Complete rollback?

The election of a conservative outsider as Kentucky governor has given Republicans a laboratory to show the rest of the country how they’d replace President Barack Obama’s health care law.

Three years into a coverage expansion that has brought the share of uninsured Americans to historically low levels, Matt Bevin’s lopsided victory underscores how politically divisive the law remains. But experts say slamming the brakes in a state already deeply entrenched in the Affordable Care Act would cost lots of time and money, testing the new Republican administration’s ability to rein in costs.

Kentucky has been one of the health care law’s success stories. The share of uninsured state residents has been slashed from about 20 percent in 2013 to 9 percent by the middle of this year, according to the Gallup-Healthways Well-Being Index, a major independent survey. Experts credit that to a synergy between Kentucky’s state-run insurance marketplace and the decision to embrace Medicaid expansion.

But the expansion added 400,000 people to the state’s Medicaid rolls, more than twice what officials had predicted. Combined with the existing Medicaid program, Kentucky taxpayers now pay for the health insurance of a quarter of the state’s population. The state will begin paying for the expansion in 2017, and costs could surpass $300 million by 2020.

“(Bevin) is the one who has received the mandate here. We have to do something different,” said Republican state Sen. Ralph Alvarado, a doctor who opposes the Affordable Care Act. “The legislature and the governor needs to follow through. It’s clear on what voters are telling us they want to do.”

Outgoing Democratic Gov. Steve Beshear initiated both the insurance exchange and the Medicaid expansion by executive action. Bevin has said he’d dismantle the insurance marketplace, which would revert to federal operation. Kentucky would become the first state to do so for political reasons. Residents covered through the marketplace would continue to get subsidized health insurance, but they would do so through the federal website HealthCare.gov.

On Medicaid, it’s unclear how far Bevin would push for changes. He has said he would reverse the expansion “immediately,” and his campaign website says the Medicaid expansion “should be repealed.” But Bevin has tried to walk back those comments when confronted with the fact that a complete rollback would mean 400,000 people losing coverage.