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Virginia Attorney General Kenneth T. Cuccinelli II, who was the first to file a lawsuit against the Affordable Care Act shortly after lawmakers passed it, said he will meet with Gov. Bob McDonnell over the next few weeks to decide whether Virginia will participate. He said opting out of the expansion of the federal-state program could save Virginia $200 million a year.

“Now we must squarely face questions like … if we should enter this new program,” Mr. Cuccinelli said. “Given the extraordinary expense to Virginia, there might be reasons for why Virginia might not go down this road.”