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Massachusetts extends healthcare benefits to immigrants

Robin Wulffson MD's picture
Commonwealth Care, healthcare reform, immigrant healthcare, budget crisis

BOSTON, MA - Throughout the United States, healthcare reform is a hot button topic. The debate has intensified since the December 19 announcement that the U.S. Supreme Court announced that it will hear arguments regarding President Obama’s healthcare reform beginning March 26. Both opponents and proponents of the president’s plan are looking to Massachusetts, which already has a universal healthcare plan, known as Commonwealth Care, in place. A new decision handed down on January 5 by the Massachusetts Supreme Court will undoubtedly add fuel to the ongoing debate.

According to the Massachusetts Supreme Court ruling, the state cannot bar legal immigrants from Commonwealth Care. The decision pushes the state closer to its goal of providing near-universal healthcare coverage to all residents of the state. The ruling should also intensify debate as to whether illegal immigrants should be added to those entitled to state health insurance benefits. That issue is of less significance in Massachusetts than it is in states such as Arizona, California, and Texas, which have a much larger illegal immigrant population.

According to the ruling, a 2009 state budget violated the State Constitution. The budget dropped approximately 29,000 legal immigrants who had lived in the U.S. for less than five years from Commonwealth Care, which is at the core of the Massachusetts’ 2006 healthcare reform. “This appropriation discriminated on the basis of alienage and national origin,” wrote Justice Robert J. Cordy of the Supreme Judicial Court. He added that the action “violates their rights to equal protection under the Massachusetts Constitution.”

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In 2009, when the state was facing a major budget crisis, the state legislature voted to eliminate these legal immigrants’ from the program; they asserted that the policy would save the state about $130 million each year. However, Justice Cordy wrote, “Fiscal considerations alone cannot justify a state’s invidious discrimination against aliens.” In addition, he dismissed the state’s argument that the cuts were in line with federal policies to deny Medicaid assistance to the same group of legal immigrants. He wrote, “The legislature may not lean on federal policy as a crutch to absolve it of examining whether its own invidious discrimination is truly necessary.”

Massachusetts Governor Deval Patrick initially opposed excluding the immigrants from the program and worked with legislators to create an alternative program that cost about $40 million and was more limited in scope.

Wendy E. Parmet, a professor at Northeastern University School of Law who argued the case, said that she hoped the ruling would result in a quick redemption of benefits for the immigrants who lost some or all of their health insurance coverage because of the budget measure. She explained, “I think it sends a clear message that it is unconstitutional in the state of Massachusetts that the state can’t deal with its budget problems on the backs of the legal immigrants.”

Obviously, state officials must abide by the ruling; however, they express concerns regarding how to pay for the influx of health insurance recipients. “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,” noted Jay Gonzalez, secretary of administration and finance. However, he added, “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 today’s decision.”

Reference: Massachusetts Supreme Court