Before the ink was even dry on the Affordable Care Act back in March 2010, Senate Minority Leader Mitch McConnell (R-KY) announced his Republican Party's response. "I think the slogan will be "repeal and replace", "repeal and replace," Mr. McConnell said. "No one that I know in the Republican conference in the Senate believes that no action is appropriate."
Four years and 17 million ACA enrollees later, Congressional Republicans admit they still don't have a plan to replace it with. But while Senator McConnell is still calling the Affordable Act "disastrous" and "catastrophic," 370,000 of his constituents who obtained coverage through his state's Kynect health care marketplace would disagree. Making matters worse back home for McConnell, the enrollment rates are highest precisely where Republicans poll best.
That's the word from the Lexington Herald-Leader, which in late February reported "Eastern Kentucky counties lead in enrollment for Affordable Care Act":

Kynect.Ky.gov is the tool Kentuckians have used to sign up for health insurance, but in Estern Kentucky an old fashioned, boots-on-the-ground outreach -- in restaurants, cash advance businesses, and churches -- appears to be key to getting people to use the website...
A Herald-Leader analysis of who has enrolled and where shows that the percentage of previously uninsured who now have health insurance ranges from a high of 67 percent in Perry County to a low of 17 percent in Owen County.
A cluster of nine contiguous counties in southeastern Kentucky -- Perry, Leslie, Letcher, Breathitt, Owsley, Harlan, Wolfe, Lee, Letcher -- and their near neighbor, Whitley, have the highest rates of enrollment.

Many of those counties provided Mitt Romney with 40, 50 and even 60-point margins over Barack Obama in the 2012 election.
Those same counties also have the highest rate of enrollment perhaps because they also have the highest rates of uninsured residents and the worst health care outcomes in Kentucky. And that's saying something in a state America's Health Rankings scored 45th overall, with rankings for smoking (50), diabetes (38) and obesity (42) among the worst in the country. The Commonwealth Fund's State Healthcare Scorecard gave the home of Mitch McConnell and Rand Paul the same grim 45th place. And as it turns out, the Kentucky counties with the very worst health care outcomes are all within hollerin' distance (pun intended) of Rep. Hal Rogers, whose district leads the Blue Grass state in food stamp recipients as a percentage of the population.
Already facing a tough reelection fight, Mitch McConnell is going have to explain to those 370,000 people--1 in 12 of all Kentuckians and equal to about 27 percent of the entire 2010 midterm electorate--why he wants to take away their health insurance. And as their numbers continue to grow with late sign-ups for private insurance and ongoing Medicaid enrollment, McConnell's only plan for hundreds of thousands of his "diskynected" constituents is to tell them to go to the emergency room. As he described the plight of the nation's 47 million uninsured five years ago:

"They don't go without health care."