Gov. Andrew M. Cuomo’s challengers on the right and left are reviving the debate over the idea of a single-payer, universal healthcare program for New York state.

Democrat Cynthia Nixon backed the New York Health Act on Tuesday while Republican Dutchess County Executive Marc Molinaro asserted on Wednesday his intention to veto the bill if it were to pass both houses of the Legislature.

“New Yorkers can’t afford a $90 billion annual tax increase,” Molinaro said, sparking a debate between legislators and policy analysts on Twitter.

The bill, sponsored by Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, has passed the Assembly numerous times, but has not been brought to the floor for a vote in the Republican-controlled Senate. It is co-sponsored by every member of the Senate Democratic caucus, and the bill’s prospects could change if Democrats retake the Senate in November.

The governor appears undecided on the program. Last year, he called it a “very exciting possibility” but said it’s feasibility would depend on the federal government’s response.

Since New York’s Medicaid program is reliant on federal funding, it would be detrimental to the state if “they turn off that valve or slow that valve,” Cuomo said on the WNYC-produced Brian Lehrer Show in 2017.

“His statement is very reasonable for a governor at this point, and it’s probably a warmer statement about the bill than you’d hear from 49 other governors,” said Gottfried, who has introduced his single-payer bill every year since 1992. “I’m personally very optimistic that as he looks into it more deeply, he would end up supporting the bill.”

Regarding Molinaro’s opposition, Gottfried said he wasn’t surprised. “That’s an utterly conventional Republican position,” he said.

The legislation has long been debated by Gottfried, who projects it will save the state $45 billion a year, and the conservative-leaning Empire Center for Public Policy’s Bill Hammond, who said implementation will be prohibitively expensive and poses many logistical challenges, beginning with securing a waiver from the federal government.

“I don’t think it’s gotten anywhere near the serious thought it deserves because it hasn’t been  a serious possibility,” Hammond said. “I’m grateful that this is coming up in the governor’s race because it’s important to get whomever is going to be the next governor on record.”

Similar programs have been introduced and debated in a number of state legislatures, including Hawaii and California. Vermont’s failure to implement a single-payer health system after becoming the first state to pass such a program in 2014 is often cited by detractors of the program. Gottfried maintains that there were other issues at play in Vermont, and lessons to be learned from a failed single-payer healthcare referendum in Colorado.

The state would have to raise $91 billion in revenue to fund the single-payer system, and any revenue proposal would need to account for the potential ending of local payments for Medicaid, according to the New York bill.

On a federal level, support for Senator Bernie Sanders’ Medicare for All bill has become a litmus test of sorts for Democrats, and several rumored 2020 presidential contenders, including Sen. Kirsten Gillibrand, have backed the bill. A spokesman for Cuomo, who is believed to have presidential aspirations, did not respond to the question definitively.

Former Syracuse Mayor Stephanie Miner, who is running for governor independently on a newly created line, said she would support single-payer system “if we can make the numbers work.”

“All other states that have tried to go single payer haven’t been successful,” she said. “I understand the need to reform our health care system and provide affordable and accessible health care for everyone. As governor, I will be committed to working on that goal.”

Green Party gubernatorial candidate Howie Hawkins said he has campaigned for single-payer healthcare “since before it was written.”