McCarthy is still popular in his district despite his opposition. | John Shinkle/POLITICO Loving Obamacare – and McCarthy

BAKERSFIELD, Calif. — Nearly 70,000 people in the Central Valley’s Kern County have gotten health care coverage this year because of Obamacare. But their congressman, new House Majority Leader Kevin McCarthy, faces no danger of those newly insured kicking him out of office for voting dozens of times to repeal the law.

It’s a sharp disconnect, one that is taking place not just in McCarthy’s deep-red Bakersfield district but in many other Republican districts throughout the country ahead of the 2014 midterm elections: Constituents benefiting from Obamacare coverage aren’t turning against the politicians who want to repeal it.


And even as Obamacare beneficiaries grow into the millions, there doesn’t appear to be a tipping point in the near future when Republicans’ opposition to the health care law could actually hurt them politically.

William McKenzie is one of McCarthy’s constituents who says he loves the law. The 31-year-old unemployed oil refinery worker hadn’t had insurance coverage for at least a decade when he was diagnosed as HIV positive in December. A few weeks later, on Jan. 1, Medicaid became available to him under the Obamacare expansion.

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“Without this plan, I would probably be in the ground,” McKenzie said after a recent appointment at a community health center in Bakersfield. Medicaid pays for his $113 tests to measure his viral levels and the $1,200 monthly cost of antiretroviral medications.

“It’s real. It doesn’t get more real than that,” he said. “Without these meds, I don’t know how my health would be.”

An estimated 68,000 people got Obamacare coverage here in Kern County, which makes up a portion of McCarthy’s expansive district in the southern part of the valley. As of April, 18,000 of those people had gotten private coverage, many with federal subsidies. Nearly 50,000 enrolled in Medicaid, a number that is still rising.

Yet here in Bakersfield, McCarthy is popular. Everyone from the local health clinic director and coffee shop barista to the Kern County Museum staffer refer to him simply as “Kevin” and mention the last time they saw him in town. He faced no threat of an Eric Cantor-style primary loss in June; he didn’t even have a challenger on the ballot. In November, he’s virtually guaranteed to win his fifth term in this district, which includes more than a dozen oil refineries and generates billions of dollars in crops such as grapes, pistachios and citrus.

( Also on POLITICO: Full health care policy coverage)

Drew Altman of the Kaiser Family Foundation, which does monthly polling on the health law, said Obamacare is unlikely to directly play a positive or negative role for any House candidates this year.

“The only effect it really could have is on turnout because the electorate is already completely locked up in a partisan divide on the ACA,” he said.

In Washington, McCarthy as majority leader will play a key role in the Obamacare dilemma confronting House Republicans: whether and when to put forward an alternative policy. The party has been promising as much for several years but hasn’t been able to coalesce around one plan.

McCarthy’s office refused to comment or make him available for an interview for this story. In a separate POLITICO interview in late July about his leadership goals, he didn’t commit to a GOP replacement vote. “We have a lot of health care bills out there,” he said then. “You also have to look to the committee process, what’s been through, what’s not. It’s all part of the discussion.”

Republicans are split on how to proceed. Former Majority Leader Cantor promised earlier this year to hold a vote, and new Republican Whip Steve Scalise has strongly backed a vote on the Republican Study Committee plan. But others have now all but ruled that out for 2014, according to Rep. Phil Roe (R-Tenn.), one of the chief proponents of the conservative alternative. House Speaker John Boehner told reporters shortly before the House recessed earlier this month that the GOP is “not there yet” on a plan.

Many House Republicans privately worry that unless they have the 218 votes needed to pass a bill this fall, it’s futile to put something on the floor only to see it fail and expose them to Democrats’ attacks before the November elections. They insist that full repeal remains a top priority and that they want to pursue a step-by-step replacement plan with such ACA provisions as ensuring coverage for pre-existing conditions and keeping dependents on a parent’s insurance policy until age 26.

Still, the longer it takes Republicans to draft and vote on a plan — if they do it at all — the more daunting their political and policy problems become.

More than 15 million Americans already have coverage under Obamacare — 8 million through the exchanges and more than 7.2 million in Medicaid, according to the Obama administration. While Republicans downplay those numbers, arguing that many of the “newly insured” previously had plans that were eliminated under the law, they admit some people are indeed benefiting.

“You can’t throw that much money at a problem without helping somebody,” said Rep. Kevin Brady (R-Texas), chairman of the Ways and Means health subcommittee. He pivoted fast, though: “In my district I’ve heard from many more that have been harmed and are frightened going forward as well — from small businesses to those who were grandfathered this year and may not be next year.”

Party leaders say they have to ensure that people who got Obamacare coverage stay covered under an alternative. “There’s no question — we have to,” Roe said. “You have to have a bridge to cover these folks — have a place for them to go to buy insurance.”

Some in Bakersfield agree with Republicans like Roe who say that the Obamacare premiums may look affordable, but the care is not.

Greg Wegis, a local farmer and the Kern County Farm Bureau president, said the community is concerned about high deductibles and other costs. Many farm workers may not realize they could face big out-of-pocket expenses when they use their insurance.

“We’re not fans of Obamacare,” Wegis said. “What we’re worried about and what we’re hearing is that people can’t afford it.”

Then there’s Lisete Villarrel, a medical aide who lives in Bakersfield with her young family.

Even when she was uninsured, she was always able to get treated at the local Clinica Sierra Vista because of its sliding scale. But she likes her coverage under MediCal, as the California Medicaid program is called. She likes the security of knowing she and her 1-year-old son won’t face big bills if one of them gets sick.

“You never know what can happen,” said Villarrel, 27, who admits she has worried about paying for prescriptions. “With medications, they’re not going to say, ‘you can make a payment.’ You either have to pay for it or they’re not going to give it to you.”

For people like William McKenzie, the coverage is lifesaving. Before Obamacare, he would have qualified for other federal programs that help low-income HIV patients. But none would have offered the comprehensive health care he now has.

McKenzie doesn’t say MediCal is perfect. His application last December got stuck in a nearly six-month backlog of state Medicaid applications.

“I had to sign up for so many different things. … I came to the clinic and they said, ‘You don’t have coverage right now,’” he said. “It’s been a bumpy road, but it’s all straightened out now.”