Last August I visited the college town of Columbia, Missouri, and did man-on-the street interviews with small business owners, college students, and people getting care at a community clinic. I went back to Columbia last week and visited the same shops, the same clinic, and talked to people walking Columbia’s streets. We talked about health reform. What I found corroborates anecdotally what the polls are finding scientifically: that people don’t like reform; believe much of the misinformation that they’ve heard; don’t see how it will help them; and have a bad feeling about what will happen to their benefits. Many had not even heard of the reform law. Yet many I interviewed, even if they didn’t support the law, did not vote for the state to opt out of the federal law. This is the first of two posts that takes the pulse of Missourians.
Some people I chatted with had followed health reform closely during the presidential campaign and the debate leading to the law’s passage in March, and they were unhappy with what Congress brought forth. “I was disappointed insurance companies had so much to say about it. It was pretty much made according to what they could live with,” said Vicki Smith, a fiber artist who works part time at Bluestem, a gift shop featuring high quality crafts by Missouri artists. “I have strong feelings for a universal system, and this reform is pretty short from what I would have liked. I suppose it’s small step,” she told me. I talked to Smith last year. Then, she said then that she had no idea how reform would affect her. She still doesn’t. She has no health insurance—the cost problem, she explained. Because she has just turned sixty, she says “a lot of it isn’t going to affect me.” We talked about Medicare, though, and its problems down the road. “I don’t know enough to be worried,” Smith said.
When we talked last year, Smith didn’t know much about the individual mandate that will require her to buy insurance in four years, one year before she becomes eligible for Medicare. Smith has now heard of the mandate and doesn’t like it, but she did not vote in the referendum for the state to opt out of it. “I didn’t want to vote against the small reform we got. It just makes Missouri look stupid again,” she said.
Sonya Nicholson is also a part-timer at Bluestem, and sells her origami creations through the Internet. She is now fifty and hasn’t had health insurance in eighteen years, since when her husband was a teacher. He now sells rifles and works part time as a realtor. The family income is pretty middling. “I pay cash or don’t get sick,” she told me. How will health reform affect her? “It will make insurance more affordable for me and will require me to have health insurance in some form,” she said.
But will it be affordable? Nicholson wasn’t sure, and raised an important point overlooked in the exuberance of passing the reform law. The family still may not be able to afford coverage even with the government subsidies, which favor people with very low incomes. Those with average incomes may well find the subsidies too low to buy the coverage they are required to have. “We’re the people caught in the middle—not poor enough to get lots of help and not wealthy enough to buy coverage.”
Charles Paxton, age fifty-six, had also followed the debate. “When they started it, I was for the law,” he told me. “By the time they got it done, I thought it was not a good idea.” Why, I asked? Paxton, who is the supervisor of landscape services at the University of Missouri, said it fell short of what it should have been. What they passed was too complicated, he thought: “It is so complicated I’m not sure people at the university who study these things know what’s in it.”