The view from the ground: How the health law is playing

News outlets examine how political stigma, expectations, understanding and misunderstanding are playing roles in the health law's impact in states like West Virginia, Kentucky and Colorado.

The New York Times: In Poorest States, Political Stigma Is Depressing Participation In Health Law
Inside the sleek hillside headquarters of Valley Health Systems, built with a grant from the health care law, two employees played an advertisement they had helped produce to promote the law's insurance coverage for young, working-class West Virginians. The ads ran just over 100 times during the recent six-month enrollment period. But three conservative groups ran 12 times as many, to oppose the law and the local Democratic congressman who voted for it. This is a disparity with consequences. Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular (Calmes, 4/26).

USA Today/Louisville Courier Journal: Health Care's Appalachian Spring: Obamacare Comes To An Old Battlefield In The War On Poverty
When Eula Hall is asked about Obamacare, you expect this veteran of the war on poverty, who lives in the sickest county in one of the sickest states, to sing hosannas. Instead, she hedges. ... "We'll have to wait and see." Her ambivalence, which largely epitomizes Floyd County's reaction to Obamacare, contrasts with some outsized expectations. ... Four months after it took effect, Obamacare here is a neither a train wreck nor a cure-all. It's a work in progress, widely misrepresented and misunderstood. Some people have been helped, some hurt, and many others affected not at all (O'Donnell, Hampson, Kenning and Ungar, 4/26).

USA Today/Louisville Courier Journal: Scenes From Floyd County, Kentucky: A Closer Look At The Affordable Care Act's Impact In Eastern Kentucky
Of the many groups affected by Obamacare, small business owners -- those with at least 50 full-time employees -- are among the most aggrieved by the law's requirement to provide their workers with insurance. ... Nearly four of 10 adults in Floyd County, Ky., have lost at least six teeth because of decay or gum disease. Statewide, more than half of adults have had at least one tooth pulled, and a quarter of those over 65 have lost all their teeth. When it comes to dental care, the Affordable Care Act's reach is limited (4/27).

The Denver Post:  Health Law Presents Options, Challenges For Colorado Small Businesses
About half of small businesses in Colorado are seeing double-digit premium increases under the ACA while the other half are seeing the typical single-digit increases they have had for years, said Jim Sugden, small-business marketplace manager for the state exchange. He was not surprised that some companies are getting out of providing health insurance for employees. Jim Noon, owner of Denver cardboard box seller Centennial Container, has offered his employees health care coverage for three decades, but he isn't sure he will continue to offer the benefit after this year (Kane, 4/27).