Legal immigrants eligible for Massachusetts insurance plan

Preventing legal immigrants from participating in a state medical assistance program for low-income residents is unconstitutional, the Supreme Judicial Court of Massachusetts has ruled.

The Jan. 5 decision by the state high court ended a two-year court battle between patient advocates and the state over medical care for about 35,000 Massachusetts immigrants. Arguments were heard twice by the court, both times ending in favor of the plaintiffs.

"We're very pleased that the court affirmed our position and our clients' rights in such a clear unanimous and unequivocal manner. There was no legal basis for this discrimination," said Wendy Parmet, the plaintiffs' attorney and a law professor at Northeastern University School of Law in Boston.

A group of legal immigrants sued the state in 2010 after the state Legislature cut funding the year before for immigrant care under the Commonwealth Care program from $130 million to $40 million. The reduction was made to help balance the state budget. Commonwealth Care provides free or subsidized health care to low-income residents without health insurance.

Because of the cut, about 26,000 legal immigrants lost insurance coverage and were transferred to a new plan with fewer benefits and higher out-of-pocket costs, the lawsuit said. An additional 8,000 legal immigrants were left uninsured.

One Supreme Court justice reviewed the case in 2010 and sent it to the full court on four questions of law. In May 2010, the judges ruled that the state Constitution entitles legal immigrants to equal protection and that the funding cut probably was invalid. The court sent the case back to the lower court for review, but it returned to the high court after the state raised a new argument, saying legislators had a "compelling government interest" for cutting the program and that the cut could survive a strict constitutional review.

After a second review, the court ruled again for the plaintiffs. The program cut was based on the goal of saving money, which does not validate discrimination, the court said.

"Fiscal considerations alone cannot justify a state's invidious discrimination against aliens. ... The discrimination against legal immigrants that its limiting language embodies violates their rights to equal protection under the Massachusetts Constitution," judges said in their opinion.

The ruling poses a financial burden to the state, but government leaders plan to comply with the decision, said Jay Gonzalez, Massachusetts secretary of administration and finance.

"This decision has significant fiscal impacts for the Commonwealth, adding somewhere in the range of $150 million in annual costs to what is already a very challenging budget," Gonzalez said in a statement. "However, we respect the court's decision, and we will work expeditiously to identify the resources required and the operational steps that need to be taken to integrate all eligible, legal immigrants into the Commonwealth Care program in accordance with" the court's decision.

The Massachusetts Medical Society applauded the ruling. The state law frustrated physicians who often treated immigrants without health insurance, said Charles Alagero, the society's general counsel.

The medical society was not involved in the lawsuit but was part of a coalition of health professionals and others who supported the immigrants in the case.

The law was problematic because doctors "ended up seeing patients in the ER as a result of them not getting the proper preventative care along the way. That's a challenge," Alagero said.

States must find better ways to resolve budget shortfalls, a point that is illustrated by the court's ruling, Parmet said. She said she hopes the ruling means that "when fiscal issues arise, which they always do, states can't make budget cuts on the backs of vulnerable populations.

"We don't fix our fiscal problems by singling out a group of people who are unpopular or who don't have influence with the Legislature. That's not a valid way for a state to respond to fiscal constraints."