Citizens in three states cast their votes on anti-Affordable Care Act (ACA) ballot initiatives on Tuesday. All of the ballot measures presented citizens with an up or down vote on whether the state constitution should be amended to allow its citizens to legally opt out of the law’s requirement to hold health insurance. Many assumed these measures would pass with ease in an anti-establishment atmosphere, but Colorado proved the pundits wrong by defeating its ballot question, Proposition 63 — a noteworthy achievement for advocates. Arizona, the first state to propose an anti-ACA measure, voted 55 percent in favor of the amendment; in Oklahoma there was a two to one margin of support for the measure. It is important to note that this was a largely symbolic vote on health reform — similar to that in Missouri where the measure appeared on the primary ballot and passed.

These votes are symbolic because first, the individual mandate, or requirement to purchase health insurance, does not go into effect until 2014; second, the real action is in the courtroom. The ballot measures are all various incarnations of a template developed by the American Legislative Exchange Council (ALEC), a non-profit conservative DC-based group. ALEC is particularly astute at lobbying conservative state legislators to adopt ALEC ballot language, advancing their own legislative agenda. The gist of these measures is that no one is required to have health insurance or pay a penalty.

Second, the issue of the individual mandate is already moving through the court system, driven by a group of mostly (save one) Republican attorneys general who promote the idea that requiring Americans to have health insurance is unconstitutional. The AG-led court case is the Goliath in this story relative to the state amendments; court hearings will be underway as soon as mid-December. It is expected that this lawsuit will continue to roll along toward the Supreme Court where it will ultimately be decided.

That being said, the passage of these ballot initiatives is reflective of popular unrest, frustration, and a general misunderstanding of the health reform law and its implications. Advocates should continue their good work in advancing the benefits of health reform and dissolving fears about its implementation. The bright spot in all the power shifting that occurred overnight is that the 2010 midterm election, in general, was really about “the economy, stupid.”

— Eva Marie Stahl, Policy Consultant