Massachusetts Supreme Judicial Court Rules Unconstitutional Legislature's Attempt to Cut Health Insurance Premium Assistance Funding to Noncitizen Immigrants
Michael L. Calder | Bloomberg Law
The Massachusetts Supreme Judicial Court ruled unconstitutional the state legislature’s attempt to significantly reduce state-funded health insurance premium assistance to certain noncitizen immigrants. The decision restores funding for nearly 30,000 noncitizen immigrants lawfully residing in Massachusetts.
Massachusetts Health Insurance Reform
In 2006, the Massachusetts legislature enacted a sweeping health care insurance reform law, which mandates near universal health insurance coverage. The legislation was signed into law by then-Governor Mitt Romney. The law is often cited as the model for the federal Patient Protection and Affordable Care Act,Pub. L. 111-148, 124 Stat. 119 (2010).
The law created an independent public authority, the Commonwealth Health Insurance Connector Authority “to facilitate the availability, choice and adoption of private health insurance plans to eligible individuals and groups.” The law also established Commonwealth Care, a program to provide health insurance premium assistance to certain residents earning incomes below the federal poverty level, including noncitizen immigrants who have lawfully resided in United States for less than five years, but who do not qualify for federal benefits (qualified aliens).
The Legislature Responds to the Financial Crisis
In the aftermath of the global financial crisis in 2008, Massachusetts, like most other states, faced a daunting budgetary shortfall as tax revenues plummeted. To address the problem, the legislature made changes to the eligibility requirements of Commonwealth Care by enacting a two-part supplemental appropriation for fiscal year 2010.
The first part, section 31(a), excluded from eligibility all aliens who did not meet federal eligibility requirements under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Pub. L. No. 104-193, 110 Stat. 2105 (1996), (codified as amended at 8 U.S.C. §§ 1601-1646), thereby excluding qualified aliens residing in the United States for less than five years. The second part, section 31(b), established the Commonwealth Care Bridge program designed to provide continuing coverage to those qualified aliens who were previously covered under Commonwealth Care, but who lost premium assistance benefits as a result of section 31(a). The supplemental appropriation provided $40 million in funding to the Commonwealth Care Bridge Program, $90 million less than the amount of funding previously provided to qualified aliens under Commonwealth Care. Thus, the supplemental appropriation significantly reduced the amount of money available for premium assistance to low income qualified aliens.
Individuals who were terminated from Commonwealth Care or denied eligibility solely as a result of their alienage sought a declaration that the legislature’s appropriation violated their equal protection rights under the Massachusetts Constitution. Because the appropriation discriminated on the basis of alienage and national origin, the Massachusetts Supreme Court determined that the appropriation should be subject to strict scrutiny. Under Massachusetts law, strict scrutiny in cases arising under the Massachusetts Constitution is applied in the same manner as federal courts analyzing cases arising under the U.S. Constitution. That is, the law in question “must be narrowly tailored to further a legitimate and compelling governmental interest and be the least restrictive means available to vindicate that interest.”
No Compelling Governmental Interest
In order to determine whether the appropriation served a compelling governmental interest, the court examined the actual purpose and motivation behind the legislation. Because the U.S. Supreme Court previously held that fiscal motivations alone cannot serve as a compelling governmental interest in discriminating against aliens, the Commonwealth argued that the plain language of the appropriation furthers the national priorities articulated in PRWORA’s preamble, to promote self-sufficiency among aliens and reduce incentive for illegal immigration.
In rejecting the Commonwealth’s argument, the court noted that the appropriation made no reference to PRWORA’s preamble, but only referred to sections of PRWORA that specified funding qualifications. More tellingly, the appropriation could not have been intended to further the goal of alien self-sufficiency because section 31(b) authorized the establishment of a less costly plan for immigrants disenrolled by section 31(a). The court also cited legislative pronouncements in the media, including a statement by the chairman of the senate Ways and Means Committee that because of the size of the budget deficit “everyone is going to share in the pain and some, unfortunately, more than others.” Additionally, the Governor repeatedly cited budgetary concerns as the motivation for the cuts in funding to qualified aliens. Therefore, the court held that the motivation for appropriation was purely fiscal and did not meet the compelling governmental interest prong of the strict scrutiny test.
Not Narrowly Tailored
In order to pass strict scrutiny, states must specifically identify a problem that needs to be solved. The Commonwealth conceded that it made no inquiry into the self-sufficiency of legal immigrants in Massachusetts nor did it evaluate whether cutting funding was narrowly tailored to promote self-sufficiency. Instead, the Commonwealth argued it was entitled to bypass this requirement because by adopting PRWORA’s eligibility rules, it is by definition, narrowly tailored to national policies.
The court rejected the Commonwealth’s argument, noting Congress’s plenary authority to legislate the rights and benefits of aliens in the United States versus state classifications based on nationality, which is inherently suspect and subject to closer judicial scrutiny.
Accordingly, the court held that the appropriation could not pass strict scrutiny, and that it violates legal immigrants’ rights under the Massachusetts Constitution.
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