The 2014 midterm elections could reshape how states go about implementing federal health insurance laws and other federal insurance laws and policies.

At press time, only 16 state governorships were firmly in Democratic hands. Democrats had a shot at seeing their candidates lead three other states.

Republicans had a firm hold on 31 governorships. Because of a combination of concerns about the Patient Protection and Affordable Care Act (PPACA), the soft economy, and other local and national issues, Republicans succeeded at wrestling governorships away from Democrats in traditional Democratic strongholds such as Arkansas, Illinois, Maryland and Massachusetts.

Pennsylvania is the only state in which a Democrat took a governorship away from a Republican. There, Tom Wolf has defeated Tom Corbett, a strong PPACA opponent.

It’s not immediately clear what effect the Republican wins will have on their states’ PPACA public exchange program. In Massachusetts, for example, previous governor, Deval Patrick, had little luck with getting his state’s exchange to work. The incoming governor, Charlie Baker, has talked about applying for waivers from some federal requirements but has not suggested that his state should shut down its exchange.

But new governors with the ability to appoint their own insurance commissioners could change PPACA implementation that way, and influence the implementation policies the National Association of Insurance Commissioners (NAIC) sets.

See also: NAIC appoints Adam Hamm to FSOC.

Meanwhile, voters in three states — California, Georgia and Kansas – voted on insurance commissioners at the polls, and voters in California and Louisiana voted on ballot measures with major implications for the health insurance and long-term care insurance (LTCI) markets.

Here’s a look at the results.

1. California

Dave Jones, the Democratic incumbent, won with 56 percent of the vote.

Ted Gaines, the owner of Gaines Insurance Agency Inc. and vice chair of the state Senate Insurance Committee, received 44 percent of the vote.

Insurers and their allies — including allies at Covered California, the state’s state-based PPACA public exchange, managed to defeat the Proposition 45 health insurance rate change referendum, with 60 percent of the voters voting against the measure.

Supporters argued that the measure would have given consumers much-needed power to slow unreasonable health insurance rate increases, by letting consumers go to court to oppose increases. Opponents argued that the private-right-of-action provision would have encouraged lawyers to file rate increase suits to maximize their own income.

2. Georgia

Ralph Hudgens, a Republican incumbent, won re-election with 55 percent of the vote.

Elizabeth Johnson, a Democrat, won 42 percent of the vote.

Edward Metz, a Libertarian, won 3.4 percent of the vote.

3. Kansas

Ken Selzer, a Republican Certified Public Accountant (CPA) who presented himself on election posters as “Ken Selzer, CPA,” won with 62 percent of the vote.

Dennis Anderson, the Democrat, received 38 percent of the vote.

Selzer emphasized that he was a pragmatist, during an election in which Democrats argued that they had to take Kansas back from extremists. Selzer got a much higher percentage of the vote than Pat Roberts, the Republican senatorial incumbent, who won re-election to the Senate with 53 percent of the vote, and Sam Brownback, the Republican gubernatorial incumbent, who won re-election to his seat with 50 percent of the vote.

Sandy Praeger, the Republican incumbent, is retiring.

Surgeon

4. Louisiana

Voters in Louisiana approved a Medical Assistance Trust Fund ballot measure with a 56 percent vote, and a Hospital Stabilization Fund measure with a 56 percent.

The medical assistance measure is supposed to add constitutional protection to the money in an existing state fund, and set a minimum baseline pay rate for participating nursing homes and other participating providers.

The hospital fund measure is supposed to impose an assessment that would create a new, constitutionally protected fund for hospitals, and use that fund to draw matching funds from the federal Medicaid program.

See also: Health insurance costs to soar in some states