Most ballot initiatives have little resonance outside the states that consider them. That’s not so with the upcoming vote in Ohio. Ohio’s November vote on the Health Care Freedom Amendment (Issue 3) will have national implications, and could play a role in determining the future of our nation’s health-care system.

The Ohio Health Care Freedom Amendment preserves the freedom of Ohio citizens to choose their health care and health insurance. It makes clear that no government has the right to force free people to buy a government-approved health-care package from a government-approved insurance company.

In this, it’s following in the footsteps of efforts made in numerous other states, from Idaho to Missouri to Georgia, that have adopted measures to reject aspects of the new Obamacare law and reclaim some basic freedoms for citizens from an overreaching federal government.

Ohio’s ballot initiative, however, will be particularly significant because of its timing. Earlier this month, both the plaintiffs and the Department of Justice filed petitions for certiorari, asking for an ultimate review by the Supreme Court of HHS v. Florida. In all likelihood, the Supreme Court will review the case in January or February 2012, with a decision coming by June. That means the vote in Ohio will be the last expression of popular will on the question of Obamacare before the Supreme Court hears and rules on the health-care law’s constitutionality.

Obviously, the Ohio vote does not change whether the law known as Obamacare is unconstitutional. It has no impact on whether the Commerce Clause really gives the federal government the authority to compel citizens to purchase a good from a private company. However, we know that Supreme Court justices are human beings and cannot help but be influenced by the political environment that surrounds them. It can only help the cause of striking down the law to remind the justices that Obamacare is deeply opposed by the American people, as well as fundamentally unconstitutional.

Poll after poll has shown that, indeed, a majority of Americans want the law reversed. This might lead many to assume that the vote on Issue 3 in Ohio is a sure thing. However, unfortunately, the outcome on Issue 3 is very much undecided, as polling also shows that most Ohioans are unaware that this amendment is on the ballot.

Complicating this further is a lopsided likely turnout. Issue 2 is a referendum on Gov. John Kasich’s union-reform bill. Unions have vowed to prevail on Issue 2 — this is a survival issue for them — and are throwing millions of dollars into get-out-the-vote efforts. The union supporters who turn out to vote on Issue 2 are likely to disproportionately side with liberals on government-controlled medicine, and so will give the opposition to Issue 3 a big advantage.

Savvy observers may understand that a loss on Issue 3 is a reflection of the particular circumstances in Ohio this November, and not at all reflective of Obamacare’s support. However, that won’t stop the Left from trumpeting a loss on Issue 3 as proof that the American people have become used to Obamacare, that overturning it in toto is no longer warranted, and that even if a portion of it is ruled against, severability should apply.

Little effort has been made to raise awareness of this important referendum in Ohio (something that Independent Women’s Voice is working to change, while being sensitive to the importance of Issue 2 as well). It’s vital that voters in Ohio, as well as concerned citizens everywhere, understand the stakes of the contest in Ohio, and work to send a message that will reverberate beyond the state into Washington and the Supreme Court.

— Heather Higgins is president and CEO of Independent Women’s Voice; Dr. Eric Novack is an orthopedic surgeon and chairman of the US Health Freedom Coalition.