Healthcare for All: Ensuring States Comply with the Equal Protection Rights of Legal Immigrants

Abstract

Noncitizens lawfully residing in the United States are considered a “discrete and insular minority” in equal protection jurisprudence. Foreclosed from meaningful political participation because of an inability to vote, this population is frequently the target of budget cuts in an economic downturn when legislators struggle to preserve benefits for their voting constituents. Recently, Massachusetts and New Jersey dealt with looming deficits by eliminating many legal permanent residents’ eligibility for state-funded health insurance programs. Each state relied on provisions in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, federal legislation that purports to allow individual states to discriminate against legal immigrants in state-funded social welfare programs. This Note concludes that states like Massachusetts and New Jersey cannot adopt a federal classification scheme excluding newly arrived legal immigrants from their respective state-funded healthcare programs without running afoul of the Equal Protection Clause. First, Massachusetts and New Jersey’s state-funded healthcare programs are unrelated to, and thus not justified by, federal immigration policy. Second, federal legislation cannot authorize individual states to circumvent strict scrutiny review by the courts. Moreover, it is economically unwise for a state to exclude its “citizens in waiting” from cost-effective, accessible healthcare, despite the federal government’s decision to do so.