The preliminary steps from the eight-year leadership of moderate Democrat Steve Beshear to Tea Party conservative Matt Bevin began behind the scenes and in a cooperative spirit.

But emotions are stirring about a candidate elected with a mandate Tuesday who has promised to cut the size of government, rework public pensions, initiate charter schools, adopt a so-called right-to-work law, blasted Obamacare and embraced the cause of Rowan County Clerk Kim Davis.

But the biggest question to me will be how he chooses to address health care here. Bevin was adamant in February that he wanted to reverse Gov. Steve Beshear's (D) executive order that expanded Medicaid to 138 percent of the federal poverty level.

With more than 400,000 Kentuckians having signed up, that position was untenable in the general election, and Bevin repeatedly tried to walk it back.

He never hedged, however, on his pledge to shutdown Kynect, the state's health care exchange, and transfer those who signed up to the federal exchange.

After two years of being hailed as the nation's gold standard for "Obamacare" implementation, we might be about to find out how it looks when a state goes 180-degrees in the other direction.

Top health policy experts contacted by TPM the day after Bevin's victory weren't panicking or predicting a dramatic rollback of Obamacare in Kentucky. They were generally concerned about mischief Bevin could make at the margins, because any additional hassle faced by insurance customers can dampen participation. But experts watching closely said they were skeptical Bevin would be able to deliver a grave setback to the progress the state has made through its Obamacare programs.

“It is nearly politically impossible to take benefits from people -- even for Republicans,” Caroline Pearson, vice president of Avalere Health, an independent consulting firm and a top expert on health policy, told TPM. “I think that’s not likely to happen, even though that might sell well on the campaign trail.”
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“To the extent that he wanted to disrupt things for people, that would be an option,” Rosenbaum said. The turbulence the transition would cause should not be understated, as users would have to learn a new system. But states are required to give the federal government a year’s notice before eliminating their own exchange, giving the feds time to smooth out the process.

“There’s no reason in terms eligibility why anybody should lose coverage, so the question would be, would they lose coverage because of some bureaucratic screw up in the transfer process,” said Timothy Jost, a health law specialist at the Washington and Lee University School of Law. “If they give a year’s notice, I think it should be feasible to make the transition and there shouldn’t be too much chaos.”

Bevin’s intentions for the Medicaid expansion are much murkier. He could roll it back entirely, as he at first suggested he would do. But in more recent interviews -- perhaps due to political blowback -- he has said he would alter the expansion instead.

“Obamacare is here to stay,” Pearson said. “At this point it’s going to be about how you deliver that coverage more efficiently and sort of modifying the flavor a bit, but none of it’s going to disappear.”