Kentucky voters have elected just the second Republican in four decades to hold the governor’s office, in a race that hinged largely on President Barack Obama’s signature legislation, the Affordable Care Act.

The result was a potentially troubling sign for Democrats ahead of next year’s presidential election and represented a big win for the GOP as it continues to consolidate political power across the South. Democrats also were rebuffed in Virginia, where they made a costly push to win a majority in one chamber of the state Legislature.

The governor’s race in Kentucky was the highest profile contest in Tuesday’s off-year elections. The only other gubernatorial campaign was in Mississippi, where Republican Gov. Phil Bryant easily won re-election.

Elsewhere, Houston voters defeated a closely watched ordinance that would have established nondiscrimination protections for gay and transgender people in the city, and Ohio voters rejected an initiative that sought to legalize the recreational and medicinal use of marijuana.

In Kentucky, Republican businessman Matt Bevin had 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.

“The degree to which the national party is out of step with mainstream Kentuckians has created an environment where it’s extraordinarily difficult for a Democrat to win statewide,” said state Auditor Adam Edelen, who lost his re-election bid to a little-known Republican state representative.

Around the country, several high-profile ballot initiatives tested voter preferences on school funding, marijuana, gay and lesbian rights and the sharing economy. Despite the relatively low number of races, the results could be an important bellwether of sentiment ahead of next year’s presidential elections.

In Virginia, a swing state, Democrats failed in an expensive bid to take control of the state Senate and empower Democratic Gov. Terry McAuliffe in negotiations with Republicans who control the state House. With the losses in Virginia and Kentucky, it was a rough Election Day for Democrats.

“I don’t think you can point to one singular issue as to why these defeats happened tonight, but it’s an opportunity for Democrats to recalibrate and continue to develop a plan and a strategy to win in 2016,” said Tharon Johnson, who led Obama’s 2012 re-election effort in the South and helps oversee finances for the Democratic National Committee.

The governor’s race in Mississippi was overshadowed by a fight over a constitutional amendment that would allow people to sue the state to increase funding for public schools. Voters defeated the proposed amendment.

Critics say it would have taken budget decisions away from Mississippi lawmakers and given the courts too much power.

In Houston, the nation’s fourth-largest city, efforts to secure non-discrimination protections for gay and transgender people failed by a 2-to-1 margin.