The lawsuit claims that it compels the states to enforce the federal law or to operate exchanges that would make health insurance available to consumers. Section 1321 gives states the choice of doing so or not, and if states elect not to do so, the federal government will enforce the law and operate the exchange in the state.
No state has to do anything, except make its choice known to the federal government. Moreover, section 1333 of the act allows states to apply for a waiver to take a completely different approach to covering their residents if they have a better idea.
The complaint also attacks the provisions of the law that provide Medicaid coverage for all Americans whose income is under 133 percent of the poverty level. These Medicaid expansions are not effective until 2014, and the federal government pays the entire cost until 2017, after which the state's share gradually increases to 10 percent by 2020.
It is hard to understand how the states are harmed in any way by the billions of dollars the Medicaid expansions will pour into their states to cover millions of their residents, many of whom would otherwise be treated by providers without compensation. But in any event, states can simply opt out of Medicaid if they choose not to participate.
http://www.cnn.com/2010/OPINION/03/24/jost.health.bill.challenges/index.html?hpt=T2