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Even before the president signed the health care legislation this spring, Arizonans were starting to mobilize behind greater individual choice in health care. Two years ago, a nearly identical initiative - Proposition 101 - lost by a nose despite an overwhelmingly Democratic tide.

“In 2008, in a bad year, we lost 50.2 percent to 49.8 percent,” said Dr. Eric Novack, the orthopedic surgeon leading Arizona’s health care choice movement. “Our opposition outspent us 5-to-1. [Gov. Janet] Napolitano was the unofficial spokeswoman for the other side, and we still almost won.”

Ms. Napolitano, a Democrat, now serves as homeland security secretary.

This year, Gov. Jan Brewer, a Republican, has thrown her support behind the measure, saying that a victory would send a message to Washington “that this type of overreaching by the federal government will no longer be tolerated.”

Even though foes of the measures insist the ballot challenges will never stand up in court, they’re still mounting opposition campaigns. The “No on 106” campaign in Arizona is running on the theme that “Proposition 106 endangers your health,” with campaign literature featuring skulls and crossbones.

The principal opponents include teachers and nurses unions, in addition to retirees and public health groups. They argue that the measures will hurt access to health care and will plunge the state into lengthy and expensive legal battles.

They are also redundant, said Dede de Percin, executive director of the Colorado Consumer Health Initiative. She said that the 20-state lawsuit filed by the attorneys general would accomplish the same ends as the ballot measures.

“Amendment 63 will cost taxpayers money by forcing them to pay for the lawsuits that are the goal of the proponents of Amendment 63,” said Ms. de Percin.

Proponents worry that if the lawsuit is successful the federal government may push for state measures based on the Massachusetts’ health care program, which requires state residents to have health insurance and is in many ways the model for Mr. Obama’s national plan.

“We’re taking a proactive measure to make sure that doesn’t happen,” said Mr. Caldara. “This will make health care choice a fundamental right in Colorado, which means Colorado won’t be able to enforce federal mandates. If the feds want to enforce their mandates, they’ll have to do it on their own.”