(L-R) Jeff Fletcher, an uninsured resident of Breathitt County, laughs after enrolling in the Affordable Care Act with the help of Kentucky health care exchange navigator Courtney Lively at the Breathitt County Family Health Center on Thursday, November 21, 2013 in Jackson, Ky. Due to poverty and the decline of the coal industry in Appalachia, many residents cannot afford health insurance and are uninsured or rely on the government for their health care needs. (Photo by Luke Sharrett/For The Washington Post via Getty)

FRANKFORT, Ky. — In one of the poorest areas of Appalachia, about 2,500 people have signed up to get health insurance over the last six months — a number that represents more than a tenth of Clay County’s residents.

One-hundred-and-twenty miles way, the county’s state senator, Robert Stivers, is laying out his plans to gradually gut the Affordable Care Act in Kentucky, which provided his constituents with insurance. The soft-spoken 52-year-old Republican is hardly a fiery Tea Party type: He first joined the state Legislature in 1997 and slowly rose through the ranks to become the state Senate president. In a mid-March interview in a small room just off the floor of the Senate in Kentucky’s Capitol building, Stivers acknowledged that Kentucky Gov. Steve Beshear had handled the rollout of President Barack Obama’s health care law smoothly in this state and that some people in his district now have health insurance for the first time.

Stivers, though, is unmoved. The Affordable Care Act, he says, is “unsustainable” in the long run. If Republicans can gain more seats in the state Legislature here over the next year, he said, they will look to peel back Kentucky’s participation in the health care law by limiting the expansion of Medicaid in the state. And he backs scrapping the entire law, too, at the federal level. “I do think it should be repealed,” he said emphatically at the end of the interview.

Kentucky's implementation of the Affordable Care Act has been wildy successful, with a well-functioning state website from day one of open enrollment and a major push that’s led to more than 300,000 signing up for the exchanges or Medicaid. Indeed, the rollout in this red state has been so successful that Obama invited Beshear, a Democrat, to attend the State of the Union address in January and praised him by name during the speech.

Far from being seen as a success story, though, in Kentucky, the health care law and Beshear's strong embrace of it remain deeply controversial. A recent poll showed that a plurality of Kentuckians continue to favor repealing the law. Other than Beshear, many of the state's leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of "Obamacare."

And Kentucky Republicans are acting just like those in Washington and states around the country: GOP state legislators in the Democrat-controlled Kentucky House this month pushed unsuccessfully for a provision to repeal the state’s Medicaid expansion under the ACA and suspend its health care exchange.

“The politics have really not changed,” said Regan Hunt, executive director of Kentucky Voices for Health, a nonprofit group that supports the health care law. She noted that while it’s easy to find Republicans in the state’s Legislature who will publicly blast the law, “I don’t know if we have true Democratic champions” besides Beshear.

The lingering opposition isn’t surprising. Kentucky didn’t become the poster child for Obamacare because of a broad consensus in the state, but because of the actions of one man: Beshear.

Like the rest of the South, the state, once dominated by Democrats, has moved decidedly right over the last 15 years. Bill Clinton won here in 1992 and 1996, but Obama was defeated by 23 points in 2012. Kentucky’s U.S. senators, Mitch McConnell and Rand Paul, are ardent conservatives.

At the same time, five of Kentucky's six statewide nonfederal officers are Democrats, including Beshear, and the party has maintained a majority in the state House of Representatives. That’s because state Democrats distance themselves from the national party whenever possible. Beshear, first elected in 2007, won again in 2011 by blasting Obama as an enemy of the state’s coal industry.

Through his first five years in office, the governor had high approval ratings, but that was largely because he hewed close to the political center.

Then came Obamacare. Freed from political considerations because term limits prevent him from running again, Beshear over the last two years has stunned Republicans and even Democrats here with his forceful advocacy of the ACA. He unilaterally decided to create a health care exchange and expand Medicaid, ignoring complaints from Republicans in the state's Legislature who either opposed those moves outright or wanted to reach some sort of compromise.