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.”
Paxton admitted that he didn’t understand the new law, but it worries him all the same. “There were way too many compromises made to get it passed. You know it’s not going to do what it should.” His specific worry: “My benefits could become less and I could have to pay a larger portion of (the premium) for my benefits.” Each pay period, he and his wife, who also works at the university, have $170 for health insurance deducted from their compensation. Paxton says that amount will increase because of health reform.
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.”
She has insurance through the university, and, like Paxton and Smale, her health benefits will eventually be cut. She didn’t seem to know about that. She sees some value in the reform law, but adds “I don’t like the mandate. I don’t see how it’s going to work. Everyone has a right to health care but it shouldn’t be forced.” Her solution: allow the state or the federal government to give people the choice of opting into Medicaid. Medicaid is good insurance, she explained. That would, of course, put the system on a path to a national health insurance system, an approach the pols and the stakeholders rejected last year.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.