A year ago 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 a few weeks ago 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 second of two posts that takes the pulse of Missourians. The first post is here.

Given all the press coverage of health reform last year, both good and bad, and the Obama administration’s recent publicity blitz to promote the law’s most favorable elements, it was astonishing to me that many I visited with in Missouri had never heard of the law, much less knew anything about what it did or how it affected them. Twenty-one year old Jennifer Kincheloe was one of them. She kept an eye on Johnny, her one-year old toddler, a cute little boy with blonde curly hair who was trying to keep still in the waiting room at the Family Health Center where they had come for his check-up.

“I know nothing about the law,” she told me. Her husband is a roofer, and she works as a custodian at the University of Missouri’s athletic department. Neither has health insurance. She said she was on Medicaid until her son was born; she’s off the program; he is still on. When it came to other aspects of health care and the reform law, I might as well have been chatting with a Martian. “We really don’t watch TV,” she told me. “So I heard nothing about it.”

Others had heard snippets about the law, but had more pressing concerns on their minds. At the St. Louis airport, I talked with twenty-nine year old Elonna Paraham, who was working at The Paradies Shops selling newspapers and sundries. She has health insurance from the job that requires her to pay high copayments. I asked how the law affects her. “Actually, I haven’t thought about it,” she said. Her main worry is just scraping up enough money to live. Paraham told me she gets up each day at three in the morning to drive from her home in Bellville, Illinois, forty-five minutes away. She works at Paradies from 5 am to 12:30 and then heads to her second job, at Busch Stadium, where she is a supervisor for the diamond box seats. Her two jobs bring in about $2200 a month after taxes. “I have to have two incomes at this time,” she said. “I have a mortgage, food, car notes and everyday bills to pay.” She said she has no time to watch TV or do much reading. It’s no wonder she knew nothing about health reform.

Hannah Spratt, a sophomore at the University of Missouri majoring in English and technical theater, does a lot of reading, but not the kind that tells her much about health care politics. “I always tell myself that I will read more newspapers, but I would rather read a novel instead,” she told me. “The Count of Monte Cristo, that’s got to be my favorite.” Spratt was reading Women in Love by D. H. Lawrence the day I found her sitting on a bench near the campus bookstore.

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.

If you'd like to help CJR and win a chance at one of 10 free print subscriptions, take a brief survey for us here.

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.