A Governor's Last Campaign: To Prove Health Law Works

FRANKFORT, Ky. - In the windowless nerve center that resembles a campaign war room, Gov. Steven L. Beshear studied projections on a wall showing that 600 people were logged on to the state's health insurance exchange.

Some 34,000 had begun applications, and more than 11,000 had signed up for plans, making Kentucky one of the most successful state-run insurance marketplaces under the new federal health care law.

'You are all doing a fantastic job,' Mr. Beshear told two dozen bleary-eyed workers.

In a state where dislike of President Obama runs strong and deep, Mr. Beshear, a Democrat, has positioned himself as a champion of the Affordable Care Act, out ahead of public opinion. It has endeared him to the White House at a time when news of the problem-plagued federal exchange, HealthCare.gov, has been embarrassing and damaging.

'My message to Kentuckians is simply this,' Mr. Beshear said in his office in the State Capitol. 'You don't have to like the president; you don't have to like me. Because this isn't about him, and it's not about me. It's about you, your family and your children. So do yourself a favor. Find what you can get for yourself. You're going to like what you find.'

Kentucky is the only Southern state to operate its own insurance exchange as well as expand Medicaid coverage for the poor. It is an anomaly on the polarized political map, and a test - in a red state that has elected to the Senate Mitch McConnell, the Republican leader, and Rand Paul, a Tea Party favorite - of whether bitterness over the law will dissolve if people decide it effectively provides affordable health care.

Mr. Obama 'bragged on Kentucky,' Mr. Beshear said, describing a speech by the president that singled out the traffic to Kentucky's exchange, Kynect, while attacking Republicans for shutting down the government over the law.

Yet even as the law wins some new fans who are able to sign up for benefits, there is a risk that those who already have insurance and see their premiums rise will blame the Affordable Care Act.

At 1,000 new sign-ups a day, which the governor called a great success, less than a third of the 640,000 Kentuckians who are uninsured will have signed up by March 31, the cutoff for coverage next year. (Through Thursday, enrollment had reached 15,480.)

Without large numbers of enrollees to spread risks, experts have said, the law could collapse.

Republican strategists in Kentucky said the health care overhaul would be a weight around the neck of every Democrat on the state ballot next year, as well as Democrats hoping to hold their majority in the State House.

'Kentuckians are suspicious and deeply concerned about Obamacare,' said Jesse Benton, Mr. McConnell's campaign manager. 'Any Democrat running in Kentucky in 2014 is going to be in a box: stand against your base, or endorse a policy that's very unpopular and not working well.'

Wilson Stone, a tobacco farmer and Democratic state representative, said voters in his southern Kentucky district did not like the law. 'People ask me if we can afford the Medicaid increase,' said Mr. Stone, who hopes his focus on constituent service secures his re-election next year. 'I'm a little bit worried about how all this plays out and how aggressive the governor is.'

Mr. McConnell's likely Democratic opponent, Alison Lundergan Grimes, has been noticeably quiet since the rollout of Kynect on Oct. 1.

'Alison has heard from Kentucky businesses and families who are afraid their rates are going up,' Charly Norton, a spokeswoman for Ms. Grimes, said in a statement. 'She is concerned with some aspects of health reform, specifically the regulatory burden placed on small businesses, and believes Congress must come together to provide businesses additional tax relief.'

Ms. Grimes, the secretary of state, may face a tough campaign in a state that handed Mr. Obama a 23-point defeat last November. But Mr. Beshear does not. At 69, he is in the final stretch of his second term, the limit that Kentucky law permits. Many political observers believe he is acting to secure his legacy as an old-fashioned Kentucky liberal representing a tradition that has been in retreat for a generation, since social conservatives began defecting to the Republican Party.

'Steve Beshear is a man on a mission,' said Al Cross, the director of the Institute for Rural Journalism and Community Issues at the University of Kentucky. 'He no longer has to worry about politics.'

Mr. Beshear, who failed in a 1996 challenge to unseat Mr. McConnell, spent a decade out of politics before capturing the governor's office in 2007.

With control of the Legislature split between the parties and a shrinking budget, Mr. Beshear has had little chance to enact an agenda, except for a few hard-fought victories in education.

He insisted that Kentucky was at heart a progressive state. 'When most of you all think about Kentucky,' he told an out-of-state visitor, 'you think about the face of our Congressional delegation. That's not really what Kentucky's all about.'

Mr. Beshear said his decision to embrace the law was not political.

'To me this was a moral decision,' he said. 'We've got 640,000 Kentuckians who don't have access to any kind of affordable health care. The last ranking I saw, we're 44th out of 50 in health status. You take any chronic disease or condition - heart disease, cancer, smoking, obesity, you name it - and we're either the worst or close to the worst.'

He also said the law made economic sense, citing a state-commissioned study that found that an expansion of Medicaid over eight years would 'create a $15.6 billion economic impact' and almost 17,000 new jobs.

He blamed the law's unpopularity on Republicans who were 'adept at demonizing the name 'Obamacare.' '

'Most of these critics are going to end up with egg on their face,' the governor predicted. 'People are finding that I can get health insurance for the first time in my life that I can afford. They're going to look back at these folks after all the dust settles and say, 'You misled us.' '