She knew that there had been a bill passed that would require everyone to have health insurance. “It’s a good and bad thing. I don’t like the fact people will be forced to buy insurance,” she said. Spratt, who is nineteen, told me she had one more year on her parents’ health insurance plan, and then she had to find something else. She pulled out her insurance card. The copayments and coinsurance were steep—$50 to see a specialist, $75 for a visit to an urgent care center—and she had to pay 50 percent of any bill if she went to an out-of-network doctor. She had heard nothing about one of the good features of the law—allowing young adults to stay on their parents’ policies until they turn twenty-six. She said she would tell her parents. Spratt did not vote in the state referendum on health care this summer: “I don’t like to vote when I don’t know a whole lot about what’s going on.”

On this trip to Missouri I took the pulse of people on Medicare. They, too, knew little about health reform but had heard plenty about the possibility they might lose their Medicare benefits.

Peggy, a retired teacher who was probably in her mid-seventies, was really down on Medicare. She wouldn’t give her full name or her age and launched into an attack on the program that pays her health care expenses. “It’s another program that has promised things and there’s not enough money,” she told me. “I don’t think Medicare has money to pay us.” The reason for this, she explained, was that Medicare is not managed efficiently. But she was angry that there were people getting Medicare who didn’t deserve it: “They have people drawing Medicare benefits and never paid into it. It’s broke. They made promises they can’t keep.” I asked her how she knew all this, and she seemed a bit offended by my question. “I read a lot of different sources,” she said. “There’s not any one of them that’s 100 percent available for accuracy.”

The thread of fear seemed everywhere. Charles Paxton, the superintendent of landscape services at the University who chatted with me about his own health insurance situation, told me about his parents who are in their late seventies. “They are scared—really scared—about what the bill would do. They are somewhat afraid of the rationing part of it,” he explained. “They listen to Fox News way too many hours. But they probably should be worried.”

Joyce and her husband Jessie were waiting with their adult daughter, who needed to see a doctor at the Family Care Center. They wouldn’t give their last name, but said they were both sixty-seven and on Medicare. Joyce had begun to worry about whether the program would continue. Her husband, who has high blood pressure and diabetes, said it will be a mess if it goes away. He said he had a regular doctor but stopped going to her because the out-of-pocket costs were too high, even with Medicare.

Both had been factory workers making auto parts, but the factory closed five years ago, when they were sixty-two. They had no choice but to take their Social Security benefits early. Their combined Social Security income is $1800 a month. “If we had a mortgage, we’d really be hurtin’,” Jessie told me. “If they don’t get a real president in there, things are going to get real bad.” I asked what he meant, but he wouldn’t say. “We don’t vote. We aren’t registered to vote,” he said. Neither Joyce nor Jessie would say why.

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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.