Health and education in Kentucky: Where Obamacare dare not speak its name THE president is unpopular in Kentucky. In its mountainous east, his name is radioactive: in Clay County, for example, he won only 15% of the vote to Mitt Romney's 84% in 2012. Even Democrats have doubts: in the state's primary that year 42% of them chose "uncommitted" rather than vote for Barack Obama. Yet some of his policies are popular - so long as they are not labelled as having anything to do with him. Take the Affordable Care Act, better known as "Obamacare." The people whose job it is to persuade rural Kentuckians to sign up for it play down any connection with Washington, DC, or even with Frankfort, the state capital. Cara Stewart, an Obamacare promoter in Clay County, is hard at work wooing parents and grandparents at a school Thanksgiving pageant. A relentlessly upbeat young woman, she bounces from table to table where folks are cramming themselves with turkey and mashed potatoes. She starts by reassuring them that she comes from eastern Kentucky - she is one of them, not a carpetbagger. She tells them that they have "a health-care option." She informs a grandmother that "almost everyone can get some assistance." The grandmother, who is in remission from cancer, learns that her husband could receive Medicaid (health care for the cash-strapped: a government programme that many Americans are qualified for but do not realise it). An older man with a natty moustache says he has heard that the (federal) government's health-care website isn't working. "That doesn't matter for us," says Ms Stewart. Here in Kentucky we have our own website. And it works. Kentucky is the only southern state that is enthusiastically implementing Obamacare. Its Democratic governor, Steve Beshear, agreed both to expand Medicaid (an important plank of the reform) and to set up a state-run health-insurance exchange, known as "kynect." By December 5th nearly 454,000 Kentuckians had undergone preliminary screening to determine eligibility for Medicaid or subsidised coverage, and almost 72,000 had enrolled. Only in Washington state has a larger proportion of people applied for coverage. In other states, Obamacare promoters are called "navigators." In the Bluegrass State they are called "kynectors" - and they operate in all 120 counties. Keeping them local, says Carrie Banahan, who heads the kynect office, fosters trust: "People know them; they go to church with them; maybe their kids go to school together. They're comfortable filling in applications and sharing personal information with them. Bluegrass, Blue Shield This is just as well, for Kentuckians are an unhealthy bunch: more likely to smoke or die of cancer than people in any other state, and in the worst ten for heart disease and obesity. Some 17.5% of Kentuckians under 65 lack health insurance. A white paper for the state's healthcare agency estimated that 276,000 will be able to get subsidised coverage through kynect (federal subsidies cover people with incomes up to 400% of the federal poverty line); another 308,000 will be eligible for Medicaid. For a relatively poor state like Kentucky, embracing Obamacare is a neat way to grab federal subsidies. Uncle Sam initially covers 100% of Medicaid costs for new enrollees; in 2020 it will still cover 90%. The white paper forecasts a net economic benefit of $15.6 billion for Kentucky between now and 2021, as federal cash pours in and pays for thousands of new jobs. The most powerful Kentuckian in Washington, DC, Mitch McConnell, the top Republican in the Senate, calls Obamacare a "disaster." But it also represents a big transfer of wealth from other states to Kentucky. Mr Obama's school policies are also more popular in Kentucky than the man himself. It was the first state to adopt "Common Core" standards, in 2010: these set out essential skills that pupils are expected to learn each year. Mr Obama's administration did not create Common Core, but it has made some federal funds conditional on accepting it. So far 45 states have done so, but some red-state governors, such as Rick Perry of Texas, consider it an unwelcome federal intrusion. Legislation to repeal it is pending in at least 12 states. In Kentucky, however, criticism has so far been muted. Terry Holliday, the state's education commissioner, puts that down to a "massive communications campaign." Mr Holliday and Dave Adkisson, the head of Kentucky's Chamber of Commerce, toured the state making speeches about the three Es: education, employment and the economy. "We explained to people that standards are just strategies to help Kentucky," says Mr Holliday. Such advocacy matters: one of the political risks of stricter standards is that they reveal how badly Kentuckian children are really doing. When Kentucky first administered the new tests in 2012, the share of elementary-school pupils who were rated "proficient" in reading plunged from 76% to 48%; in maths, from 73% to 40%. Grumbles are growing. On November 13th a father of two Kentucky pupils sued Mr Beshear and other state officials, complaining that the standards were adopted "without sufficient knowledge or understanding of the costs of such action, in violation of state law." Still, Mr Beshear is holding firm: he has invested a great deal of political capital in both reforms. He says that Kentuckians are "practical," and "want their political leaders to make things happen to improve their quality of life." Perhaps this is why he is more popular in Kentucky than Mr McConnell, who faces a difficult re-election battle next year.