More than four months after pushing through President Obama's health care legislation, Democrats said Missouri voters who overwhelmingly rejected the new law still don't know enough about it.
"Once you explain what's in this bill, the American people, of course, like it," said Senate Majority Leader Harry Reid, Nevada Democrat.
But in the vote that energized the GOP, 71 percent of Missouri voters supported a proposition on Tuesday that states that no rule or law can compel a person or business to participate in any health care system and prohibits laws that level penalties against people who do not buy health care insurance.
Republicans say it exemplifies an electorate irate at a "blatant power grab" by Democrats and ready to punish its supporters at the ballot box this fall.
"Americans weren't kidding when they said they said they opposed this health care bill, and they're not going away," said Senate Minority Leader Mitch McConnell, Kentucky Republican. "This is just the beginning."
The referendum was helped by high Republican turnout on a day in which party primaries also were held. In Missouri's open primaries, voters do not have to register their party affiliation, and far more people picked Republican ballots than Democratic ones Tuesday.
Mr. Reid questioned against reading too much into Missouri's results, in part because the turnout was "really, really low." He added that the "trend is turning" and that the public soon will embrace the administration's health care reforms that he helped pass.
But some political analysts say that the Missouri measure's decisive margin of victory was impressive despite the high Republican turnout and indicates strong grass-roots distrust of the health care law.
"With the exception of some deep-blue [Democratic] states, I think [the Missouri measure] could pass pretty much anywhere in the country right now," said Michael D. Tanner of the Cato Institute, a libertarian Washington-based think tank.
''The polls all show that this bill has not gotten any more popular with age. This is still pretty much a mess."
Mr. Tanner estimated at least 40,000 Democratic voters also supported the referendum.
"And these are not just run-of-the-mill Democrats, these are the party base that turned out for a primary," he said. "If you lose about one out of every eight members of your base on an issue like this, it's pretty unpopular."
Republicans on Wednesday trumpeted the overwhelming rejection of the Obama administration's health care plan by Missouri voters, saying it will help propel the GOP in its quest to regain control of Congress.
The Missouri vote "shows how completely detached the Democrat agenda is from the American electorate, and is another reason why Republicans will win back the majority in November," said Republican National Committee Chairman Michael S. Steele.
The Missouri Hospital Association spent $400,000 warning people that passage of the ballot measure could increase hospitals' costs for treating the uninsured. But there was little opposition to the measure from either grass-roots organizations or from unions and consumer groups that backed the federal overhaul.
Health care reform backers said the Missouri referendum was less about health care and more about local politics in an election dominated by Republican primaries for U.S. Senate and House races, and others.
"The Missouri vote was nothing more than a Republican straw poll," said Ethan Rome, executive director of Health Care for America Now, a coalition of unions and liberal advocacy groups pushing for affordable health care. "If supporters of reform thought this referendum was about the new law, we would have run a campaign against it. But it wasn't, so we didn't."
But Rep. Roy Blunt, a Missouri Republican who is running for Senate, said the seeds of the referendum's success were sown well before health care reform became law, when Democrats refused to listen to public concerns over the initiative.
"The more the public looks at the law, the less they like it," Mr. Blunt said Wednesday while campaigning in Missouri.
Mr. Blunt predicted that national momentum to repeal the health care law will increase leading up to the 2012 presidential election.
"There are better answers out there for dealing with health care," he said. "It's not like the choice is do this or do nothing."
Arizona and Oklahoma will have similar constitutional amendments on their November ballots to opt out of all or part of the new federal health care reforms.
The president's health care reform took another hit Monday, when a federal judge refused to dismiss a legal challenge against the law by the state of Virginia.
About 20 other states also have challenged the law's constitutionality.
"Obamacare hasn't had a good week," Mr. Tanner said.
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