Kentucky's implementation of the Affordable Care Act has been wildly successful, with a well-functioning state website from day one of open enrollment and a major push that’s led to more than 300,000 signing up for the exchanges or Medicaid. Indeed, the rollout in this red state has been so successful that Obama invited [Governor Steve] Beshear, a Democrat, to attend the State of the Union address in January and praised him by name during the speech. Far from being seen as a success story, though, in Kentucky, the health care law and Beshear's strong embrace of it remain deeply controversial. A recent poll showed that a plurality of Kentuckians continue to favor repealing the law. Other than Beshear, many of the state's leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of "Obamacare."

Why are Kentucky Democrats running away from a law that has for the first time brought free or affordable health insurance to hundreds of thousands of their constituents—mainly at the expense of wealthy out-of-staters? This is one of the poorest, unhealthiest, least-insured states in America, the state with the fourth-highest rate of Social Security disability status in the country, a state that is a byword for cancer-ridden smokers and black-lung-plagued coal miners. Why, among these voters especially, is Obamacare such a losing issue?

There are certainly plenty of things about the ACA to be lukewarm about. There are the short-term questions about whether the exchanges have signed up enough healthy clients, or whether they have brought in enough of the previously uninsured. Then there are the long-term concerns about whether the ACA's payment reforms succeed in slowing healthcare inflation. (The Dutch experience suggests that the all-private insurance model, whose chief raison d'etre is to hold down costs, doesn't do this very well.)

But these issues don't explain the bitter opposition to Obamacare. What does? Some of it came early, in response to the unpopular prospect of an individual mandate; Americans tend to bristle when forced to do anything. Some is driven by the experiences of people who have been on the losing end of the law's reforms; while the sick and the poor overwhelmingly benefit, many others will indeed be stuck paying more for insurance. Others are angry to have lost policies which they liked, but which did not meet Obamacare's requirements. For yet others, every frustrating change in the healthcare system has become identified with Obamacare, regardless of whether it actually has anything to do with the law. And Republicans have certainly tried to ensure we hear every single health-related sob story, regardless of whether the facts are confused or untrue.

For the most part, though, opposition to Obamacare now is based on two things. At one level, it's a question of partisanship. Republicans have turned "Obamacare" into a word that much of the country finds inherently distasteful. No matter how well the system performs, it's too late to reverse those associations. At another level, many dislike the basic transaction at the heart of universal coverage: richer people have to basically pay for poorer people's health-insurance. In Kentucky, for example, Republicans are avidly working to reverse the state's Medicaid expansion, even though the federal government pays for the entire thing initially, with the state expected to kick in 10% in the future.

“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?"

"Can't afford," here, is a euphemism. If, as Mr Benvenuti says, Kentucky "can't pay for" a 10% contribution towards Medicaid for its poorer citizens, it is because he believes the state's wealthier taxpayers don't want to pay for it. To warn of "creating dependency" is to pretend that there is some other way to make it possible for poor people to get decent health-insurance coverage. But there is no other way, as America's health-insurance system has proven. Obamacare has given people who fundamentally don't want to have to pay for universal health insurance a word on which to focus their disgust. They need not acknowledge that they would simply prefer for many people to go without healthcare.

Last October, in the panic after Healthcare.gov's launch, many on the left began wondering whether the government is even capable of taking on major social and economic reforms in the modern era. The system has been fixed adequately enough that this question doesn't seem so pressing anymore. It seems government can still tackle big problems. The question now is whether we can still build political support for government to even bother. If Democrats continue to suffer at the polls regardless of how well the ACA works, I'm not sure why, in the future, anyone would have the will to try.