Health care and guns were among the top concerns Missourians raised with Sen. Claire McCaskill at a town hall the Missouri Democrat held Tuesday in Ozark.

About 100 people showed up to the Ozark Community Center, where McCaskill allowed herself to be quizzed by constituents and reporters for over an hour. More than 20 questions were pulled out of a basket, which McCaskill gave to a man in the front row who said he'd never vote for her, though he thanked her for putting on a town hall.

Health care

Republicans in Congress have so far failed to take significant action to undo the Affordable Care Act, a campaign pledge of President Donald Trump backed by many others on the right.

But judging by the frequency at which McCaskill faced health care questions, Missourians are still preoccupied with the issue — whether they're small business owners upset with rising premiums for plans bought through the health care exchanges or citizens worried that a repeal-and-replace bill will amount to sweeping reductions in Medicaid spending.

McCaskill, who voted for the Affordable Care Act, acknowledged that parts of the law have not worked as well as she and other Democrats hoped, including the requirement to buy health insurance.

"I know how unpopular the mandate is, and frankly, it hasn't been as effective as we thought it'd be," she said, responding to a man who said his premiums had quadrupled. "...So we've gotta get at this, because I understand that these costs are unsustainable."

Asked by another person who expressed frustration with health care inaction, McCaskill floated the possibility of a "copper" plan to complement the exchange's bronze, silver, gold and platinum options. This low-tier option would provide catastrophic coverage but feature a high deductible.

"That's a way of getting younger, healthier people in the pool, which helps share the risk," she said.

McCaskill also criticized Trump's idea of cutting off cost-sharing subsidies paid to insurers — in line with the president's suggestion to "let Obamacare fail." She added she was optimistic that enough Republicans would take action to stabilize the existing markets.

The Missouri Democrat also had an explanation for why Republicans were unable to pass meaningful health care reform legislation, despite holding majorities in the House and Senate and controlling the White House.

"It was a tax cut for people in the 1 percent and corporations ... paid for by an $840 billion cut to Medicaid, and it just (would have) made insurance a lot more expensive for people shopping on the exchange," she said of the House version of the bill.

Guns

Others questions McCaskill answered appeared to originate from people with a range of different views on firearms.

One question was about interstate reciprocity for permits to carry concealed weapons.

A bill establishing a federal CCW standard has been introduced in the House, though it has not had a subcommittee hearing. The legislation could allow people with a CCW permit in Missouri to bring a gun to any other state that allows concealed carry.

Last year, the Missouri legislature pushed through permit-less concealed carry, allowed for "lifetime" CCW permits and expanded the state's castle doctrine.

"Our state has passed some of the most liberal gun laws in the country, and that's the law here," McCaskill said. "But I don't think it's fair for us to impose our laws on another state."

Another person asked her about her views on silencers. McCaskill expressed reservations about making devices that suppress the sound of gunshots more widely available.

"I don't think we need to allow everybody to buy silencers," she said. "If you're going to have a mass casualty (shooting), sometimes that sound is what saves lives."

Dribs and drabs

McCaskill opened with some criticism of the news media for what she perceived as inadequate coverage regarding her efforts to help to World War II veterans exposed to mustard gas and related to federal regulations for hearing aids. She implied that reporters ignored these topics because "it didn't make you angry, and it didn't make you afraid."

The Missouri Democrat also offered her insight on Trump's stated plan for U.S. military involvement in Afghanistan, which includes an increase in the number of American troops in the war-torn Middle Eastern nation the U.S. invaded 16 years ago.

"I think it's just him acknowledging that he's going to continue to do exactly what the generals were advising under President Obama," she said to a reporter after the town hall. "... I'm not sure I still see what the end game is."

Amid speculation that tax reform could be next on the agenda in Congress, McCaskill stressed the importance of public input in the process.

"I would like to see us focus on families and Americans and Missourians who make too much money to qualify for the safety net programs but are still living paycheck-to-paycheck," she said. "... If they come with a plan that's just taking care of the 1 percent again on some kind of bogus trickle-down theory, don't count me in, 'cause it doesn't ever trickle down."

Infrastructure was among the topics McCaskill said she discussed with Jared Kushner, a senior advisor to the president and Trump's son-in-law.

"He asked, 'What would you be working on now if you were us?' and I said, 'I'd be working on infrastructure,'" McCaskill told a reporter after mentioning the meeting in the town hall.

McCaskill also reiterated her opposition to a single-payer health care system, which was asked about by at least one town hall participant. The idea of a nationalized health insurance system rose to prominence during Sen. Bernie Sanders' presidential campaign, and a June study by the Pew Research Center found that most Democrats favor a single-payer system.

Asked whether she was concerned about losing support among her base, McCaskill said, "I hope not."

"My opposition to it is not based on anything other than whether or not we can afford it right now with health care costs as high as they are," she continued. "Our debt matters. ... Medicare is driving our debt now. We can't expand that until we figure out how to get the cost down.

"It's what I believe, so if it means I don't win, I guess I don't win, right?"