In its initial formulation, the ACA linked a host of federal payments to each state’s participation in health care reform. Thanks in part to an amicus brief filed by a conservative Vanderbilt University law professor named James Blumstein, the court ruled that the ACA exceeded its constitutional authority by “coercing” states into participating in Medicaid expansion. The court held that Medicaid expansion was “optional” for states and that each state could make its own choices about coverage for the less fortunate.4
