Did the Missouri AG approve the ballot summary for Winston Apple's 2019 statutory initiative creating a state-run health insurance cooperative through the Department of Health and Senior Services (file 2020-096)?
Plain-English summary
Petition 2020-096 was Winston Apple's statutory initiative to amend Chapter 192 RSMo (which governs the Department of Health and Senior Services). The petition would have created a new state-run health insurance cooperative, opt-in for Missouri residents, providing coverage for treatments and procedures the DHSS deemed medically necessary. Premiums (called "membership dues") and out-of-pocket maximums would be adjusted annually based on the participant's income.
This is a "public option" framework, narrower than full single-payer (because it is opt-in and runs alongside private insurance) but broader than expansion of existing safety-net programs (because eligibility is universal among Missouri residents, not means-tested). Comparable proposals have surfaced in Washington, Colorado, and Connecticut.
The original opinion letter was sent August 2, 2019. AG Schmitt re-issued it on August 5 to correct a typographical error; the re-issued letter (this one) supersedes the original. After the Secretary of State drafted the ballot summary, the AG reviewed it under § 116.334 RSMo and approved its legal content and form. The AG's review is narrow, a legal-form check on the ballot question, not an endorsement of the policy.
Currency note
This opinion was issued in 2019. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.
The exact ballot summary the AG approved
Do you want to amend Missouri law to create a state-run health insurance cooperative provided through the Department of Health and Senior Services, allowing Missouri citizens the choice to participate in the state-run health cooperative that only provides coverage for treatment and procedures deemed medically necessary by the Department of Health and Senior Services; and with membership dues (premiums) and out-of-pocket maximums to be adjusted annually based on a participant's income?
Common questions
Q: Is this single-payer health insurance?
A: No. Single-payer means one government insurer covers everyone and replaces private insurance. The Apple petition is opt-in (it adds a public choice without replacing the private market) and limited to "medically necessary" coverage as defined by DHSS, which is narrower than typical single-payer benefit packages.
Q: How would premiums work?
A: They would be income-scaled, recalculated each year. The summary calls them "membership dues" rather than premiums, which is the standard cooperative-insurance terminology. Same for out-of-pocket maximums.
Q: Why amend Chapter 192?
A: Chapter 192 sets up DHSS and its programs. Adding a new health-coverage program administered by DHSS belongs there. The petition does not change the Department of Insurance's authority over private insurance; it creates a parallel public option.
Q: What did the August 5 reissue change?
A: A typographical error in the original August 2 letter. The opinion does not specify the typo, but the re-issued letter supersedes the original and is the operative one.
Q: Did this petition reach the ballot?
A: The opinion does not say. Apple's 2019 petitions do not appear to have advanced to the 2020 ballot.
Q: Who can challenge the summary statement?
A: § 116.190 RSMo lets any registered voter challenge the official ballot summary as "insufficient or unfair" by filing suit in Cole County circuit court within ten days of certification.
Background and statutory framework
Chapter 116 RSMo lays out the initiative-petition pipeline:
- Proponent files the petition with the Secretary of State.
- AG reviews sufficiency as to form under § 116.332 RSMo.
- State Auditor prepares a fiscal note; AG reviews under § 116.175.4 RSMo.
- Secretary of State drafts a summary statement; AG reviews under § 116.334 RSMo (this opinion).
- Petition certified for circulation.
Citations and references
Statutes: § 116.334 RSMo (the operative provision); § 116.190 RSMo (judicial challenges); § 116.175 RSMo (fiscal-note pipeline); § 116.332 RSMo (sufficiency-as-to-form); Chapter 192 RSMo (Department of Health and Senior Services).
Source
- Landing page: https://ago.mo.gov/other-resources/ag-opinions/
- Original PDF: https://ago.mo.gov/wp-content/uploads/attachments/161-2019.pdf?sfvrsn=2
Original opinion text
ATTORNEY GENERAL OF MISSOURI
ERIC SCHMITT
August 5, 2019
OPINION LETTER NO. 161-2019 (revised)
The Honorable John R. Ashcroft
Missouri Secretary of State
James C. Kirkpatrick State Information Center
600 West Main Street
Jefferson City, MO 65101
Dear Secretary Ashcroft:
On August 2, 2019 we sent you a response to your request dated July 25, 2019, for our
review under § 116.334, RSMo, of a proposed summary statement prepared for the petition
submitted by Winston Apple regarding a proposed amendment to amend Chapter 192, Revised
Statutes of Missouri (2020-096). Due to a typographical error we are reissuing our response. This
response supersedes the previous opinion letter. The proposed summary statement is as follows:
Do you want to amend Missouri law to create a state-run health
insurance cooperative provided through the Department of Health
and Senior Services, allowing Missouri citizens the choice to
participate in the state-run health cooperative that only provides
coverage for treatment and procedures deemed medically necessary
by the Department of Health and Senior Services; and with
membership dues (premiums) and out-of-pocket maximums to be
adjusted annually based on a participant's income?
Pursuant to § 116.334, RSMo, we approve the legal content and form of the proposed
statement. Because our review of the statement is mandated by statute, no action that we take with
respect to such review should be construed as an endorsement of the petition, nor as the expression
of any view regarding the objectives of its proponents.
ERIC S. SCHMITT
Attorney General
Supreme Court Building
207 W. High Street
P.O. Box 899
Jefferson City, MO 65102
Phone: (573) 751-3321
Fax: (573) 751-0774
www.ago.mo.gov
OP-2019-0186