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Kentucky's status as a one of the few Southern states to embrace the coverage expansions of the Affordable Care Act was thrown into question Tuesday with the election of Republican Matt Bevin to succeed Democrat Steve Beshear.
Mr. Bevin, a 48-year-old investment manager who has never held public office, defeated Democratic opponent Jack Conway with 52% of the vote.
When Mr. Bevin takes office, Republicans will also control the state Senate, though the Democrats will still hold an eight-seat majority in its House of Representatives. After his victory speech Tuesday night, Mr. Bevin led the crowd in chanting what is sure to be the rallying cry for Kentucky Republicans in 2016: "Flip the House!"
Mr. Bevin has said he would eliminate or modify the state's Medicaid expansion and would abolish the state-based exchange, called Kynect, both of which were established with the support of Gov. Beshear, who couldn't run again because of term limits.
The Obama administration has hailed Kentucky's success at extending health benefits to more residents under the Affordable Care Act. The number of uninsured in the state dropped from 20% in 2013 to about 9% this year.
About 400,000 people in Kentucky qualified for Medicaid with expanded eligibility, and about 100,000 gained coverage through Kynect.
Mr. Bevin may face some opposition, however, if he moves to eliminate the programs. In a recent poll, fewer than a quarter of respondents were in favor rolling back the health care programs, and more than half were opposed.
But even some residents who are enrolled in the expanded Medicaid program or an exchange plan supported Mr. Bevin.
Stanley and Deborah Harp, who own a business in Georgetown, Kentucky, were among Americans who saw their policies canceled after the Affordable Care Act went into effect. They now qualify for Medicaid, but they aren't happy about it and they voted for Mr. Bevin.
"We've had the same doctor groups for the past 20 years who have our history, our kids had as pediatricians," said Deborah Harp.
Mr. Bevin has said he wants to at least modify the state's Medicaid expansion to require recipients to pay premiums for coverage, as have Indiana and other Republican-led states.
Shannon Muchmore writes for Modern Healthcare, a sister publication of Business Insurance.