Voters in Missouri have rejected a key part of President Barack Obama's healthcare overhaul.
On Tuesday, residents of the Show-Me-State voted 3-1 to pass Proposition C, a measure which blocks the government from forcing people to purchase health insurance.
"The citizens of the Show-Me State don't want Washington involved in their health care decisions," said Sen. Jane Cunningham, R-Chesterfield, one of the sponsors of the legislation that put Proposition C on the August ballot.
"It's a big number," state Sen. Jim Lembke, R-Lemay, said of the vote. "I expected a victory, but not of this magnitude. This is going to propel the issue and several other issues about the proper role of the federal government."
Earlier this year, President Obama signed a federal health law requiring most Americans to carry health insurance by 2014 or pay a fine.
Missouri is the first state to put the president's health care law to a vote. The move is considered largely symbolic because federal law generally trumps state law.
However, Tuesday's vote could signal trouble for Democrats in November's mid-term elections.
"It's like a domino, and Missouri is the first one to fall," Cunningham said. "Missouri's vote will greatly influence the debate in the other states."
Meanwhile, Virginia, one of 21 states to challenge the new healthcare law overturned, has just cleared its first legal hurdle.
On Monday, U.S. District Judge Henry Hudson rejected a request by the Justice Department to dismiss the case.
Hudson said the law "raises a host of complex constitutional issues" as well as questions over Congress' regulation powers, which "neither the U.S. Supreme Court nor any other federal appeals court has squarely addressed."
Later this year, voters in Oklahoma and Arizona will consider similar moves to head off the insurance law.
Meanwhile, polls continue to show strong opposition to the law, especially among Republicans.
GOP lawmakers hoping to gain control of the house this November have been promising to repeal the measure.
However, healthcare and legal experts believe the real challenge to the law will be settled in the courts.