Why nearly half a million Kentuckians woke up this morning wondering if they'll lose their health insurance

Kentucky is a bit of an anomaly when it comes to the Affordable Care Act. In contrast to other deep red states like Texas, Oklahoma, and Louisiana, the Bluegrass State embraced the Medicaid expansion under the new healthcare law and set up its own exchange. The move worked out well: More than 400,000 people became insured through Medicaid and the state exchange, Kynect, and Kentucky has seen the second largest drop in its uninsured rate in the country.

But Tuesday’s election could change all that. Matt Bevin, the conservative Republican and Tea Party-favorite who won the governor’s race, campaigned hard on dismantling some of the policies, like the Medicaid expansion, enacted by his Democratic predecessor.

“Of necessity we must scale this back,” Bevin said last month on Kentucky Public Radio. “The way you do this is just to make it not as accessible for folks going forward. There’s re-enrollment for Medicaid, just as there is for any number of other programs, etc. So we would not allow people to re-enroll, going forward, at 138% of the federal poverty level.”

But it seems that even Bevin acknowledges that immediately pushing the newly insured off Medicaid could be disastrous:

Is that done immediately? That will be done in a uniform fashion because you can’t just simply end it on day one. You have to of necessity start to do this as people enroll anyhow. So we are going to scale it back. We cannot afford to do otherwise.

The question now is what will happen to the people in Kentucky who, if they lose access to Medicaid, will have to go without insurance because they cannot afford to do otherwise.