Kentucky has an identity crisis when it comes to Obamacare.

The state’s senior senator, Republican Majority Leader Mitch McConnell, is one of the law’s leading opponents in Washington, regularly demanding the entire thing be repealed. But back home, Democratic Gov. Steve Beshear has embraced the law and seen its implementation go so well that Kentucky has become the poster child for Obamacare’s promise.

It’s the only southern state that decided to both expand Medicaid and set up its own health insurance “exchange,” and unlike the federal Obamacare website, HealthCare.gov, Kentucky’s online market has worked consistently — something Mr. Beshear said was the result of extensive testing and a clean website design that forsook bells and whistles in favor of convenience.

“Every time the topic of reform comes up, both pundits and the president of the United States himself say, ‘Look at what Kentucky’s doing,’” the governor told the Families USA Health Action 2014 conference in Washington.

But consensus on the topic is hard to come by in the Bluegrass State.

For Mr. Beshear, the law’s implementation has been a point of pride. On the other hand, it’s kindling for Mr. McConnell’s fiery campaign rhetoric as he tries to protect his seat from GOP primary challenger Matt Bevin and then Alison Lundergan Grimes, the Democratic front-runner.

As minority leader, Mr. McConnell frequently uses his time on the Senate floor to rail against the law and Mr. Obama’s flawed promise that if Americans liked their health plans, they could keep them.

Sen. Rand Paul, the junior senator and fellow Republican, has criticized Kentucky’s health exchange, “kynect,” for adding more people to the government-funded Medicaid rolls than to private insurance.

But to Mr. Beshear, Kentucky is a progressive state with a “red-state persona.”

“People who don’t know Kentucky might consider the commonwealth an odd choice to be leading the nation in implementing federal health care reform,” he said. “After all, my state has historically suffered from a national stereotype of being, ya’ know, just another one of those southern states that are a little bit behind the times.”

One out of six Kentucky residents lacked health insurance before the law, but some 175,000 people have signed up for Medicaid or a private insurance since Oct. 1, according to the governor.

“These aren’t some group of aliens from a distant planet,” Mr. Beshear said. “These are our friends and our neighbors.”

He said his embrace of the law was the “morally right thing to do” and offered a holistic solution for Kentuckians, who ranked all-too-high in many health-risk categories.

A new McConnell campaign ad argues that health is one of the senator’s priorities, although the TV spot has been criticized by the Grimes campaign as a stale retread from the senator’s 2008 campaign.

In the ad, a throat cancer survivor from Paducah, Ky., who was exposed to radiation on the job said Mr. McConnell’s “strong voice” led to compensation and cancer-screening programs for sick workers.

A Grimes campaign spokeswoman said Mr. McConnell’s 2008 campaign used a rather similar ad and that it is “insulting to Kentuckians for McConnell to haul out this old, dishonest play every six years when he’s on the ballot,” according to Politico.

McConnell campaign spokeswoman Allison Moore hit back last week, saying, “Only the most partisan, embittered, dogmatically liberal activists would have the audacity to call a Paducah cancer survivor’s story dishonest.”

On Obamacare, Ms. Grimes must walk the political tightrope that other Democratic candidates face in 2014, after millions of Americans said their health policies were canceled because of the health care law.

Her campaign website talks about preserving Medicare but does not tout the health overhaul that, by many accounts, her state has implemented so well.

“I will continue to make sure the concerns I have about the Affordable Care Act are taken to heart,” she said at a campaign stop this month in Prestonsburg, Ky., according to WKYT, a CBS affiliate. “That, for instance, when Washington politicians make promises that if you like your doctor and you like your plan you can keep it, that we follow through with that.”

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