He said it sounded like the new law would require him to subsidize those who had no insurance. Obama, he said, “did not do a very good job of explaining how all this gets paid for.” But, he added, “too much detail would have meant no bill at all.” Still, he did not vote for the state to opt out of the federal law. The state doesn’t have the right to do that, he explained. “If they want to change the law, they’ll have to go back to Congress. It’s like when they passed civil rights.”

Another university employee, assistant professor Robert Smale, knows his benefits will be reduced as a result of health reform. The university has already told him that through an e-mail sent to employees. Smale, whose speciality is Latin American history, told me that Mizzou offered one of those Cadillac plans that Congress has mandated out of existence in a few years, in an effort to keep workers who have them from going to the doctor too often. A cost-control measure for the country, the pols told us. Smale, who is thirty-seven, said that the e-mail noted that our level of benefits is too high. “Our insurance is too good, according to health care reform.”

Does that make you made? I asked. “Yes,” Smale said. “My belief is that health care is a right and that there should be basic protection offered by the government. You get up in the morning; you feel sick, you go to the doctor; you get seen quickly and you don’t pay a dime.” He was also angry at the unions for selling out their members on the Cadillac plan. When it came to the health care referendum, Smale voted against Missouri opting out of the new law, even though he doesn’t like it very much. “Barack Obama’s plan is to prop up the profitability of insurance companies and the medical industry at the expense of working people. Forcing people to buy crappy health insurance is no improvement for people.” But he voted against what he called “the crazy Republicans.”

“I disagree with them on everything,” he explained. “It was my own personal protest. I realize the insidious and backward ideology and who pushed it (the referendum) in the first place.”

Forty-six year old Karen Hayes, a community support worker, had just taken a client to the Family Health Center, which provides medical care to low income families and individuals. While she waited, she had time to chat about health care politics and her own situation. She wasn’t sure how health reform would affect her, but she did know that the coinsurance and the copays on her employer-provided coverage are killing her. Her income varies from about $27,000 to $30,000 a year, so between the $20 copay and the negotiated amount paid by her carrier, United Healthcare, she still has to come up with $50 to pay off a $150 bill. That’s hard to do sometimes, she says. “My health insurance is not adequate by any means.”

As for health reform, she says, “none of us know the total truth. It’s sketchy. In theory, I support it, but I want to see what the actual law says.” She called Missouri Sen. Claire McCaskill’s office to find out. She was referred to a website where she could read sections of the bill summarized by others, but not the actual law. “It was someone else’s interpretation. It’s all these people saying what it does say but I want to see for myself,” she said. “What might be a focus point for them might not be a focus point for me.”

Hayes, too, said she voted against the referendum to opt out of the federal law. She supports Obama “whole heartedly, but I knew he was not liberal.”

While at the clinic I stopped by to talk to Thania Fitzgerald, a Brazilian by birth, who came to Missouri as an exchange student and stayed. She is now a research specialist at the university and starting a new program at the clinic to screen patients for substance abuse. Fitzgerald, who is thirty-one, had worked two years as a therapist and saw patients struggling to get health insurance. She isn’t keen on the U.S. system. “Honestly, I wish there was socialized medicine like in other countries.” She said that while the health system in Brazil is not perfect, “nobody dies because they can’t go to a hospital. Everyone in her family is a doctor, she told me, so she knows the system in her native country. “I feel in Brazil people won’t die because of lack of care.”

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.