McAuliffe wants Medicaid to be expanded, Cuccinelli doesn't.
In Virginia, voters are about to make a choice between two candidates who have a stark difference of opinion about expanding Medicaid.
These days, most of the talk about the Patient Protection and Affordable Care Act has turned to the exchanges, where people without health insurance can sign up to get coverage. But next week, voters in Virginia will participate in a referendum of sorts on a different key provision of the law — whether or not Virginia should expand Medicaid to 400,000 new recipients. Republican Ken Cuccinelli says no.
"I am not willing to risk Virginia's budget when the federal government is already taking the position, many of them are taking the position, that they can't afford it even if they wanted to," he says.
Under the new law, the federal government would pick up 100 percent of the cost of expanding health care for poor people and the disabled until 2016. Then Virginia would be required to pay for 10 percent of the program. But what happens after that? Cuccinelli says he doesn't want to find out.
Democrat Terry McAuliffe says it would be irresponsible not to take advantage of the money, which will be taken from Virginia taxpayers whether the commonwealth participates or not.
"We are going to bring back to Virginia over the course of the next seven years, $21 billion of our money that we are paying in," he says.
Some of the politics are familiar, with Republicans standing against President Barack Obama's healthcare reform and Democrats standing with it. But University of Virginia Center for Politics analyst Kyle Kondik says the politics of Medicaid expansion cross party lines because of the money involved.
"Some traditional constituency groups, including for instance hospitals and doctors, really want it because it's essentially good for the bottom line for hospitals and then by extension doctors," he says.
A commission created earlier this year to consider whether Medicaid expansion should move forward. That commission has yet to make a ruling, although the next governor is expected to play a major role in the process.