouri was the first of four states to reject the federal passage of affordable healthcare.