Kentucky voters elected the second Republican in four decades to hold the governor's office, in a race that became something of a referendum on health care reform and gay marriage.
The results Tuesday were a potentially troubling sign for Democrats ahead of next year's presidential election.
Matt Bevin, a Republican businessman, had waged a campaign to scale back the state's Medicaid expansion that was made possible by President Barack Obama's health care overhaul. He also played up his support of Kim Davis, the Rowan County clerk jailed for refusing to issue marriage licenses to same-sex couples.
Bevin's win over two-term Democratic Attorney General Jack Conway is another victory for Republicans as they continue to consolidate political power across the South.
Around the country, voters also weighed several high-profile state and local ballot initiatives, including ones on school funding, marijuana and restrictions on Airbnb. Also on the ballot are mayors in more than 300 cities.