Following passage of the Patient Protection and Affordable Care Act (ACA) in the United States, the Kentucky Health Benefit Exchange, Kynect, began operating in Kentucky in October 2013. Kentucky expanded Medicaid eligibility in January 2014. Together, Kynect and Medicaid expansion provided access to affordable health care coverage to hundreds of thousands of individuals in Kentucky. However, following the Kentucky gubernatorial election in 2015, the newly inaugurated governor moved to dismantle Kynect and restructure the Medicaid expansion, jeopardizing public health gains and the state economy. As the first state to announce both the closure and restructuring of a state health insurance marketplace and Medicaid expansion, Kentucky may serve as a test case for the rest of the nation for reversal of ACA-related health policies. This article describes Kynect and the Kentucky Medicaid expansion and examines the potential short-term and long-term impacts that may occur following changes in state health policy. Furthermore, this article will offer potential strategies to ameliorate the expected negative impacts of disruption of both Kynect and the Medicaid expansion, such as the creation of a new state insurance marketplace under a new governor, the implementation of a private option, and increasing the state minimum wage for workers.