The conversation turned to health, and he laid his Mass Health card on the table. Mass Health is the state’s expanded Medicaid program, one of the building blocks of reform. Because he has no income, Darling qualifies. “It’s not worth a bean,” he said. “Not the plastic it’s written on.” He had tried to find a dentist to pull a bad tooth. One dentist said he wouldn’t do it, and sent Darling to another one who would accept his Mass Health card. The wait was at least ninety days.

Darling had run into smack into the state’s doctor shortage, and he didn’t like it one bit. Doctors look at you differently with Mass Health, he told me. “The guy who has regular insurance versus the guy who has Mass Health is going to be seen first.” He found the wait to see a doctor can be two or three months.

So he uses emergency rooms. He’s diabetic with high blood pressure, but did not appear overweight—one of the two percent of diabetics who don’t have a weight problem, he told me. Recently he waited hours in the ER at the University of Massachusetts Hospital in Worcester. They gave me a pill for the blood pressure, Darling said. “The streets have taken a toll on me.”

Christine Arentz was smoking a cigarette outside Borders Books. She works for the state Department of Public Health. “I don’t pay attention to the law,” she admitted. “I know it’s selfish.” She said that the department discourages employees from talking about the reform law anyway. “It’s not really about censorship,” Arentz explained, adding that they are worried people will say the wrong things.

Rocco LaMonica, age fifty-two, was standing inside the door at Borders. He works in loss prevention and customer assistance at the store, a job he has had for a year. Two years ago he was tending bar at a Boston food chain, but got laid off. “I was too fat, too ugly, and too old,” he said.

“I came here for the health insurance,” LaMonica explained. “I had to use it a couple of times. It’s a pretty good deal. He wasn’t sure how much he pays each month, but knows that it costs $25 for a doctor visit. I asked if he knew much about the reform law. “Not too much,” he said. “I know Uncle Ted was trying hard to push it through.”

Dao Nguyen, a twenty-seven-year old who works in finance at a wealth management firm, said she didn’t know much about the reform law. Nor did she know much about her own coverage from her employer, a Blue Cross Blue Shield policy: “I imagine it’s $100 a month, but I really haven’t kept track of it. Is that crazy? I mostly focus on what’s going into my account.”

She did know that, in Massachusetts, people are penalized if they don’t buy insurance. “From my understanding, it’s a pretty big fine for not having it—like $400 for not having it. It would be $400 a month.” (Actually, it’s about $1000 a year.) She did know there was something called Comm Care. A lot of her laid-off friends were turning to that.

Connie Green was on her way to her job as a housekeeper at the Copley Square Marriott where she has worked for twenty some years. She said she pays $39 a week for health insurance from the company, but was worried because Marriott had just changed insurers from Tufts to Cigna, and she wasn’t sure what that would mean. She also didn’t know what reform in the state means. I asked what she knew about it. “Not anything. I can’t say I do support it, and I can’t say I don’t.”

A fifty-nine year old man selling newspapers on a street corner wouldn’t give his name, but he knew a lot about the state’s reform law. He read the business section of the Boston Herald every day. Did he have insurance? “I can’t afford it,” he replied. Did he have to pay the penalty? “They haven’t caught up with me yet.” He did say that if things turned around, he might consider buying it. “But I am working in a dying industry. When the money comes back, then I’ll get interested.”

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.