People standing in line for pork products usually aren’t preoccupied with health. But this is the Iowa State Fair in Des Moines, an event where pork-on-a-stick, “hot beef sundaes” and livestock of unusual size have traditionally blended with politics. These days, politics means one thing: health care reform. And if the mood here is any gauge of Middle America, reform may be in trouble.

At lunchtime Monday, two members of the House of Representatives—Iowa Democrats Dave Loebsack and Leonard Boswell—served ice water to a well-fed crowd at the Pork Tent, a traditional stopping point for politicians who come to the fair every year.

Iowa may be geographically and culturally distant from Washington, D.C., but people here, like people there, are both politically aware and highly opinionated. This is, after all, a state whose early primary caucuses mean residents can realistically expect to see presidential candidates in a neighbor’s living room, if not their own. They’re used to shaping debates, and they’re used to being heard.

Clarence Leichty, 69, a retired electrician from Iowa City, shared his concerns with Boswell between bites of beans. To Leichty’s mind, the reforms being considered by Congress are a classic case of the government overstepping its role. “The government should not have any more control than it already has,” Leichty said. He especially doesn’t want the government to make life-or-death decisions. “If you get to a certain age and you have a disease, they won’t want to take care of you.”

Leichty hit on themes that Boswell and Loebsack had heard many times before at the fairground, at their offices and, of course, at town hall meetings. In a state that Obama won by 10 points in the general election, a large and vocal group is worried that the proposed health care reforms go too far, will cost too much and could actually be dangerous.

An emotional subject

Some of their concerns—death panels, rampant socialism, desecration of the Constitution—seem to push the bounds of plausibility, but the emotion is real. “It’s a very personal issue,” said Loebsack, whose district includes Iowa City and Cedar Rapids. “There’s still a lot of anger and disinformation, here and elsewhere. I do what I can to defuse that. I bring along a copy of House Bill 3200 and encourage people to read it.”

At a recent overflow town hall meeting in Sigourney, Boswell (whose district includes Des Moines) received a literal thumbs-down from much of the crowd when he said, “We’re going to have to have a public option.” The meeting didn’t have quite the venom of other town halls getting so much coverage on cable news—“Iowans are above that sort of thing,” Boswell said later—but it did give him a firsthand view of the discontent surrounding reform.

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