Heading into the 2022 midterm elections, there were still 12 states that refuse to embrace Medicaid expansion through the Affordable Care Act. On Election Day, voters in South Dakota successfully lowered that total to 11 states.

Now, the number is on track to shrink to 10. The News & Observer in Raleigh reported:

The [North Carolina state] House and Senate have agreed to pass Medicaid expansion, reaching a breakthrough after years of debate. House Speaker Tim Moore and Senate leader Phil Berger held a joint news conference on Thursday at the Legislative Building announcing the compromise between the Republican-majority chambers. Democratic Gov. Roy Cooper has been a longtime supporter of expansion, which would provide health insurance coverage to hundreds of thousands of North Carolinians.

Some caveats are in order. The state’s Democratic governor, an enthusiastic proponent of Medicaid expansion, wasn’t involved in the negotiations, so the bill won’t necessarily reflect all of his priorities. What’s more, the legislation still has to actually pass the Republican-led legislature.

That said, there’s clearly reason for optimism.

“An agreement by legislative leaders to expand Medicaid in North Carolina is a monumental step that will save lives and I commend the hard work that got us here,” Cooper said in a written statement. “Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health. I look forward to reviewing the details of the bill.”

Soon after, President Joe Biden was also in a celebratory mood. “I work every day to bring down health care costs, and I’ve called on leaders to do the same. This is what I’m talking about: This bipartisan deal would expand Medicaid to hundreds of thousands of people,” the Democrat wrote on Twitter. “That’ll be 40 states who’ve expanded. 10 more to go.”

The president’s statistic wasn’t an exaggeration: If the state successfully expands Medicaid through the ACA, an estimated 600,000 low-income North Carolinians will finally have access to affordable health care.

All of this comes roughly two years after voters in Oklahoma and Missouri approved Medicaid expansion, which followed similar votes in Idaho, Nebraska, and Utah, where locals also ignored the wishes of their GOP-led state governments and also backed Medicaid expansion at the ballot box.

As for the 10 remaining holdouts, these are the remaining states: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

Of these 10, Kansas, where Democratic Gov. Laura Kelly is starting her second term, is probably the next state where health care advocates should look for a possible breakthrough.

This post revises our related earlier coverage.