While much of the political attention is on the 2016 presidential race, there’s also a big election that’s not getting nearly as much coverage — and it’s taking place this week.

As John Oliver pointed out on HBO’s “Last Week Tonight,” this week’s election could determine who might fall into the “Medicaid Gap” in several states.

“I know that sounds like a terrible clothing chain where you can buy khaki hospital gowns sewn by children in India,” Oliver said. “But amazingly, it’s even worse than that.”

The gap refers to people who earn too much money to qualify for Medicaid, but not enough to be eligible for subsidized insurance under the Affordable Care Act.

The ACA was supposed to expand Medicaid to cover more people, but the Supreme Court ruling that upheld it also allowed states to opt out of that expansion.

Or as Oliver pointed out, it didn’t uphold all of the law… just “nearly all” of the law:

The federal government is covering most of the cost of that expansion, but governors that accept the money to expand the program have come under fire from conservatives.

Ohio Gov. John Kasich, who is seeking the Republican presidential nomination, has been defending himself for accepting the federal subsidies to expand Medicaid in his state.

“Good for him. Although it’s a bit weird when accepting billions of dollars to give healthcare to poor people is somehow a brave and noble stand,” Oliver said. “All Kasich technically did was see a dump truck full of money backing into his driveway and not say ‘stop.'”

Check out the clip above to find out what’s really at stake for hundreds of thousands of Americans on Tuesday.

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