01.05.12 — In a precedent-setting decision, the Massachusetts Supreme Judicial Court has ruled that a state law excluding legal immigrants from subsidized health coverage violated the state constitution. The Court unanimously ruled that prohibiting some 40,000 legal immigrants in the commonwealth from obtaining coverage “violates their rights to equal protection under the Massachusetts constitution.”

The suit, filed by Health Law Advocates (HLA) on behalf of tens of thousands of low-income Massachusetts legal immigrants, sought to strike down a law passed in 2009 eliminating access to Commonwealth Care for legal immigrants who had been in the US for less than five years. Massachusetts’ historic health reform law passed in 2006 allowed legal immigrants who met eligibility requirements to obtain health insurance through the Commonwealth Care program.

Professor Wendy Parmet, who argued the case on behalf of the immigrants said, “Our constitution prohibits the government from trying to solve its financial problems on the backs of a vulnerable class of people.”

“Massachusetts justifiably takes great pride in our ‘first in nation’ adoption of a health reform program that expanded access to quality healthcare to virtually all residents,” said Matt Selig, executive director of HLA. “It was critical that low-income immigrants, a group of already vulnerable, tax- paying residents, not be left behind.”

As a result of the ruling, the Massachusetts state legislature will likely need to allocate additional budgetary resources to the state’s Commonwealth Care program to meet its constitutional obligations. Once that occurs, legal immigrants will once again be afforded access to affordable health insurance. “Fiscal considerations alone cannot justify a State's invidious discrimination against aliens,” notes the ruling. “The discrimination against legal immigrants that its limiting language embodies violates their rights to equal protection under the Massachusetts constitution.”

In this case, the Supreme Judicial Court took the unusual step of permitting the plaintiffs to file their lawsuit directly in the high court as opposed to requiring them to begin the litigation in a lower court. Professor Parmet and HLA attorneys successfully argued to the
justices that the issues in the case met the Court’s standard permitting the direct filing of cases of “broad public importance.” As a result, HLA won invalidation of the Commonwealth’s discriminatory policy sooner than if the Court had declined their request for direct review. 

In May 2011, the Court made an initial ruling in the case that the Massachusetts Constitution virtually prohibits the Commonwealth from adopting policies that discriminate against legal immigrants by limiting their access to public benefits compared to citizens. The Commonwealth cannot use financial reasons to defend discrimination against legal immigrants, the Court said. In the ruling, the Court affirmed that the state must allow legal immigrants back into Commonwealth Care because there was no justification for the discriminatory policy. The ruling vindicates the position of HLA and the tens of thousands of low-income legal immigrants it represents.

“From a legal perspective, it was clear that legal immigrants couldn’t be denied access without violating the premise of equal protection,” said Lorianne Sainsbury-Wong, an attorney with Health Law Advocates. “This ruling is a victory not only for Massachusetts residents who were negatively impacted by the Commonwealth’s decision to rescind coverage, but a message to all states that legal immigrants and other protected groups must be treated equally as we expand access to healthcare.”

Legal immigrants and providers expressed relief at the ruling, noting that the resumption of coverage for needed medical services would limit unnecessary emergency room trips for routine care.

The federal Affordable Care Act requires that as of 2014, federal subsidies to obtain private health insurance are to be made available for low-income, uninsured US residents including legal immigrants. Massachusetts had been providing a state subsidy to this population for this purpose as of 2006, as part of its implementation of Health Care Reform. This ruling requires the full resumption of those subsidies to low-income legal immigrants. The Massachusetts case may serve as a precedent as other states prepare to implement expanded health coverage in compliance with the Affordable Care Act and as many state’s implement and weigh additional policies that discriminate against immigrants.

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