In Kentucky, voters complain about Obama, but take his care

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Breathitt County resident Mary Blair arrives at the Breathitt County Family Health Center before her appointment with Dr. Hamilton on Tuesday, January 21, 2014 in Jackson, Ky. Despite suffering from a past heart attack and diabetes Blair was able to receive medical coverage through Medicaid expansion under the Affordable Care Act. (Photo by Luke Sharrett/For The Washington Post via Getty Images) Obamacare Affordable Care Act Healthcare Breathitt County

Breathitt County resident Mary Blair arrives at the Breathitt County Family Health Center before her appointment with Dr. Hamilton on Tuesday, January 21, 2014 in Jackson, Ky. Despite suffering from a past heart attack and diabetes Blair was able to receive medical coverage through Medicaid expansion under the Affordable Care Act. (Photo by Luke Sharrett/For The Washington Post via Getty Images) Obamacare Affordable Care Act Healthcare Breathitt County

HAZARD, Kentucky – She still hates him.

With her new health care coverage under Medicaid through the Affordable Care Act, Tammy Clark was sitting in the waiting area on a recent Friday afternoon at Hazard ARH Regional Medical Center in Kentucky’s coal country, enthusiastically listing all of the benefits she gets now, like heart screenings and other tests she couldn’t get before because she didn’t have insurance. It was her third trip to see her doctor since Jan 1., when Clark’s new insurance started.

“Before, I had to go to the free clinic and get services,” she said, smiling. “Now, I can go to a real doctor. It’s a lot better.”

But when asked about President Obama, Clark’s smile disappeared. Clark, who is a Republican but says she would consider supporting Hillary Clinton in 2016, said she understands her new insurance comes from the health law Obama advocated. But Clark says still remains a strong opponent of Obama.

“He promised change. And I come from a long line of people who worked in coal mines. He destroyed the coal mines,” she said. Clark added, “If I had to think of one thing good about him, it’s the insurance.’

While officials in many states and the federal government have struggled to roll out the Affordable Care Act, Kentucky has been a rare bright spot: a state that has successfully operated its own health care exchange, developed a functioning website and enrolled more than 100,000 people in insurance since October. President Obama has been so delighted by this success, particularly in a red state where he lost badly in 2008 and 2012, that he has repeatedly mentioned Kentucky’s rollout, most notably in his State of the Union address last month.

But if Obama loves Kentucky, the feeling is not mutual. A poll released over the weekend of the state’s voters found that just 34 percent of Kentuckians approve of the president, similar to the 38 percent here who voted for him in 2012. (Mitt Romney won 60 percent.) That same survey found that 49 percent of Kentucky voters want to repeal the Affordable Care Act, despite its success in the Bluegrass State, compared to 44 percent who did not.

And in interviews here, even people who have directly benefited from the health care law remain either ambivalent or outright opposed to it.

“When something is too good to be true, it usually is,” Clark said, adding that she felt at some point her new insurance would either go away or the price would vastly increase. “I think it’s a good thing now, but I’m waiting for the catch.”

Kentucky’s conservative politics are not new.  Bill Clinton won here in 1992 and 1996, but as the Democratic Party has become more aligned with the environmental movement, it has struggled in coal-producing regions like Eastern Kentucky. Kentucky Gov. Steve Beshear, a Democrat, won reelection easily in 2011, but one of his key strategic moves was distancing himself from Obama, who he cast as an enemy of the state’s coal industry.

When it was time to promote the health care law last fall, Beshear and his team, aware of Obama’s unpopularity here, dubbed the state’s new health insurance program “kynect” (combining the words Kentucky and connect) and downplayed its connections to the broader national “Obamacare.”

But more important than the marketing was the reality: plenty of people in Eastern Kentucky, before the health care law, were either jobless and therefore lacking health insurance or in jobs that didn’t offer coverage. The Appalachian region has long been one of the poorest in the country. Lyndon Johnson visited the town of Inez, Kentucky, about 75 miles northeast of Hazard, during his “War on Poverty” in the 1960’s. President Obama announced last month a group of counties, including Perry County, where Hazard is located, would be targeted for special help under his “Promise Zones” program.

So people in Eastern Kentucky have put their politics aside to enroll in the health care plans. The region includes four counties where the number of people who have signed up for Medicaid under the health care law now exceeds the number that voted for Obama in 2012. In Perry County, Hazard, Obama earned 2,047 votes in 2012, about 20 percent. According to state data, 2,287 people are newly enrolled in Medicaid here since October.

But those new enrollments are not resulting in Obama’s poll numbers surging here. Kentuckians cast the president as too liberal, too eager to push environmental regulations that might limit coal production, insufficiently pro-gun rights. Energy experts say the decline of coal jobs in this region is real, but the causes are much more complicated than Obama’s policies, with the rise of natural gas in particular reducing the demand for coal.

“It’s alright,” said 30-year-old Eric Stidham, who lives in Hyden, another small town in Eastern Kentucky, referring to his new  insurance under the health care law. But Stidham, who said he had been laid off from a coal mining job and unable to find work, added of Obama, “I don’t have anything against the man, but he’s trying to turn everything green.”

Melissa Butterworth, who manages a Holiday Inn Express in Hazard, said she encourages her employees, most of whom don’t have coverage through working at the hotel, to go online and get insurance through the new health care law. She even goes on the website with some of them to explain the various coverage options.

But she’s not sure the new insurance through Medicaid for her low-income employees is worth the disruption and increased costs she says the law has caused for her friends who already had insurance.

“His intention (on health care) was good, even if his other ideas suck,” Butterworth said of the president, who she did not vote for in either of his campaigns. “It’s a good thing Americans can get health care, but I wish he had a found a better way to do it.”

A few voters in this region do acknowledge some rethinking about the president because the law.

Bridgett McWhorter, another Republican who is a teacher in this area, she said she had voted against Obama, disagreed with the health care law before it was passed and thought it was driving up her premiums now. But McWhorter said that when her niece recently called her complaining about getting injured and then having a high medical bill, McWhorter immediately told her she should sign up for insurance under the new health care law to avoid paying so much again.

“It was probably hypocritical to say my niece should get it,” McWhorter said.