Health care appears to have played an unexpectedly robust role in Tuesday's off-year elections, as Democrats swept statewide races in Virginia and New Jersey and voters told pollsters it was a top concern.

The health headline of the night came in Maine, where voters by a large margin rebuked Republican Gov. Paul LePage and approved a referendum expanding Medicaid under the Affordable Care Act. Maine is one of 19 states that has not expanded the program to people with incomes up to 138 percent of the federal poverty line, or about $16,600 for an individual. An estimated 70,000 to 90,000 Mainers could gain insurance under the expansion.

The Legislature has passed similar bills five times, but LePage vetoed each one. And despite Tuesday's outcome, he held firm in his opposition. The governor announced Wednesday that he would not implement the expansion, which he said would be "ruinous" for the state's budget, unless it is fully funded by the Legislature.