SJC ruling a boost to immigrant health care

Court says Mass. erred in coverage cut; decision could hit state finances hard

Samuel Goncalves, 23, has a rare form of lung cancer, and was placed on a stripped-down health plan by the state in 2009. Copayments for treatment were much higher under that plan. Samuel Goncalves, 23, has a rare form of lung cancer, and was placed on a stripped-down health plan by the state in 2009. Copayments for treatment were much higher under that plan. (Aram Boghosian for The Boston Globe)
By Kay Lazar
Globe Staff / May 7, 2011

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The Massachusetts Supreme Judicial Court ruled yesterday that the state’s exclusion of thousands of legal immigrants from subsidized health coverage probably violates protections in the state constitution, and a legislative leader said the impact on the state budget could be significant.

The court said that Massachusetts erred in 2009 when it cut health coverage for about 26,000 immigrants after state lawmakers eliminated $130 million in funding for the program to help balance the budget.

The ruling did not order the state to reinstate full coverage for legal immigrants, but it paves the way for legal action by immigrant advocates that could lead to such a mandate.

The court said it was acutely aware of the financial implications for the cash-strapped state, but said money had no bearing on the legal question.

“The fiscal consequences of any subsequent judgment on the merits cannot be permitted to intrude on consideration of the case before us,’’ Associate Justice Francis X. Spina wrote in a 3-to-2 decision.

Wendy Parmet, a Northeastern University School of Law professor who argued the case on behalf of the immigrants, said they never doubted the state’s fiscal dilemma, just its method of denying health coverage to legal residents who do not, as immigrants, have the option to voice their unhappiness over the loss at the voting booth.

“The constitution prohibits the Legislature from trying to solve financial problems . . . on the backs of a vulnerable class of people,’’ she said.

For Samuel Goncalves, 23, the ruling caps a painful odyssey. The Brazilian immigrant was midway through intensive chemotherapy, radiation, and bone marrow transplants to treat a rare form of lung cancer when the state moved him to a stripped-down health plan it created for legal immigrants in 2009. It came with much heftier copayments for treatment by specialists.

“I had to see my doctors three times a week sometimes, and that [copayment] kept adding up,’’ Goncalves said.

He said his father, a church missionary who moved his family to Massachusetts in 2001, is still digging out from bills that piled up as the family struggled to pay for his care. Diagnosed five years ago, just as he was about to start college, Goncalves said that his cancer is in remission and that he hopes to enroll in college next year. But the intensive treatments took their toll on his liver and kidneys, and he requires further medical care.

“I am really happy now I might get back to the insurance I had before,’’ he said.

But that outcome is not clear.

The Massachusetts House recently approved a proposed state budget that includes $25 million, enough to provide the reduced coverage only through December for about 20,000 legal immigrants like Goncalves. Advocates said an estimated 20,000 immigrants who have tried to enroll since 2009 have been locked out, because the Legislature capped enrollment.

The Senate is expected to release its proposed budget next week.

Senator Stephen Brewer, a Barre Democrat who chairs the Senate Ways and Means Committee, said budget writers are still trying to sort out the fiscal impact of the court’s ruling, but said it probably would be significant.

“We will not rush to any decision and it will be a thoughtful deliberation,’’ he said. “But it will be the intention to honor the court’s decree as we develop’’ the budget.

Health Law Advocates, a Boston-based public interest law firm, filed the suit in February 2010 on behalf of the immigrants. Matt Selig, the group’s executive director, said lawyers are studying the complex ruling to figure out the next step for immigrants.

“The bottom line,’’ he said, “is that the court has decided that our clients are entitled to equal protection under the Massachusetts Constitution.’’

The ruling said that “state laws that discriminate against legal immigrants in the distribution of economic benefits are subject to strict scrutiny,’’ a stringent standard of judicial review. The court said the state’s Connector Authority, which provides subsidized insurance, used an inappropriate lesser standard, known as “rational basis,’’ when it decided the stripped down coverage was legal.

After the Legislature cut funding for immigrants in 2009, it set aside $40 million and told the Patrick administration to develop a scaled-back program for legal immigrants’ care. Yesterday’s ruling did not throw out this separate program. Rather, it instructed state judges to apply a much higher standard of review in future litigation of the matter.

Jay Gonzalez, the Patrick administration’s chief budget executive, said in a statement that the administration has made “equal coverage for legal, taxpaying immigrants’’ a priority.

“While this unfortunately has not been possible under the budget constraints of the past few years, the administration has worked successfully with the Legislature to preserve comprehensive coverage for this population,’’ he said. “We will closely review the ruling and our options as we await final adjudication of these issues.’’

Lawmakers have said they were reluctant to cut immigrants’ coverage, but made the choice because they are more expensive for the state to insure: The federal government does not chip in for their care the way it does for US citizens. Yesterday’s ruling noted that lack of federal funding for legal immigrants in the Commonwealth Care insurance program meant that it cost the state twice as much to cover a person from this group than a citizen.

Steve Kropper, cochairman of Massachusetts Citizens for Immigration Reform, said the ruling highlights the cost of immigration to this country. Kropper’s group lobbies for laws that cap legal immigration.

“Americans often wonder what the cost of immigration is, both legal and illegal, and the issue is often obscured by imperfect data,’’ he said. “This ruling provides a more tangible estimate of the tremendous cost of legal immigration in one particular area, health care.’’

Kay Lazar can be reached at