JEFFERSON CITY, Mo. -- While some religious institutions are challenging part of President Obama's Affordable Healthcare Act in court, some states are going directly to the voters.
In Missouri, CBN News investigated the coming Election Day showdown.
Rob Schaaf is a family physician in St. Joseph, Mo. When he's not with patients, you might find him practicing at the state Capitol in Jefferson City, where he's a part-time politician.
"This isn't about whether we need a health insurance exchange at all. It's purely about who should decide," the Missouri state senator said.
Schaaf is behind Proposition E, a state ballot measure that puts the next critical step of the president's health care law directly to Missouri voters: the creation of health insurance exchanges.
Think of it as a Web-based shortcut to compare insurance plans, much like Expedia or Travelocity. The law requires each state to have one by January 2014.
"They won't do anything to increase competition among health care providers. There's already competition between health insurers," Schaaf said.
Sen. Schaaf believes the federal requirements of Obamacare could potentially penalize voters. But experts like University of Missouri law professor Philip Peters say that unless the states takes the lead residents may be hurt. Listen to their comments below.
Schaaf proposed the measure to stop Democratic Gov. Jay Nixon from creating an exchange by executive order, although the governor's office has said repeatedly he has no plans to do so.
If it passes, Proposition E would prevent a state-based exchange unless it is first approved by the legislature or voters.
This is not Missouri's first challenge to the Affordable Care Act.
In 2010, Republicans in the statehouse pushed through Proposition C, a ballot measure that allowed Missourians to voice their opposition to Obamacare. Voters approved it overwhelmingly, and many expect the same outcome with Proposition E.
"My guess is that it will pass by a fairly big number, and the narrative after it passes will be that Missourians once again made it clear that they don't like the Affordable Care Act," Tony Messenger, with the St. Louis Post-Dispatch, said.
The Dispatch wants Missourians to vote no because residents in any state without an exchange will have to use the one created by the federal government.
"If the state doesn't do its own, it loses out," Messenger said.
Schaaf said believes the state loses either way.
"If the state creates it, they have to pay for it," Schaaf told CBN News. "If the federal government creates it, the state doesn't have to pay for it. Let them pay for it."
Schaaf said believes if his measure prevails, it will guarantee power stays in the hands of the people.
St. Louis University law professor Sidney Watson is concerned the language of Prop E could make the state vulnerable to nuisance law suits. Click below for her comments.