THE BURNED OVER DISTRICT

Here comes the Kentucky syndrome. Perhaps it is just a variation on why domestic abuse victims stay with their abusers, but the people of Kentucky are poised to vote for the very people who kick them like dogs on the furniture.

The Affordable Care Act allowed Robin Evans, an eBay warehouse packer earning $9 an hour, to sign up for Medicaid this year. She is being treated for high blood pressure and Graves’ disease, an autoimmune disorder, after years of going uninsured and rarely seeing doctors.

“I’m tickled to death with it,” Ms. Evans, 49, said of her new coverage as she walked around the Kentucky State Fair recently with her daughter, who also qualified for Medicaid under the law. “It’s helped me out a bunch.”

But Ms. Evans scowled at the mention of President Obama — “Nobody don’t care for nobody no more, and I think he’s got a lot to do with that,” she explained — and said she would vote this fall for Senator Mitch McConnell, the Kentucky Republican and minority leader, who is fond of saying the health care law should be “pulled out root and branch.”

Ms. Evans said she did not want the law repealed but had too many overall reservations about Democrats to switch her vote. “Born and raised Republican,” she said of herself. “I ain’t planning on changing now.”

Kentucky is arguably one of the health law’s biggest early success stories, with about 10 percent of the population getting coverage through the state’s online insurance marketplace — albeit mostly through Medicaid, not private plans — and none of the technology failures that plagued other enrollment websites. The uninsured rate here has fallen to 11.9 percent from 20.4 percent, according to a recent Gallup poll that found only Arkansas experienced a steeper decline.

But there is little evidence that the expansion of health coverage will help Kentucky Democrats in this fall’s midterm elections. Republicans hold all of the state’s Congressional seats except for one, in a district centered in Louisville, and none are considered vulnerable this year. Republicans, who already control the State Senate, have a chance of taking the State House of Representatives, where Democrats hold an eight-seat majority. And several recent polls have put Mr. McConnell ahead of his Democratic opponent, Alison Lundergan Grimes, even though his approval ratings are tepid.

Mr. McConnell and other Republicans here, while more focused on other issues, like protecting Kentucky’s coal industry, continue to attack the health law as a symbol of government overreach and Democratic bungling. And far from flaunting Kentucky’s strong enrollment numbers, Democratic candidates — most notably Ms. Grimes — have remained reticent about the law, even its successes.

“Born and raised Republican,” is no reason why she should support a man who would be happy to take away the program that will keep her alive. It is quite obvious in Kentucky that years of pouring bullshit into their ears has replaced the brains of far too many of them.