First Person: Missouri Can't Let Citizens Go Uninsured

I voted against Prop. C because a lack of insurance for anyone could be disastrous. While the ballot measure only addresses the penalty for failure to carry insurance under the new plan, the vote is being cast as a symbolic strike against reform.

Missouri can't afford to let its citizens go uninsured. The Census Bureau says more than 13 percent of Missourians lived below the poverty level in 2008. Missouri's unemployment rate is hovering around 9 percent. And one in eight Missourians are uninsured, according to the Missouri Foundation for Health's Cover Missouri project.

I've been there. From age 18 to 24, I went without insurance. In that time, while working in retail and tech support, I used worker's compensation three times: for a back injury, a sprained wrist and a broken arm.

Each time, I feared I wouldn't receive treatment and that worker's comp wouldn't cover me. A broken arm costs hundreds of dollars in health care costs. I was already paying out of pocket every month for rescue inhalers for my asthma. I never went to the doctor for anything.

But I'm now lucky. At 24, I only pay $125 for insurance a month with about $30 in out-of-pocket costs. If I were still in the same uninsured boat, though, it comforts me to know that under the first big wave of health care reform (coming in 2014) I'd have qualified for Medicaid.

Employed or not, though, I collect this kind of information because I'm a transgendered man living in Missouri. Even in the relatively liberal college town of Columbia, I don't have a right to work, and I can be dismissed from my job solely on the basis of my gender identity. I constantly worry whether my insurance company will change my coverage or refuse a claim for anything they deem to be a result of my transition.

Because I could be out of work or out of insurance at any moment. A vote for Prop. C felt like a vote against my own security and the security of a whole lot of other Missourians.

And yet, in a state where The Patient Protection and Affordable Care Act could do some good, Missouri's majority Republican legislature wants to use my state on the national stage to incite a whole new round of opposition to health care reform.

The ballot measure is bizarrely specific, targeting only the provision that individuals will be expected to purchase insurance or face a minimal penalty (for which there are exemptions) once health care reform takes effect, and -- in a magical leap of legislative non sequitur -- whether we should also change the rules about liquidating insurance companies.

This is at odds with the way Republicans have been trying to sell the measure: namely, that a vote for Prop. C is a vote to bring the whole thing down before it goes into effect. That's ironic, considering that the measure itself may be unconstitutional in Missouri because of the way it connects two unlike things.

Unless I miss my guess, though, those specifics are less important than a symbolic stand in the run-up to this November's election. This success for health care opponents will encourage the anti-reform voting base just as much as a failure would have energized it. Courts of law are slow, but the court of public opinion moves lightning-fast and doesn't care as much about the details.