WASHINGTON -- In his Friday op-ed in The New York Times, titled "My State Needs Obamacare, Now," Kentucky's Democratic Gov. Steve Beshear said he had a simple message for Republicans who don't like the law: "Get over it."
"Frankly, we can't implement the Affordable Care Act fast enough," Beshear wrote. "As for naysayers, I'm offended by their partisan gamesmanship, as they continue to pour time, money and energy into overturning or defunding the Affordable Care Act. It's shameful that these critics haven't invested that same level of energy into trying to improve the health of our citizens. ... So, to those more worried about political power than Kentucky's families, I say, 'Get over it.'"
Of course, Beshear comes from the rarefied perch of a popular two-term governor in a fairly red state. He also has practice defending the health care law, having poured millions into the effort with marketing and branding campaigns. And he commissioned an economic study that projected that the ACA would create at least 17,000 jobs. President Obama even used Kentucky to illustrate a point about the ACA; feedback during the promotion of Kentucky's health benefits exchange, Kynect, had been so positive that some Kentuckians didn't even know it was the state's implementation of the federal law.
But you don't have to be a powerful governor to win the Obamacare debate. Kentucky officials and outreach workers have been everywhere -- the state fair, minor league ballgames, community meetings in libraries -- pitching Kynect. It's starting to feel like a Vegas act; on some days, health department workers will be doing four events. Here, they explain what they've experienced pitching the new law to skeptical residents, and what it takes to win over converts.
Don't call it Obamacare. Erin Hoben, an outreach worker with Kentucky Voices for Health, a coalition pressing for affordable and effective health care, has traveled all over the state explaining the new law to both health care workers and the state's most vulnerable residents. "I don't say Obamacare," Hoben says. "I don't ever use the term. I think if you don't call it the Affordable Care Act then you would be doing a disservice to Kentuckians."
"I don't want to be confrontational from the get-go," she explains. "If you use that term, the walls automatically go up."
Dispensing with the controversial nickname means you can get to what's actually in the legislation, explains Cara Stewart, a health law fellow and attorney with the Kentucky Equal Justice Center. "No one is very angry once they find out about the law," says Stewart, who has also done outreach in every corner of the state. "I don't even say ACA. I say health care coverage and health options."
You have to become a myth-buster. The advocates and state officials interviewed by The Huffington Post all brought up examples of residents who lacked information. Abramson, the lieutenant governor, says some still pepper him with basic questions, such as where can they find Kynect.
The state set up a call center in mid-August. In the first six weeks, as of Sept. 29, they have received 7,487 calls, with the number of calls growing rapidly by the week, according to Gwenda Bond, assistant communications director with the Cabinet for Health and Family Services. In the last full week they answered more more than 1,000 calls. The top five questions fielded by the call takers include basics like "What is the Affordable Care Act?" and "Will I be covered with a preexisting condition?"
Stewart gets these questions regularly. She says one Kentuckian called her an "angel" after she explained that he could get coverage, even with his old ailments.
Democratic state Rep. Jimmie Lee (Hardin) says the people he hears from mostly have a lot of uncertainty about the coming changes. "I think fear is 90 percent of our problem right now," he says. "The fear of the unknown ... Most of the people that have called me have insurance. They have it now and they are worried they won't be able to keep it."
A lot of time is spent dispelling those myths. One of the more common conspiracies: If you don't sign up for Obamacare, you could end up behind bars. And, of course, the so-called death panels still get brought up in community forums. "The death panels are still not gone," Stewart says. "Those are still coming up. When people bring stuff like that up, I just politely say there's no such thing."
Hoben says people are still unsure the ACA is even real. "One of the things that we've kind of learned -- people are still unclear that the Affordable Care Act is the law. A lot of people think it's been repealed," she explains.
Stewart says the emergency room has become the health care version of food stamps -- its use is eyed with suspicion and resentment. A frequent tall tale, Stewart says, is that, "people are in the ER with splinters."
"I don't know that that's ever happened," Stewart says. "It's been an example that people have thrown at me a couple of times. Blisters and splinters. People go to the ER for a blister."
Abramson offers a simple way to bust through the myths. "What I have found if someone comes up to me and begins to ask questions, you can normally -- from the way they frame the question, you can decide whether they are watching Fox News or they are trying to grasp the facts as they exist," he says. "What I'm trying to do is get to the bottom line -- get them to Kynect by phone or through the computer."
The idea goes that once they hop on to Kynect, they can see for themselves the plans that are out there and what kinds of subsidies might be available. More than 90 percent of uninsured Kentuckians will qualify for some kind of assistance under the ACA.
Make it personal. Not political. Hoben says when she is giving her ACA pitch, she wants to hear Kentuckians tell their own health care stories.
"I met a woman at the London homecoming who has two children, and has KCHIP for them but no health insurance for herself," Hoben says. KCHIP is the state's subsidized health insurance program for low-income children.
"She has not had insurance since she was a dependent and had always neglected her health for that of her two children," Hoben explains. "She had Medicaid when she was pregnant with both of her children, but didn't have any afterward. She has missed work in the past because her illnesses have lasted longer than they would had she been able to get care, which makes it more difficult to pay her family's monthly expenses. She is in nursing school, and won't have an opportunity for employer-sponsored insurance until she graduates, at least two years from now. She says that having the opportunity for health care will be a huge stress relief, both financially and because she can address some lingering health concerns, such as back pain, which could affect her ability to practice nursing when she graduates."
Once Hoben explained the ACA, the woman was hopeful. Now she would have the chance to get health insurance.
Stewart says a lot of people just want to tell their stories, even in rooms filled with strangers. "A lot of people share openly," she says, adding that she expects to be kept after meetings for at least an hour to hear those stories one on one. After a recent event, a woman handed over her cell phone and just told her to tell her mom about the new reforms.
She had to take the phone. "I'm talking to momma who is a manager at a car wash who doesn't have insurance," Stewart recalls. "She was like, 'Will I be able to get help with my blood pressure pills?'"
People actually want health insurance -- even those living in places with universal coverage. "I had a family who moved because his daughter had special needs and the mom is British so they moved to England. Now they want to move back," Stewart says. The family contacted her online. "I introduced him to an immigration attorney. They own a house here but the decision is a factor on whether their daughter gets health care."
Keep it simple. Abramson says there's an easy route to a successful Obamacare argument: Use facts. "Our job is just to get the real facts," he says. "Let us run those facts against your specific, personal profile and here's what it costs and here's what you'll get -- this robust expanded health care list of services. ... When you lay out the specifics, I get a lot of positive feedback."
You meet potential supporters everywhere. Stewart says a surefire way to reach possible Obamacare converts is to go out to eat. "One of my most successful ways to find people," she says. "I ask the servers -- they are typically uninsured."
Stop worrying about the tea party. In Kentucky at least, tea party enthusiasts have largely stayed away from community meetings and interfering with Kynect's rollout, besides an unsuccessful court fight. "I have never faced any opposition," Hoben says.
Jean Klingle, director of education and outreach with Kynect, has spread awareness at the state fair and other events. "We have not seen anything," she says when asked about any tea party presence. "They have not approached us."
Stewart recalls encountering one tea party supporter. "He was there to find out how to get out of [the ACA]," she says. "He stayed the entire time, and was polite. He was one of the ones that said he wanted to avoid jail."