It is widely believed that Medicaid is a voluntary program. While this may have once been true, it is no longer the case. Today, states confront the dilemma of having to choose between joining Medicaid or being forced to sacrifice any health care "safety net" for their indigent populations, writes Jeffrey A. Singer. This is all because of a law enacted by Congress in 1986 called the Emergency Treatment and Labor Act (EMTALA)—the heretofore-unnoticed 800-pound gorilla in the room that just might secure the argument that "Obamacare" violates state sovereignty.