In a largely symbolic vote that will no doubt be challenged in court, primary voters who went to the polls in Missouri last week overwhelmingly approved a proposition blocking a new federal law requiring uninsured individuals to purchase health insurance.

Despite the Missouri voters’ rejection of a key element of the nation’s health care overhaul, most state legislatures are working to implement the federal health reform law, according to the nonpartisan political organization Progressive States Network.

Calling the referendum in Missouri an “anti-mandate” vote, Nathan Newman, executive director of Progressive States Network, said last week that low turnout and a high number of Republican primary voters explained the defeat of the so-called Obamacare plan in the Show-Me state. Nationally, Republicans seized on the vote as proof that Americans want the federal health care law overturned.

While some state attorneys general have challenged the insurance mandate as unconstitutional, Connecticut Attorney General Richard Blumenthal in June denied a request from 12 Republican state senators to join a multi-state lawsuit challenging the federal health care law.

“Many states, including conservative states, have declined to oppose the federal law,” Newman said, adding that the group will file an amicus brief in support of the federal government in a lawsuit being brought by Virginia’s Attorney General to nullify the health care law.

In June, Connecticut became the first state to permanently add low-income adults to its Medicaid program under the new federal law. The law permits states to receive federal funding for providing Medicaid coverage to adults. According to Blumenthal, Gov. M. Jodi Rell’s decision to apply for federal funding to transfer low-income adults from the state rolls to the federally funded Medicaid program played a central role in his refusal to join a lawsuit against the federal law.

“While right wing attorneys general claim to have the support of the public in their efforts to nullify the reforms enacted under the health care law, the evidence in recent polls is clear: people overwhelmingly support the provisions of the law and oppose efforts to repeal things like the ban on denial of coverage for pre-existing conditions, tax credits for small businesses, the closing of the Medicare donut hole, and the addition of children up to age 26 to their parent’s health care policies,” said Newman.

Defying attempts by conservatives to nullify the new federal health care overhaul, 26 states have failed to pass anti-health care bills amid growing support for the new health care law from legislators in states across the nation.

“We’re turning away from legislation toward implementation of health care reform,” said Iowa State Sen. Jack Hatch, who chairs the White House Working Group of State Legislators for Health Reform. “We’re coordinating with advocacy groups around the country and challenging the right-wing attacks.”

“Although there has been a lot of rhetoric by Gov. Rick Perry and the Attorney General, now the law has passed we need to move the politics aside,” said Texas State Rep. Garnet Coleman, noting that Texans reject the idea of “kicking people off the rolls” when they have a serious illness like cancer. “Texas has six million uninsured people, the most uninsured children and the most underinsured in the nation. Without this law there would be no reform.”

Health and Human Services Secretary Kathleen Sebelius acknowledges that many people are confused about the new law, which provides subsidies for lower-income Americans to obtain coverage through Medicaid or health insurance exchanges. “The notion that somehow people, even if they can’t afford coverage, are going to have to buy coverage, that’s just not accurate.”

Although states will be required to provide Medicaid coverage to all low-income adults starting in 2014, the federal government will reimburse 60 percent of the cost of care for individuals enrolled right away. The transfer of 45,000 individuals from the State Administered General Assistance program (SAGA) to Medicaid is expected to save Connecticut $53 million over the next 15 months. Rell has also agreed to administer a federally funded high-risk insurance pool for individuals with pre-existing medical conditions.

Beyond extending health care coverage to the uninsured, cost-cutting measures in the newly enacted federal legislation are projected to improve the fiscal outlook for Medicare, ensuring that its trust fund will remain solvent until 2029.