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Obamacare's unwitting fans

This anecdote, reported by Jason Cherkis after attending an event in Louisville, speaks to a fascinating larger phenomenon.

A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state's health benefit exchange established by Obamacare.

The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers.

"Do I burst his bubble?" wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.

Yep, that guy in Kentucky has been told so many times to hate Obamacare that he genuinely believes it's awful. But in Kentucky, a red state with a Democratic governor, implementation of the Affordable Care Act is continuing apace with the creation of "Kynect" -- the state's new health care marketplace. Indeed, as Cherkis explained, "The state had spent millions establishing the exchange, staffing up outreach, and conducting market research that included holding a dozen focus groups in Louisville, Paducah and London."

And as the anecdote helps demonstrate, it's having some success. People don't necessarily realize that new benefits available in Kentucky have anything to do with the federal law they've been conditioned to reject. It's why they're impressed when they hear the pitch from policy experts like Reina Diaz-Dempsey -- the benefits sound like a pretty good deal for folks.

If they think those benefits "beat Obamacare," so be it.

Of course, this does suggest something health care proponents are going to have to get used to: the Affordable Care Act has an Obamacare problem.

As Jonathan Bernstein explained a while back, "The law is going to make health care better for many Americans. A lot of them just won't realize it's the same thing as the Obamacare they hate."

From the very beginning, and certainly before Democrats also adopted "Obamacare" as the shorthand name for health-care reform, Republicans have strongly opposed a fantasy version of the landmark legislation. Whether it was "death panels," or "government takeover," or any number of wacky claims in chain emails, Republican opposition has rarely been focused on what's actually in the ACA.

And no matter how successful reform turns out to be, that's unlikely to change.

See, the funny thing about the Affordable Care Act is that a whole lot of it will either be invisible or, oddly enough, won't be identifiable as "Obamacare." The core of the program is the system of health-insurance exchanges and subsidies, but little or none of these operations will have the words "Affordable Care Act," much less "Obamacare," attached to them.

Quite right. That middle-aged man in the red golf shirt at the Kentucky State Fair may very well get coverage through Kynect, benefit from protections extended to those with pre-existing conditions, and be thankful for the elimination of lifetime caps -- all the while assuming that the dreaded Obamacare is a bad idea.

Or as Bernstein put it, "Fortunately, the Limbaugh self-employed listener will think, I don't have Obamacare; I have the private health insurance I purchased on that StateCare web site. But if the liberals had their way, everyone would be forced to have Obamacare, and ... America would be ruined."

For several years now, it's been the dirty little secret the political world brushes over when talking about health care reform: Americans don't like the law, but they love everything in it, and don't want anyone to take those benefits away.

It's a detail Republicans need to understand. When they vote several dozen times to repeal the reform law, GOP lawmakers assume they'll pay no political price. But the more Americans take advantage of the law, the more voters will balk at a Republican crusade that undermines families' health care security -- whether "Obamacare" polls well or not.

As for Kentucky, Gov. Steve Beshear (D) isn't backing down. The Kentucky Farm Bureau Country Ham Breakfast is usually a non-political affair, but this week, the two-term governor put his platform to good use in support of health care reform his constituents like more than they realize.

Beshear's advocacy ... was striking in its intensity and in how personally he approached the issue, picking up on the idea that many people who don't have health insurance are embarrassed by that and don't talk about it.

The governor compared health insurance to "the safety net of crop insurance" and said farmers need both. He said 640,000 Kentuckians -- 15 percent of the state -- don't have health insurance and "trust me, you know many of those 640,000 people. You're friends with them. You're probably related to them. Some may be your sons and daughters. You go to church with them. Shop with them. Help them harvest their fields. Sit in the stands with them as you watch your kids play football or basketball or ride a horse in competition. Heck, you may even be one of them."

Beshear went on to say that "it's no fun" hoping and praying you don't get sick, or choosing whether to pay for food or medicine. He also said Kentucky is at or near the top of the charts on bad-health indicators, including heart disease, diabetes, cancer deaths, and preventable hospitalizations. He said all that affects everything from productivity and school attendance to health costs and the state's image.

"We've ranked that bad for a long, long time," he said. "The Affordable Care Act is our historic opportunity to address this weakness and to change the course of the future of the commonwealth. We're going to make insurance available for the very first time in our history to every single citizen of the commonwealth of Kentucky."

About half the audience burst into applause at that point while the other half sat on their hands. But he wasn't done. He cited a study that showed the law would inject about $15.6 billion into the Kentucky economy over eight years, create 17,000 new jobs, and generate $802 million for the state budget.

"It's amazing to me how people who are pouring time and money and energy into trying to repeal the Affordable Care Act sure haven't put that kind of energy into trying to improve the health of Kentuckians. And think of the decades that they have had to make some kind of difference," Beshear finished pointedly.

Senate Minority Leader Mitch McConnell (R-Ky.) was there, listening to this, suggesting the governor was talking quite directly to him.