In states without Medicaid expansion, collectively more than 2 million Americans are in the so-called coverage gap with incomes too high to qualify for Medicaid but too low to qualify for federal subsidies.

South Dakota voters will decide in November whether the state should become the 39th to expand Medicaid under the Affordable Care Act, a move that would provide coverage to 42,000 low-income residents.

State officials on Monday officially placed the issue on the ballot after validating thousands of petition signatures.

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