Fletcher graduated from the University of Kentucky and joined the United States Air Force to pursue his dream of becoming an astronaut. He left the Air Force after budget cuts reduced his squadron's flying time and earned a degree in medicine, hoping to earn a spot as a civilian on a space mission. Deteriorating eyesight eventually ended those hopes, and he entered private practice as a physician and conducted services as a Baptist lay minister. He became active in politics and was elected to the Kentucky House of Representatives in 1994. Two years later he ran for a seat in the U.S. House of Representatives, but lost to incumbent Scotty Baesler. When Baesler retired to run for a seat in the U.S. Senate, Fletcher again ran for the congressional seat and defeated Democratic state senator Ernesto Scorsone. He soon became one of the House Republican caucus' top advisors regarding health care legislation, particularly the Patients' Bill of Rights.