5 days in Kentucky: Insurance enrollment up; just don’t say ‘Obamacare’

This is the second in a five-part series, “Fed up in Kentucky,” exploring how political issues are playing out in personal ways in the Bluegrass State this election season.

BENHAM, Ky. — Frank Dixon is only 52, but his body is damaged from decades working as a mechanic in the mining industry. His back hurts from an injury sustained in a fall from a bulldozer at work years ago. He has two rotator cuff tears that trouble his shoulder and gets cortisone injections in his knees to keep pain at bay. 

“There’s mornings, days I can’t hardly get up,” he said, easing into a chair in his living room. But say the word “Obamacare,” and Dixon bristles — even though he’s covered by it.

It’s a feeling he and other Kentucky voters will take to the ballot box in four weeks, when views about the Affordable Care Act help shape the tight Senate race between Minority Leader Mitch McConnell, R-Ky., and Democrat Alison Lundergan Grimes.

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. Kentucky is the only Southern state to have both set up its own exchange and expand Medicaid. Nearly a year later, more than half a million residents have gotten coverage — making Kentucky a state with one of the largest drops in the number of uninsured, second only to Arkansas.

Like so many others in eastern Kentucky’s mining industry, Dixon lost his job in 2012. A combination of declining production, competition from cheaper coal fields and natural gas, and environmental regulation have slashed local jobs. 

When he was working, he earned a comfortable $90,000 to $97,000 a year.

“Kind of ashamed to say it, but now I’m on $300 a month food stamps,” he said.

Losing work meant losing health coverage. He and his 19-year-old son were uninsured for a year. Dixon’s younger son was in high school, so he received state coverage, but the single father worried about not having a safety net for his older son and himself. 

Then the Affordable Care Act started, and Kentucky set up its own insurance exchange, called Kynect. Dixon signed up and qualified for a Medicaid plan. Once he was insured, he said, the first thing he did was get his back checked out.

But 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. 

“‘Obamacare” has been demonized by its opponents,” said Al Cross, a journalism professor at the University of Kentucky. “And it’s easy to demonize because the first three syllables of the word are a word that most Kentuckians don't like.”

A September CNN/ORC poll shows 65 percent of registered Kentucky voters disapprove of President Barack Obama. 

Dr. Sharon Colton works in Evarts, Kentucky, at the Clover Fork Clinic, which treats about 70 patients a day. She said many of her patients don’t realize that Kynect is “Obamacare.”

“I think some of them are just happy to have insurance, and however they got it, you know they’re happy about it,” she said. “They don't look at the politics.”

“I do recall at least one patient who said, ‘Well I don't want it, even if it is free,’” she added, “because he didn’t like President Obama.”

It doesn’t help that in the battle for U.S. Senate, neither major candidate is taking time to explain the health care law. Incumbent Mitch McConnell blasts “Obamacare” and has promised to repeal it, “root and branch.” But he claims Kentuckians will be able to keep Kynect, a complication he hasn’t been able to explain.

“Democrats think [the Affordable Care Act] is a good issue to use against McConnell because he really hasn't explained how you repeal ‘Obamacare’ and still keep the coverage for 521,000 people who’ve got it under the state insurance exchange that was created under ‘Obamacare,’” Cross said.

But Grimes isn’t exactly embracing “Obamacare.” The Democrat says she’ll work to fix it. Professor Al Cross says that for Grimes to run on a platform of supporting the law is 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,” he added.

Kentucky ranks worst in cancer deaths and smoking rates. It’s in the bottom 10 states for obesity, deaths from heart disease and poor mental health. In Harlan County, life expectancy for males is 68, compared to the national average of 76.

“Men that are involved in things like rock falls and very, very serious mining accidents, and if they are not killed, they often have devastating injuries,” Colton said. “They’re disabled for the rest of their lives.”

With Kynect, more people are able to pay for their care, and some new patients are seeing a doctor for the first time in years. Colton says it helps transport rural patients to doctor’s appointments and is promoting crucial preventive care. 

But it hasn’t been without challenges. She said issues and delays tied to preauthorization are common.

Dixon’s doctor recommended he see a surgeon after an MRI indicated an operation might help alleviate his pain. Four months later, he’s still waiting for approval from Medicaid. In the meantime, he’s getting cortisone injections in his back to help manage the pain, and he and his doctor’s office keep calling his insurance company. 

“I’ve hit a stone wall. Why? Somebody tell me why I can’t go further. Explain that to me,” he said. “I carry the card around, but how good is it?”

Dixon is disillusioned with politics, including the upcoming Senate race. He doesn’t feel like national politicians — especially the commander in chief — are listening to eastern Kentucky’s plight. 

“I would like for him to come down here — the president — come down here and sit down and talk, just like we’re talking,” he said. “I wouldn’t be a smart-aleck. I wouldn't be hateful. Man, just listen. Just look and see.”

To view the “Fed up in Kentucky” series, tune in to “Al Jazeera America News” with John Seigenthaler this Mon. to Fri. at 8 p.m. Eastern time.