The federal health-care law may not seem to have much to do with a statewide office with the responsibility for running elections and registering businesses.

But the Affordable Care Act has emerged as a bludgeon for state Sens. Scott Rupp, R-Wentzville, and Bill Stouffer, R-Napton, against House Speaker Pro Tem Shane Schoeller, R-Willard. It's also becoming a regular bogeyman in Republican primaries for other statewide offices.

In the case of the secretary of state’s contest, both state senators released ads this week accusing Schoeller of supporting President Barack Obama’s signature domestic achievement. Rupp’s ad, for instance, accused Schoeller of voting to “implement Obamacare in Missouri, the largest job-killing tax increase in American history.”

Stouffer’s spot went even further, claiming that Schoeller “cut a deal and voted for Obamacare.”

“That’s right, Shane Schoeller voted to implement Obamacare, helping Obama take over our health-care system,” Stouffer’s ad stated. “Shame on Shane Schoeller. You can’t trust him.”

What both senators are referring to legislation debated in 2011 to organize health-insurance exchanges in Missouri. Some Republicans – such as the bill’s sponsor, Rep. Chris Molendorp, R-Belton – argued that it made more sense for the state, and not the federal government, to set up the exchange.

Molendorp’s bill ended up passing in the Missouri House 157-0 but stalled in the Missouri Senate. Sen. Jane Cunningham, a Chesterfield Republican who endorsed Schoeller, said the bill contradicted a ballot initiative passed in 2010 to prevent the implementation of the federal health-care law in Missouri.

(For his part, Schoeller told an audience in Joplin Wednesday that “the vote was his only option at the time to prevent federal intervention and noted that Rupp gave his nod to the legislation while it was in his Senate committee.” He also noted that Rupp allowed the bill out of a committee he chaired.)

(Start of update) On Friday, Schoeller's campaign tried to counter the attacks by featuring Cunningham in a robocall in which she noted her role in the fight against the Affordable Care Act. She told listeners that Schoeller was the true conservative who "will stop Robin Carnahan'' from seeking to implement it.

Cunningham was apparently referring to a ballot summary that Carnahan's office wrote for a November ballot proposal to block any action to create a health insurance exchange without approval by the General Assembly or a statewide vote. Conservatives are challenging the summary, which they say was biased and intended to persuade voters to reject the ballot proposal. (End update)

Almost every single member of the House Republican Caucus, by the ad's logic, is complicit in implementing the federal health-care law. That runs the gamut from House Majority Leader Tim Jones, R-Eureka, and House Speaker Steve Tilley, R-Perryville to Rep. Paul Curtman, a Pacific Republican with strong ties to the Tea Party. 

Health care has also become an issue in the lieutenant governor's race. The two main GOP competitors – Lt. Gov. Peter Kinder and state Sen. Brad Lager, R-Savannah – have questioned each other’s credentials in opposing the law.

Kinder, for instance, has accused Lager of being insincere in his opposition to the ACA because he works for Cerner, a North Kansas City company that’s benefited from  Obama’s policies. Lager chastised Kinder for not supporting his call for a special session to opt out of expanding Medicaid.

And both candidates for attorney general – St. Louis attorney Ed Martin and Livingston County Prosecutor Adam Warren – have made opposition to the law a major element of their campaigns.

The GOP candidates argue that Attorney General Chris Koster didn’t do enough to oppose the law, even though the Democratic statewide officeholder filed an amicus brief arguing that the individual mandate was unconstitutional.

Carving out conservative credentials

So why has health care become such a huge issue in these races?

George Connor, a political science professor at Missouri State University, isn't surprised by the development. Connor predicted offhand to the Beacon a few weeks ago that even Republicans angling for presiding commissioner would be railing against the federal health-care law.

Winning a Republican primary requires someone “to be the most conservative candidate,” said Connor. With the U.S. Supreme Court decision coming during Missouri's primary campaign, he said, it’s not surprising that opposition to the law is a litmus test of conservative credentials.

“You can’t be middle of the road on these issues; you have to out-conservative the next guy,” said Connor, noting that former Gov. Matt Blunt attempted to be opposed to abortion and friendly to business with his support of embryonic stem cell research. “Obamacare is just the issue du jour to do that. If this would have been the same year that we voted on stem cell research, then that would have been the issue du jour.”

(In contrast, in Democratic primaries, Connor said, candidates may “run to the left.” For instance, a recent television ad from U.S. Rep. Lacy Clay’s campaign stressed the health-care law as a point of pride.)

Connor finds the Republican assault on the law interesting. While the ACA “might be portrayed as socialism," said Connor, "a good chunk of what has become Obamacare percolated out of the Republican Party, not the Democratic Party.”

Republicans now are trying to distance themselves from it, he added, even though the federal government may simply establish exchanges if the legislature doesn’t act.

Campaign Trail, a weekly column, weaves together some of the intriguing threads from the world of Missouri politics. Beacon political reporter Jo Mannies contributed information to this article.