In the South, the Obamacare debate continues, even as law insures thousands

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“300,000 people are on this now,” said one top Kentucky GOP operative. “It’s going to be hard to take this away from people.”

But other Republicans are undaunted, determined to poke holes in Beshear’s story of Kentucky as a health-care success. They emphasize that about 80 percent of Kentucky’s new enrollments have been in Medicaid, while only 20 percent are in private health-care plans, a ratio Republicans argue will be problematic when the state must start paying for some of the costs. (Under the law, starting in 2017, states must pay 5 percent of the costs of new Medicaid enrollments. Most other states have not released precise data on their enrollments, so it’s not clear if Kentucky’s Medicaid ratio is unusually high.)

“I think it’s immoral to give you something you know we can’t pay for,” said Robert Benvenuti, a Republican state representative who unsuccessfully pushed a bill that would have required Beshear and state legislators to get their own insurance through the exchange. “Why are you creating dependency you know you can’t afford?

Republicans are collecting stories of Kentuckians whose health-care plans have been changed or eliminated because they do not comply with Obamacare regulations.

Steve Robertson, chairman of the Kentucky Republican Party, said the GOP statehouse candidates would run this fall on the mantle of repealing the health care law, looking to gain five seats and the House majority. And a Republican could replace Beshear after next year’s gubernatorial elections.

“It’s a question of when, not if, when Kentucky will become just truly a red state,” said Robertson.

From there, Stivers described a gradual process to reduce Kentucky’s participation in the health-care law. He suggested, for example, that Republicans pare down the Medicaid expansion under the program, which currently covers people as long as their income is less than 138 percent of the federal poverty level, in increments, bringing it down to perhaps 130 percent initially, then a lower number after that. (The Obama administration has long said it would not support such a partial expansion of Medicaid.)

Democrats acknowledge the political challenge in defending the law. They say the policy success has done little to shift the politics because anything associated with President Obama is unpopular in Kentucky.

At the national level, Democrats, including top White House aides, have long argued Americans would view the ACA more positively once millions of people became insured through it, and that Republicans would stop urging repeal once people in their own districts and states were benefiting.

What’s happening in Kentucky directly contradicts those assumptions: The stories of the newly insured are drowned out, politicians in both parties here say, by the enduring unpopularity of “Obamacare” and the man it is named after, concerns (often unfounded) that the law has caused premiums to increase for people who previously had insurance and general confusion about the law, particularly the individual mandate.

When the state House had the vote on de-funding the health-care law, nearly all Republicans backed the provision, while a bloc of more than 20 Democrats abstained, denying it the votes to pass but also illustrating their concern over supporting the ACA publicly.  Alison Lundergan Grimes, the Democrat challenging McConnell in a closely-watched U.S. Senate race, does not include any mention of the law on her campaign website and has avoided associating herself with Beshear’s embrace of it.

McConnell, on the other hand, pledges to repeal the law in nearly every campaign speech.

“Politics is two seconds. In two seconds, you can say, ‘Obamacare, lost insurance,” said Coleman Eldridge, a top aide to Beshear. “Takes three minutes to explain why that’s really not true. They’re (Republicans) smart to do it, just matters how we defend it.”

“It’s a reflection of the reactionary and racist nature of Kentucky,” said Gerald Neal of Louisville, a Democrat who is one of the two black state senators here. “This is Kentucky and some parts of Kentucky are living in the past. They (Republicans) have been successful in associating these issues with Obama.”

This hostile political environment has left Beshear on a determined effort in his last year-and-half in office, racing to deeply entrench the health-care expansion in Kentucky, to make it so embedded that even if a Republican succeeds him, it will be politically impossible to unwind the process.

Beshear is looking for ways to fund the state’s health-care exchange without using any taxpayer dollars, a move that would it harder for Kentucky’s Republicans to suggest that implementing the ACA is draining the state’s resources. The governor and his team are already talking about conducting focus groups to study how to get more young adults to sign up for insurance when open enrollment starts again in November, to further broaden the number of people in the program.

And last month, Beshear announced a new initiative called “kyheathnow,” a kind of Obamacare 2.0 that seeks to build on insurance expansion in Kentucky and sets up a long list of new health goals for the state, such as reducing its uninsured population to less than 5 percent and cutting the state’s obesity rate by 10 percent.

Beshear aides believe that if the number of Kentuckians enrolled through “kynect” gets near 500,000 over the next year in this state of four million, Republicans will continue to complain publicly but also concede they won’t be able to unwind the ACA in Kentucky.

“I’m making sure that nothing happens during this legislative session that will stand in the way of our progress,” Beshear said. “We are also building, I think, the public support so that as we get into next year and the year after that, this will be a very acceptable effort to everyone, regardless of their political party.”

(Editor’s note: This story was done as part of a partnership between theGrio and Yahoo News.)

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