Missouri residents voted Tuesday to reject health insurance purchase mandates.

A health insurance purchase mandate ballot measure, Proposition C, won with 71% of the vote statewide.

Proposition supporters say it will change Missouri laws to “deny the government authority to penalize citizens for refusing to purchase private health insurance.”

The proposition also will keep the government from infringing “upon the right to offer or accept direct payment for lawful health care services,” supporters say.

Another section of the proposition sets rules regulators can use to liquidate an insurer and rules for a process an insurer can use to voluntarily liquidate itself.

Missouri held state and federal primaries Tuesday; turnout averaged about 23%, officials say.

Although Proposition C did well in rural areas and small towns in Missouri, it did poorly in the big cities.

In Kansas City, Mo., about 56% of the voters opposed the proposition. In St. Louis, 59% opposed it.

It is not clear what effect the proposition will have on implementation of the federal Patient Protection and Affordable Care Act (PPACA) in Missouri.

Health insurers asked lawmakers to include a health coverage ownership requirement in any health system change law, arguing that they could offer coverage on a guaranteed-issue, mostly community-rated basis only if young, healthy people paid for coverage.

Young, healthy people now have little incentive to pay for coverage, because they know hospitals will provide emergency care without asking for cash up front, requirement supporters say.

Requirement opponents say making Americans’ pay for a product from a private company violates consumers’ constitutional rights.