The state has been drifting red for a while now, but it is still Democratic enough that the governor agreed to the Medicaid expansion in the ACA so many other GOP-led states have turned down. And that’s why it’s so fascinating as a test-case for the appeal of Obamacare throughout red-state America. So far, the results are quite striking: the number of uninsured West Virginians has dropped by a third since the ACA became operational. A third. And the sole reliable statistic we have as to the impact of that event is, appropriately at this early stage, mental health. To be free of terror that you won’t be able to pay your doctor, that you may be turned down for service when you’re sick, or that you have to alternate months between spending on food and on healthcare: wouldn’t that be an indescribable relief? Yes, of course it is, according to the NYT’s report today:

Waitresses, fast food workers, security guards and cleaners described feeling intense relief that they are now protected from the punishing medical bills that have punched holes in their family budgets. They spoke in interviews of reclaiming the dignity they had lost over years of being turned away from doctors’ offices because they did not have insurance. “You see it in their faces,” said Janie Hovatter, a patient advocate at Cabin Creek Health Systems, a health clinic in southern West Virginia. “They just kind of relax.”

But just as interesting to me is how culture still impacts that kind of psychological and real relief from acute, permanent anxiety and sickness. Obama will get no thanks for tangibly improving the lives of poor West Virginians. They may like the new law in practice, but in theory, many loathe it:

Recruiters trying to persuade people to enroll say they sometimes feel like drug peddlers. The people they approach often talk in hushed tones out of earshot of others. Chad Webb, a shy 30-year-old who is enrolling people in Mingo County, said a woman at a recent event used biblical terms to disparage Mr. Obama as an existential threat to the nation.

Mr. Webb said he thought to himself: “This man is not the Antichrist. He just wants you to have health insurance.” Eventually, though, people’s desperate need for insurance seems to be overcoming their distaste for the president. Rachelle Williams, 25, an uninsured McDonald’s worker from Mingo County, said she had refused to fill out insurance forms on a recent trip to the emergency room for a painful bout of kidney stones. “I wouldn’t do it,” she said. But when she got a letter in the mail saying she qualified for Medicaid, she signed up immediately.

Isn’t that, in some ways, the entire story of this administration? That what it has actually done – from rescuing the auto-industry to ending wars, from the stimulus to universal access to health insurance – is actually popular on the ground, but still powerfully toxic to a vast swathe of Americans. Maybe history will help us understand that critical cognitive dissonance. Or maybe we’re just fucking complicated human beings, whose emotions – primarily fears – alternate and contradict each other with increasing impunity. Obama’s gift is his liability. He sees through the psyches to the actual pressing needs. He does not feel the way his opponents does. Which has made him far more effective and pragmatic in implementing his vision, while losing political altitude in a very emotional and ideological country precisely because of these successes.

(Photo: Kimberly Christian Hackney of Haysi, Virginia, cries after receiving new dentures at the Remote Area Medical clinic in Wise, Virginia, U.S., on Saturday, July 25, 2009. The clinic provides free medical, dental and optical care to people living in the region of south-west Virginia over a three day period. By Joshua Roberts/Bloomberg via Getty Images.)