Tom Pauley, owner of Pauley Insurance Agency, explains that the Affordable Care Act has many different implications for insurers and residents alike on Oct. 14, 2016 in Columbia, Missouri. Pauley says that as both an insurer and a consumer, he has seen the act both help and hurt people.

Stan Hudson, associate director for the Center of Health Policy at the University of Missouri School of Medicine, reviews Missouri’s marketplace insurance options on Wednesday, Oct. 19th, 2016 in Columbia, Missouri. Hudson explains that Columbia residents will only be able to choose between Anthem Blue Cross Blue Shield plans during the upcoming enrollment period.

Dina van der Zalm smiles as she looks over her last few monthly statements on Thursday, Oct. 13, 2016 in Columbia, Missouri, in Columbia, Missouri. She says that the Affordable Care Act has provided her with quality healthcare, but kept her premiums low.

Dina van der Zalm looks over her copayment on her Anthem Blue Shield Blue Cross bill l on Thursday, Oct. 13. 2016 in Columbia, Missouri. She only needs to pay $23.11 for this month, which she says is something she can handle.

Dina van der Zalm reviews her latest medical bill on Thursday, Oct. 13, 2016 in Columbia, Missouri. Because of the Affordable Care Act, van der Zalm says medical expenses are not something she stresses about anymore.

Donna Catt, the building administrator for Delmar Cobble School for the Severely Disabled, talks about how state-funded special education schools struggle to retain their teachers in Columbia, Missouri, on Tuesday, Nov. 1, 2016. Catt said Delmar Cobble School has had a 20 percent turnover rate every year for the past five years.

Artwork painted by students decorates the wall of Delmar Cobble School for the Severely Disabled in Columbia, Missouri, on Tuesday, Nov. 1, 2016. Building Administrator Donna Catt said the pay gap between state-funded special education teachers and public school teachers is a problem.

Debbie Muro, a teacher at Delmar Cobble School for the Severely Disabled, records the time when she changes her students’ diapers in Columbia, Missouri, on Tuesday, Nov. 1, 2016. Muro said she does a lot of paperwork in order to provide proper care for her students.

Gretchen Hein-Roberts relaxes and massages her 12-year-old son Blake’s hand in Columbia, Missouri, on Monday, Oct. 31, 2016. Gretchen said that Blake has multiple severe disabilities, and is concerned about her son developing relationships with his teachers when there is high turnover.

Gretchen Hein-Roberts holds her 12-year-old son Blake’s hand in Columbia, Missouri, on Monday, Oct. 31, 2016. Gretchen said that she is frustrated by high turnover at Delmar Cobble School for the Severely Disabled.