FRANKFORT, Kentucky — Republican Matt Bevin's win in the governor's race here gives the Republicans near total control of statehouses in the South and could result in the dismantling of one of the most extensive efforts to implement Obamacare of any state in the country.
Bevin, who has never before held elective office, is a controversial figure here — even among Republicans. He clashed with the party establishment last year when he challenged incumbent U.S. Senate Mitch McConnell. And he was sharply criticized during his 2014 Senate campaign for attending a pro-cockfighting rally. (Bevin does not support cockfighting and later apologized for the appearance.)
But Kentucky, like much of the South, has shifted towards Republicans over the last decade. Bill Clinton won the state in 1992 and 1996, but Barack Obama lost here in 2012 by 22 points.
Bevin ran an unabashedly conservative campaign, promising to pass a right-to-work law and create a school vouchers program. When Rowan County clerk Kim Davis refused to issue marriage licenses to gay couples this summer, Bevin strongly defended her, even visiting Davis in jail. He also emphasized the national Planned Parenthood controversy, attacking the group on the campaign trail.
And the Republican used his television commercials to link Kentucky Attorney General Jack Conway, his Democratic opponent, to President Obama, who remains deeply unpopular here.
The defeat of Conway is also a blow to those who back the Affordable Care Act. Outgoing Gov. Steve Beshear, a Democrat, was a huge proponent of the law, accepting billions in Medicaid funding under Obamacare, becoming one of the few governors in the country to set up a statewide exchange and campaigning all over the state to encourage people to enroll in the new health insurance.
Kentucky's uninsured rate declined over the last two years from 14% to 9%, according to the United States Census Bureau, the biggest drop of any state in the country. And more than 400,000 people have newly enrolled in Medicaid.
Conway campaigned on implementing the law as Beshear had, even as he avoided the term "Obamacare." Bevin promised to get rid of the state exchange, which would leave the federal government in charge of promoting health insurance and enrolling people in the state. And he has raised concerns about the Medicaid expansion, arguing the state won't be able to afford it once the federal government stops paying the full cost, leaving Kentucky to provide 10% of the cost for the new Medicaid recipients.
But after suggesting in the early stages of the campaign he would halt the Medicaid expansion, Bevin softened his stance. He now says he will follow the model of Republican governors like Indiana's Mike Pence, who have accepted the federal Medicaid funding but added changes like requiring some recipients to pay premium fees.
"We're going to use what's called 1115 waivers. An 1115 waiver will be our request to CMS [the federal agency that runs Medicaid) for basically the ability to take a block grant and customize as Indiana and others have done to actually come up with a program that will provide for these folks," Bevin said in an interview with NBC News on Monday.
"Nobody's losing anything," he added.
But Obamacare advocates in Kentucky are wary of how Bevin will approach the issue once in office.
"I think there is a real risk of Kentucky losing coverage with this election," said Emily Beauregard, executive director of Kentucky Voices for Health, a non-partisan group that supports the Affordable Care Act implementation in the state.
"A plan like Indiana's is going to limit coverage for Kentuckians. That's the bottom line. Fewer Kentuckians would get coverage," she added.
Democratic strategists say that while Conway emphasized the health care issue during his campaign, it is hard to mobilize the newly insured into a voting bloc. Medicaid recipients are not organized in a group with a formal e-mail list, like teachers are through the National Education Association and gun owners are with the NRA.
Arkansas and Kentucky were among the states where the uninsured rates dropped the most since the implementation of the health care law. Arkansas replaced its pro-Obamacare Democratic governor with a Republican last year, and Kentucky did the same on Tuesday.
Bevin's victory further reduces the ranks of Democratic governors, a year after the party lost gubernatorial races even in blue states like Illinois and Maryland.
After Beshear departs, there will be just 17 Democratic governors and only three in what the Census Bureau defines as the South. (Delaware [yes, the Census counts it as the South], Virginia and West Virginia.)
Louisiana is holding a runoff for its gubernatorial election on Nov. 21, and the Democratic candidate Jon Bel Edwards is running closer than expected, but still remains an underdog in that red state.
On policy, Bevin is expected to follow in the model of other Republicans elected in the Midwest and South, like Michigan's Rick Snyder and Wisconsin's Scott Walker. Those governors have pushed business-friendly measures like right-to-work laws and opposed more liberal polices such as raising the state minimum wage.
"We are getting beat out by Tennessee. We are getting beat out by Indiana," McConnell said on Monday, campaigning alongside Bevin.
Bevin will be limited in the steps he can take, because Democrats still control the Kentucky State House.
But Democrats here say that if a controversial Republican candidate like Bevin can be elected in Kentucky, the state could be heading the direction of Mississippi and other places in the South, where Republicans win nearly all elections at both the state and federal level.
The Democratic Party is increasingly reliant on white urbanities and minorities to win elections, and Kentucky is proportionately white, rural and working class.
"We are not finished in Kentucky. We are not finished in Kentucky," Kentucky Democratic Party Chairman Patrick Hughes told a stunned crowd of Democrats at the party's election night event here.
This story originally appeared on NBCNews.com