The North Dakota House has voted to expand Medicaid to cover more uninsured residents of the state.
The Republican-led chamber approved the bill 57-36. The measure now goes to the Senate.
More than 20,000 people would be added to Medicaid if the program is expanded.
Under the new Affordable Care Act, the federal government would cover the full cost of expanding Medicaid through 2016, with the state's contribution rising in stages to 10%.
Several Republican lawmakers testified that they don't like the new federal law championed by President Barack Obama, but they say it's in the best interest of the state to accept it.