Sticks and stones may break your bones, but words will never hurt you -- unless you're talking about the word "Obamacare" and its impact on the U.S. Senate race in Kentucky, the only Southern state to have both expanded Medicaid and set up its own health-insurance exchange under the federal health-reform law.
"The Affordable Care Act, known as 'Obamacare,' is a lightning rod in Kentucky, even though the state had one of the most successful rollouts in the nation," Al-Jazeera America reports in a five-part series on political issues in the state. The polarizing word is affecting the race between Senate Republican Leader Mitch McConnell and Democrat Alison Lundergan Grimes.
"In a state where 65 percent of registered voters disapprove of President Obama, even those who have signed up for coverage through Kynect don't want to think of it as Obamacare," Libby Casey and Philip Maravilla report.
In May 2013, Democratic Gov. Steve Beshear announced that he would use Obamacare to create the state health-insurance exchange and expand Medicaid rolls to cover Kentuckians earning up to 138 percent of the federal poverty level. That qualified hundreds of thousands of Kentuckians for the federal-state program, including Frank Dixon of Benham in Harlan County.
Dixon's 52-year-old body is damaged from decades working as a mechanic in coal mines where he injured his back, rotator cuff and shoulder. Like many Kentuckians who have worked hard to earn a good living all of their lives but lost jobs due to the mining industry or economic downturn, Dixon is thankful to have medical coverage and food stamps but "kind of ashamed to say it," he told Al-Jazeera:
"When asked if he supports Obamacare, Dixon lets out a long sigh and fidgets in his chair. “I don't know how to answer that,” he said. “Some things are left unsaid.” An NBC/Marist poll conducted in May found 57 percent of Kentuckians surveyed said they disliked Obamacare. But when asked about Kynect, only 22 percent disapproved. And yet they’re basically the same thing."
Republicans have more than taken notice of this sentiment, which may also be the reason Grimes hasn't made Kynect's success part of her campaign unless she is asked about it.
"Obamacare has been demonized by its opponents," Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky and publisher of Kentucky Health News, told Al-Jazeera. "And it’s easy to demonize because the first three syllables of the word are a word that most Kentuckians don't like."
Cross said that for Grimes to run on a platform of supporting the law would be risky, but could pay off: "I hope they do engage on the issue of health care because this state in many ways is the least healthy state in the country."
Aside from the questions of demonization and branding, Kentucky's health system has serious challenges, and the influx of Medicaid patients covered by Obamacare has come with new challenges for both patients and doctors, such as delayed approvals and burdensome paperwork from insurance companies.
Facing delays in preauthorization, some newly covered patients like Dixon are questioning the value of their Medicaid coverage. Others are just thankful to finally be able to see a doctor, Casey and Maravilla report.