Voters in Missouri passed Proposition C Tuesday, a referendum attempting to nullify part of the federal health care reform law that will require most Americans to purchase health insurance or pay a tax penalty. The vote is largely seen as symbolic, according to NPR, because federal law trumps state law. The tax penalty Missourians voted against will not take affect until 2014. Federal courts are expected to weigh in on whether the health care overhaul is constitutional well before the penalty takes affect, according to NPR. According to the New York Times, the vote on the referendum may not reflect the sentiments of Missouri’s general population. Many voters turned out on Tuesday to participate in the Republican primary and also voted on the referendum, which fueled the highly conservative results on the measure. Residents in Arizona and Oklahoma are expected to vote on constitutional amendments similar to Missouri’s referendum this November, according to the New York Times.