Legal immigrants sue when left out of Mass. health plan

Health reform expanded coverage, but lawmakers had to scale it back to balance the 2009 budget. A lawsuit claims that was unconstitutional.

By Amy Lynn Sorrel — Posted March 15, 2010

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Massachusetts' landmark 2006 comprehensive health system reforms hit another hurdle after a group of legal immigrants who were excluded from Commonwealth Care coverage in the wake of last year's budget cuts sued authorities overseeing the program.

As other states look to similar cost-saving cuts, the case raises questions over how to address a growing legal immigrant population and the health costs associated with the largely uninsured group.

In an effort to balance the Massachusetts 2009 budget, the Legislature cut funding for legal immigrants' coverage under Commonwealth Care from $130 million to $40 million. The program provides free or subsidized health care coverage to low-income residents who otherwise don't have access to health insurance.

About 26,000 legal immigrants lost their coverage because of the budget reductions and were transferred to a newly created, scaled-down plan with fewer benefits and higher out-of-pocket costs, according to the lawsuit filed Feb. 25 in a Suffolk County trial court. The cuts also left another 8,000 legal immigrants completely uninsured.

The plaintiffs allege in the proposed class-action lawsuit that the reductions are a violation of their constitutional rights to equal protection.

"We definitely recognize that states are under fiscal constraints. But there's also very well-settled judicial precedent that says budgetary concerns are not a significant enough state interest to justify these discriminatory policies," said attorney Matt Selig, executive director of Health Law Advocates, a public interest firm that helped bring the case.

Selig added that the Massachusetts reform law applies to all legal residents who meet the program's eligibility criteria and makes no mention of citizenship requirements.

"The state really set out a policy for universal health care coverage, and once the state sets that policy, they can't say, 'Yes, but we're only including citizens,' " he said.

The Commonwealth Health Insurance Connector Authority, which oversees the universal program and is the named defendant in the case, declined to comment on the lawsuit.

Federal statute in play

Lawmakers said they were doing the best they could given Massachusetts' cash-strapped situation. Gov. Deval Patrick initially recommended full funding for the Commonwealth Care program. But in a compromise with the Legislature, he agreed to the $40 million appropriation to establish the Bridge, the alternative cost-sharing program for legal immigrants.

The legislation relied on a 1996 federal statute that limits legal noncitizens' access to publicly funded health programs until they have been in the country for more than five years.

"What the federal government was trying to do was prevent incoming immigrants from immediately having to rely on public coffers ... and [Massachusetts] is just coming on par with federal law," said Dustin Carnevale, a spokesman for the Washington, D.C.-based Federation for American Immigration Reform, a nonprofit organization that supports reduced immigration levels. FAIR was not involved in the case.

"Anyone looking at this case can see that with a rising [immigrant] population and rising health care costs, some amount of reform has to take place," Carnevale said.

Still, federal law does not dictate what states can do, said Boston's Northeastern University School of Law professor Wendy E. Parmet. States are free to mimic the federal law to set program eligibility for federally funded programs such as Medicaid, for example. But the Massachusetts universal program "is not a Medicaid program, and federal law does not set parameters for people in Commonwealth Care and never has," said Parmet, who is assisting in the case on behalf of the plaintiffs.

Other states try same tactic

Massachusetts isn't the only state faced with such choices.

In an effort to close California's latest budget shortfall, estimated at $20 billion, Gov. Arnold Schwarzenegger in his 2010-11 budget proposal invoked federal law to restrict the availability of Medicaid services to certain legal immigrants. The move would decrease state health spending by $118 million.

In 2009, Connecticut lawmakers, also in response to budgetary constraints, passed a law terminating certain legal immigrants from state medical assistance programs. The immigrants sued, and a Hartford trial court in December 2009 found that the Legislature's actions violated their equal protection rights. That ruling has been appealed.

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Case at a glance

Were Massachusetts budget cuts excluding legal immigrants from the state's universal health program legal?

A state trial court could decide.

Impact: Some experts say the case highlights the difficulty in addressing the costs of a growing immigrant population in health system reform efforts. The plaintiffs contend that budget constraints are no excuse for violating immigrants' constitutional rights.

Dorothy Ann Finch et al. v. Commonwealth Health Insurance Connector Authority, Supreme Judicial Court for Suffolk County, Massachusetts (link)

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