Kentucky voters have elected just the second Republican in four decades to hold the governor's office.
Republican businessman Matt Bevin waged a campaign to scale back the state's Medicaid expansion that was made possible under the federal health care overhaul. Some 400,000 lower-income people who gained health coverage under the expansion could be affected.
Bevin ran as an outsider, emphasizing his Christian faith along with his support for Kim Davis, the Rowan County clerk jailed for refusing to issue marriage licenses to same-sex couples.
His Democratic opponent, two-term Attorney General Jack Conway, embraced Obama's health care reforms, saying hundreds of thousands of residents could lose access to taxpayer-funded insurance if Bevin won.
Republican victories for governor and three other statewide offices in Kentucky severely crippled one of the few remaining viable Democratic parties in the South.
Kentucky is still the only Southern state where Democrats control the House of Representatives. But Republicans now control four of the six statewide constitutional seats, including the governor's office. And they have a supermajority in the state Senate.
Democratic Auditor Adam Edelen — who lost his re-election bid — says the national Democratic Party is out of step with mainstream residents of Kentucky, making it difficult for the party's candidates to win statewide. Other Democrats, including Secretary of State Alison Lundergan Grimes, say the party must begin to rebuild.
Republican Gov.-elect Matt Bevin called for unity and vowed to work with politicians from both parties when he takes office.