I will comment on your questions. If by engage you mean have a rational-seeking discussion of matters like the ACA, I believe they are deep into the thicket of madness, and can't be reached. But that is because they do not want to be reached. They have chosen the safety of madness over the pain of reality. They have identified with a style of programmed thought that was once a past cultural norm, and comforts the ego in substitution for lost feelings or real self respect. I believe this culture is part of the culture of civil war defeat, the bitter recriminations and self assurance that is created by losing a war. War destroys, and a civil war destroys unity, the sense that we are all one American people.
But the history of this, while it would make a fascinating study, deserving of more time, effort, and scholarship and insight than I have, is also a huge topic rather unmanageable here.
The point I want to make, is that however ones sense of self loathing is created, the methodology is being put down as children, and being made to feel inferior to somebody else, such that the qualities of that somebody else, the perfect example of what one is supposed to be becomes amorphously assimilated as an idea. I say vague because no real standard for what the normal ideal person a child is supposed to become exists. You get punished for this behavior and punished for that and just grow up with the fear you will fail to be some illusive ideal person.
The important point is that once a child understands that it can and does deviate from perfection, creating the wrath of its parents, it abandons its natural personhood and seeks to please by conforming to some magical illusive ideal. The child loses its true self and becomes a token being, a member of some external standard from which it can draw security. We conform to survive and we have to in order to end our psychic torment.
So the important thing about this, is that the insanity you see in CPAC types isn't actually their fault nor is it something they can willfully change. In order to really change, they have both to see the process that created them and re-experience the pain that created their delusional condition. The generally accepted way I see this happening is for people to bottom out. I think we can see that happening today. It's why you say, 'the insight is frightening'.
The deeper into madness they sink, the more they will terrify each other and thus themselves. And the more terrified they become the faster they will sink. Hopefully, it's a plague that burns itself out as culture death. And every child born in a mad culture is born fresh. There are always those who escape the program and inhabit the real world and take the red pill.
As to "How do you even get back to some basic understanding of reality for them?", I believe you do that by doing it yourself. The only person any of us can change is ourselves, and as I pointed out, it ain't easy. It requires that you love the other because in the other we see what we are terrified to see in ourselves. When one loves the other one can love oneself. And I also believe that those rare folk who truly do love the other, to them and them alone, is given the knowledge of what to do. I myself have no idea.
I try to provide a mirror in which our insanity is reflected. I try to help people see how they feel by how they feel about me. I try to turn ape shit into a few dozen roses I can sell on my little garden plot I have here. This post may bring a few contributions.
It is very encouraging to me that you have the questions you do. They badly need answers.