The Patient Protection and Affordable Care Act, common called the ACA or “Obamacare”, is the hottest political topic in years. Even now, four years after it took effect, there are still regular battles to repeal it, weaken it, defund it, and disparage it.

Everyone agrees that it did not end up being a piece of legislation that anyone was happy with. No one seemed to really get what they wanted out of it, despite months of carving up and dealmaking. It became the focus of the 2008 Presidential election. And any politician running for anything above dog catcher is asked where they stand on Obamacare. And some dog catchers are even ready with a non-answer answer.

Commonly, Obamacare is unpopular in red states – those states that typically end up going for Republican candidates in Presidential races. But therein lies the curiosity. Red states tend to also be the poorest, with the most people on the rolls of Medicaid, Food Stamps and other such government programs. Those states actually stand to most benefit from the provisions of Obamacare, especially the expanded Medicaid provisions.

Some say that this benefit is short-lived. They say that such spending will come home to roost when those Medicaid costs are handed back to the states in a few years. Others say that the overall savings due to having healthier citizens, fewer emergency room visits for non-emergency issues, as well as good preventive care will offset those expenses, putting things on the plus side in the end.

No matter which set of numbers you believe, there is a fight brewing. Midterm elections are coming up. People like Senator Mitch McConnell of Kentucky are touting their opposition to Obamacare. His Tea Party opponent out-Herods him by saying McConnell doesn’t do enough to oppose Obamacare, painting McConnell as semi-buddies with Obama.

But the portions of Kentucky that tend to vote for either of these men are racking up some of the biggest numbers in ACA enrollment in the nation. The Courier-Journal reports that more than 370,000 people have enrolled in the expanded Medicaid program or the public exchanges provided by the law. That is one out of every 12 Kentuckians. Kentucky’s ACA website has been the talk of the nation, with its two-term Democrat governor championing it as a way to pull his state out of poverty.

According to the Secretary of State’s website, Kentucky has about 2.8 Million registered voters, though only about 1.7 Million seem to consistently vote. It has about half a million more Democrats registered than Republicans. It went for Bill Clinton both times, but since then the Dems seem to stay home or swing Republican on Presidential election day. On the other hand, It has had only 1 Republican governor in over 40 years, and he was only single-term. Its Secretary of State, Alison Grimes, is Democrat, and she is the presumptive candidate to challenge Mitch McConnell in the mid-terms.

This mix of factors is making some people wonder where things might swing in the mid-terms. Might folks who have voted for Mitch McConnell over and over since the Reagan years end up either voting for Grimes – who already holds a higher office in the state? Or might they even stay home, choosing to sit this one out rather than vote in opposition to their own newly-acquired health care packages?

It is a closely watched race, to be sure. And how this all will play out should make for some classic political theatre.

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