Lead Opinion
Oрinion by Judge McKEOWN; Concurrence by Judge BYBEE; Dissent by Judge CLIFTON.
OPINION
This case presents yet another challenge to the complex area of state-funded benefits for aliens. In enacting comprehensive welfare reform in 1996, Congress rendered various groups of aliens ineligible for federal benefits and also restricted states’ ability to use their own funds to provide benefits to certain aliens. See 8 U.S.C. § 1601 et seq. As a condition of receiving federal funds, Congress required states to limit eligibility for federal benefits, such as Medicaid, to citizens and certain aliens. For state benefits, such as the Hawaii health insurance program at issue herd, Congress essentially created three categories of eligibility. The first category — full benefits — requires states to provide the same benefits to particular groups of aliens, including certain legal permanent residents, asylees, and refugees, as the state provides to citizens. ’ Id. § 1622(b). Recipients in this category also benefit from federal funds. Id. § 1612(b)(2). The second category — no benefits — prohibits states from providing any benefits to certain aliens, such as those who are in the United States without authorization. Id. § 1621(a). The third category — discretionary benefits — authorizes states to determine the eligibility for any state bene
Within the third category are nonimmi-grant aliens residing in Hawaii under a Compact of Free Association with the United States, known as COFA Residents.
In this class action suit on behalf of adult, non-pregnant COFA Residents, Tony Korab, Tojio Clanton, and Keben Enoch (collectively “Korab”) claim that Basic Health Hawaii violates the Equal Protection Clause of the Fourteenth Amendment because it provides less health coverage to COFA Residents than the health coverage that Hawaii provides to citizens and qualified aliens who are eligible for federal reimbursements through Medicaid. Korab does not challenge the constitutionality of the federal law excluding COFA Residents from federal Medicaid reimbursements. Rather, the claim is that the prior, more comprehensive level of state coverage should be reinstated so that COFA Residents are on equal footing with those covered by Medicaid.
We are sympathetic to Korab’s argument but cannot accept the rationale. The basic flaw in the proposition is that Korab is excluded from the more comprehensive Medicaid benefits, which include federal funds, as a consequence of congressional action. Congress has plenary power to regulate immigration and the conditions on which aliens remain in the United States, and Congress has authorized states to do exactly what Hawaii has done here — determine the eligibility for, and terms of, state benefits for aliens in the narrow third category, with regard to whom Congress expressly gave states limited discretion. Hawaii has no constitutional obligation to fill the gap left by Congress’s withdrawal of federal funding for COFA Residents.
The district court thought otherwise. As Hawaii put it in its brief, “the district court ruled that the [Hawaii] Department [of Human Services] is constitutionally required to set up a state-only funded program that completely ‘fills the void’ created by the Federal Welfare Reform Act’s discrimination against aliens.” We vacate the district court’s grant of a preliminary injunction preventing Hawaii from reducing state-paid health benefits for COFA Residents because Hawaii is not obligated to backfill the loss of federal funds with state funds and its decision not to do so is subject to rational-basis review.
1. The Welfare Reform Act and Aliens
As part of welfare policy reforms enacted in 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (“the Welfare Reform Act” or “the Act”). Pub.L. 104-193, 110 Stat. 2105 (1996). Title IV of the Welfare Reform Act restricts public benefits for aliens, based on the rationale that aliens should “not depend on public resources to meet their needs, but rather rely on their own capabilities and the resources of their families, their sponsors, and private organizations.” 8 U.S.C. § 1601(2)(A). Congress declared the reforms to be “a compelling government interest” that is “in accordance with national immigration policy.” Id. § 1601(5)-(6).
With regard to federal benefits,
With regard to state benefits,
Medicaid is a cooperative state-federal program in which the federal government approves a state plan to fund medical services for low-income residents and then reimburses a significant portion of the state’s expenses in financing that medical care. See Pub.L. No. 89-97, 79 Stat. 286, 343 (1965) (codified as amended at 42 U.S.C. § 1396 et seq.); see also Wilder v. Virginia Hosp. Ass’n,
Before the Welfare Reform Act, COFA Residents were eligible for federal Medicaid subsidies and received medical services through Hawaii’s state-sponsored managed care plans. The Welfare Reform Act changed the landscape dramatically by rendering nonimmigrants and others ineligible for federal public benefits. As non-immigrants, COFA Residents are thus ineligible for Medicaid.
After Congress made nonimmigrants ineligible for federal reimbursement through Medicaid, Hawaii initially continued to provide the same medical benefits to COFA Residents as before, but funded the shortfall exclusively through state funds. The parties agree that COFA Residents received the same benefits as citizens and qualified aliens, but quibble over whether the benefits were technically provided under the same plan.
Citing budget concerns, Hawaii in 2010 dropped COFA Residents and qualified aliens who had resided in the United States fоr less than five years from the existing managed care plans. The state enrolled them instead in more limited coverage provided by Basic Health Hawaii, a new state plan created exclusively for these two groups. Haw.Code R. § 17-1722.3-1. Benefits under Basic Health Hawaii are limited with respect to physician visits, hospital days and prescription drugs, and recipients do not qualify for the state’s organ and tissue transplant program or its insurance plans covering long-term care services. Id. § 17-1722.3-18-19.
Korab, a dialysis patient who had been seeking a kidney transplant, sued to stop the diminution in benefits. He alleged that removing COFA Residents from the state’s comprehensive insurance plans and enrolling them instead in Basic Health Hawaii constituted discrimination based on alienage in violation of the Equal Protection Clause of the Constitution and in violation of the Americans with Disabilities Act (“ADA”). Korab sought a injunction based solely on the constitutional claim.
The district court reasoned that Congress’s power to pass the alienage restrictions in the Welfare Reform Act flows from the powers enumerated in the Naturalization Clause of the Constitution, which authorizes Congress to “establish an uniform Rule of Naturalization.” U.S. Const., art. I, § 8, cl. 4. The district court concluded that the Welfare Reform Act is not sufficiently uniform because it grants states some discretion with regard to the provision of state benefits to aliens. Accordingly, the district court found that strict scrutiny applied to Hawaii’s decision to treat COFA Residents differently from citizens and qualified aliens. Strict scrutiny requires the government to prove that any classifications based on protected characteristics “ ‘are narrowly tailored measures that further compelling governmental interests.’ ” Johnson v. California,
The injunction standard is well known: “A plaintiff seeking a injunction must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter v. Natural Res. Def. Council, Inc.,
Analysis
The Equal Protection Clause of the Fourteenth Amendment provides that “[n]o State shall ... deny to any person within its jurisdiction the equal protection of the laws.” U.S. Const, amend. XIV, § 1. Accordingly, states must generally treat lawfully present aliens the same as citizens, and state classifications based on alienage are subject to strict scrutiny review. See In re Griffiths,
To understand the framework for resolving this case, it is helpful to start with the two key Supreme Court cases on benefits for aliens. In Graham v. Richardson,
In the context of eligibility for the federal Medicare program, in Mathews v. Diaz,
Recognizing that Graham and Mathews present pristine examples of the bookends on the power to impose alien classifications — a purely state law eligibility restriction in the case of Graham and a federal statute without state entanglements in the case of Mathews — it is fair to say that Basic Health Hawai‘i presents a hybrid case, in which a state is following a federal direction. This variation was foreshadowed, however, by Graham. 403 U.S.’ at 381-82,
In its examination of Arizona’s residency requirement for alien eligibility for welfare benefits, the Court in Graham considered whether a federal statute prohibiting state requirements based on the length of citizenship, but not explicitly prohibiting requirements based on alienage, could be “read so as to authorize discriminatory treatment of aliens at the option of the States” and concluded that it did not. Id. at 382,
Korab does not challenge directly the validity of the federal classifications in the Welfare Reform Act. Nor does he dispute Hawaii’s selective classification within the “discretionary benefits” category of the Act — COFA Residents and qualified aliens present in the United States for fewer than five years are eligible for Basic Health Hawaii; all other nonimmigrants and parolees are ineligible under Hawaii’s plan, even though they are included in the Act’s “discretionary benefits” group. (This latter group is not part of this suit.) Instead, Korab challenges the lack of parity in benefits COFA Residents receive through Basic Health Hawaii as compared to the benefits provided through Medicaid. As part of this argument, Korab essentially brings a backdoor challenge to the federal classifications, arguing that the state
I. The Federal Classifications: A Uniform National Policy
The Supreme Court has consistently held that the federal government possesses extensive powers to regulate immigration and the conditions under which aliens remain in the United States. See Arizona v. United States, — U.S. -,
In the Welfare Reform Act, Congress announced a “national policy with respect to welfare and immigration.” 8 U.S.C. § 1601. Congress determined that immigrant self-sufficiency was an element of U.S. immigration policy and that there was a compelling national interest in assuring both “that aliens be self-reliant” and that the availability of public benefits does not serve as an “incentive for illegal immigration.” Id. § 1601(5)-(6). To accomplish these objectivеs, the statute sets out a comprehensive set of eligibility requirements governing aliens’ access to both federal and'state benefits. Federal benefits are, of course, strictly circumscribed by designated categories. Even for wholly state-funded benefits, the Act establishes three categories that states must follow: one category of aliens to whom states must provide all state benefits, a second category of aliens for whom states must not provide any state benefits, and a third category of aliens for whom Congress authorizes states to determine eligibility for state benefits. Id. §§ 1621-22. The limited discretion authorized for the third category, which includes COFA Residents, does not undermine the uniformity requirement of the Naturalization Clause.
On the federal level, only the Tenth Circuit has considered this issue. Soskin v. Reinertson,
Looking to the origin of the Naturalization Clause, the Tenth Circuit concluded that “the uniformity requirement in the Naturalization Clause is not undermined by the [Welfare Reform Act’s] grant of discretion to the states with respect to alien qualifications for Medicaid benefits.” Id. at 1257. The uniformity requirement
We agree. Considering the Welfare Reform Act as a whole, it establishes a uniform federal structure for providing welfare benefits to distinct classes of aliens. The entire benefit scheme flows from these classifications, and a state’s limited discretion to implement a plan for a specified category of aliens does not defeat or undermine uniformity. In arguing to the contrary, the dissent ignores that “a state’s exercise of discretion can also effectuate national policy.” Id. at 1255. As the Tenth Circuit explained in Soskin,
When a state ... decides against optional coverage [for certain noncitizens under the Welfare Reform Act], it is addressing the Congressional concern (not just a parochial state concern) that “individual aliens not burden the public benefits system.” 8 U.S.C. § 1601(4). This may be bad policy, but it is Congressional policy; and we review it only to determine whether it is rational.
This reading of the uniformity requirement finds an analog in the Supreme Court’s interpretation of the Bankruptcy Clause, which similarly calls for uniformity. See U.S. Const. art. I., § 8, cl. 4 (empowering' Congress “[t]o establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States”). In Hanover National Bank v. Moyses,
The principle that “uniformity does not require the elimination of any differences among the States” has equal traction here. Ry. Labor Execs.’ Ass’n v. Gibbons,
II. The State Action: Hawai'i Follows the Federal Policy and Direction
The logical corollary to the national policy that Congress set out in the Welfare Reform Act is that, where the federal program is constitutional, as it is here, states cannot be forced to replace the federal funding Congress has removed. See Pimentel v. Dreyfus,
Like the plaintiffs in Sudomir, Korab argues, and the dissent agrees, that' the state has a constitutional obligation to make up for the federal benefits that Congress took away from him. Putting this argument in practical funding terms, states would be compelled to provide wholly state-funded benefits equal to Medicaid to all aliens in the discretionary third category, thus effectively rendering meaningless the discretion Congress gave to the states in 8 U.S.C. § 1622(a). See Sudo-mir,
Congress has drawn the relevant alienage classifications, and Hawaii’s only action here is its decision regarding the funding it will provide to aliens in the third, discretionary category created by Congress — an expenditure decision. Kor-ab fails to offer any evidence that Hawaii, in making that decision, has not closely “follow[ed] the federal direction” and adhered to the requirements prescribed by Congress in its provision of state benefits. Plyler,
The dissent urges a contrary result, seizing upon the Supreme Court’s statement in Graham that “Congress does not have the power to authorize the individual States to violate the Equal Protection Clause.”
Accordingly, we vacate the injunction and remand to the district court for further- proceedings consistent with this opinion.
VACATED AND REMANDED.
Notes
. The Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau have each entered into a Compact of Free Association (“COFA”) with the United States, which, among other things, allows their citizens to enter the United States and establish residence as a “nonimmigrant.” Compact of Free Association Act of 1985, Pub.L. No. 99-239, 99 Stat. 1770 (1986), amended by Compact of Free Association Amendments Act of 2003, Pub.L. No. 108-188, 117 Stat. 2720; see also 48 U.S.C. § 1901 (joint resolution approving the COFA).
. The Welfare Reform Act defines "[fjederal public benefit” in relevant part as "any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit by an agency of the United States or by appropriated funds of the United States.” Id.§ 1611(c)(1)(B).
. With some exceptions, the Act requires qualified aliens to have been present in the United States for at least five years before they are eligible for any federally funded benefit. Id. § 1613(a)-(b).
.The Welfare Reform Act defines "[sjtate or local public benefit” in relevant part as "(A) any grant, contract, loan, professional license, or commercial license provided by an agency of a State or local government or by appropriated funds of a State or local government; and (B) any retirement, welfare, health, disability, public or assisted housing, postsec-ondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit by an agency of a State оr local government or by appropriated funds of a State or local government.” Id. § 1621(c)(1).
. The Immigration and Nationality Act defines "nonimmigrant” as any alien who has been admitted pursuant to one of the various visas set out in 8 U.S.C. § 1101(a)(15). With some exceptions, these visas generally admit aliens only temporarily and for a specific purpose, such as tourist visas, student visas, transit visas, or specialized work visas. COFA Residents, however, are entitled to reside in the United States as nonimmigrants indefinitely. Although there is no provision in 8 U.S.C. § 1101(a)(15) for COFA Residents, the Compact expressly provides for their admission as "nonimmigrants,” without regard to the provisions of the Immigration and Nationality Act relating to labor certification and nonimmigrant visas. Compact of Free Association Act of 1985, Pub.L. No. 99-239 § 141, 99 Stat. 1770, 1804.
. One limited exception to the application of strict scrutiny to state alienage classifications is the “political function” exception, which applies rational-basis review to citizenship requirements that states enact for elective and nonelective positions whose operations go to the heart of a representative government. See Cabell v. Chavez-Salido,
. In an effort to distinguish the Bankruptcy Clause from the Naturalization Clause, the dissent argues that the Equal Protection Clause places constitutional constraints on states that are not present in the bankruptcy context. This argument misunderstands the
. At this stage of the proceedings, we harbor serious doubts that Korab has carried his initial burden to establish a claim of disparity vis-a-vis the state’s actions. Under Medicaid, citizens and eligible aliens are covered under a plan funded by both federal and state funds. By contrast, Basic Health Hawaii is funded solely by the state. Here, however, Korab has not claimed that COFA Residents are receiving less per capita state funding than citizens or qualified aliens. Finch,
. The dissent that our reference to Congress’s clearly expressed will demonstrates our "confusion as to whether this an equal protection or a preemption case.” Dissent at 605 n. 7. We are not confused. To determine the applicable level of constitutional scrutiny in this equal protection case, we ask whether Hawaii is following the federal direction, see Plyler,
. Beyond asking the wrong question, the dissent muddies its own analysis by continually shifting the target of its constitutional inquiry. On one hand, the dissent argues that "the state of Hawai'i ... is ultimately responsible” for the "denial of equal benefits to COFA Residents,” Dissent at 601, and that we must subject "Hawaii's actions” to strict scrutiny, Dissent at 601-02. On the other hand, the dissent acknowledges that Congress, through the Welfare Reform Act, "was giving states broad discretion to discriminate against aliens in the provision of welfare benefits” but concludes that Congress lacked the constitutional power to do so. Dissent at 605-07. So which is it? Does the dissent challenge the constitutionality of Hawai'i’s actions, Congress’s, or both? The dissent’s own mixing and matching on this point underscores why Hawaii's conduct should be viewed as part and parcel of the federal welfare scheme, a scheme that is not challenged by Korab and has been deemed constitutional. See, e.g., Lewis, 252 F.3d at 582-84; Shalala,
. Judge Bybee has written a thoughtful and compelling concurrence urging the adoption of a preemption-based approach to alienage classifications. However, as Judge Bybee acknowledges, this fresh approach veers away from the controlling authority set forth in Graham and Mathews and goes where no circuit has gone. Concurrence at 901. It is therefore unsurprising that neither party has addressed preemption on appeal, and neither should we at this stage. Just as significantly, Judge Bybee’s preemption analysis — that the Hawai'i welfare program is not expressly or impliedly preempted nor does it violate Congress's dormant immigration power — sidesteps the ultimate constitutional question raised by Korab and briefed by both parties: namely, whether Hawai'i’s action violates the Equal Protection Clause.
Concurrence Opinion
concurring and concurring in the judgment:
I concur in full in Judge McKeown’s thoughtful opinion for the court. Her opinion captures the unsettled nature of the current state of the law and offers a way through the morass of conflicting approaches. I write separately to explain why the law of alienage remains so unclear and how we might better approach it.
The courts’ reaction to state implementation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (“PRWORA”) demonstrates the conundrum of our current Equal Protection doctrine as applied to aliens. Compare Soskin v. Reinertson,
It is not surprising that courts might divide over the application of equal protection rules to the PRWORA. Even where courts agree on the standard of review, judges may disagree over the application of the standard. See, e.g., Fisher v. Univ. of Tex. at Austin, — U.S. -,
As discussed below, the Graham doctrine — while ostensibly clear when issued — has been, in fact, riddled with exceptions and caveats that make consistent judicial review of alienage classifications difficult. In the years since Graham was decided, the Supreme Court has applied different levels of scrutiny depending on whether the state or the federal government established the challenged restriction, whether the restriction involved economic rights or the democratic process of self-government (often stretching that concept), whether the restriction involved undocumented aliens, and whether the discriminatory classification was created by Congress or an administrative agency. A review of the history of alienage jurisprudence, with a particular review of Graham — both what it said and how it has been applied (and not applied) in the past forty years — suggests that it is time to rethink the doctrinе. As I explain below, I am persuaded that an alternative approach based on preemption analysis would bring welcome clarity to this area. Employing preemption analysis instead of equal protection analysis in alienage cases will not spare us hard eases, but it offers us a mode of analysis that is more consistent with the Constitution, our history, and the Court’s cases since Graham.
I
For over a century, the Supreme Court has recognized that aliens are “persons” entitled to the protection of the Fifth and Fourteenth Amendments. See Wong Wing v. United States,
The Court’s approach to alienage restrictions began to change after the Second World War, notably in Takahashi v. Fish & Game Comm’n,
The Federal Government has broad constitutional powers in determining what aliens shall be admitted to the United States, the period they may remain, regulation of their conduct before naturalization, and the terms and conditions of their naturalization.... State laws which impose discriminatory burdens upon the entrance or residence of aliens lawfully within the United States conflict with this constitutionally derived federal power to regulate immigration ...
Id. at 419,
All persons within the jurisdiction of the United States shall have the same right in every State and Territory to make and enforce contracts, to sue, be parties, give evidence, and to the full and equal benefits of all laws a proceedings for the security of persons and property as is enjoyed by white citizens ...
It was in light of this fluctuating doctrine that the Court decided Graham in 1971.
II
The root of much of the current confusion over the courts’ treatment of alienage lies in Graham itself. Graham dealt with restrictions on public benefits imposed by Arizona and Pennsylvania. In Arizona, persons permanently and totally disabled were not eligible for assistance under a federal program in which Arizona participated if they were not citizens of the United States or had resided in the U.S. for fewer than fifteen years. 403 U.S. at SOGGY,
Second, and alternatively, the Court in Graham found the state laws preempted by federal law, thereby violating thе Su
Graham was a watershed case in equal protection analysis because it placed classifications based on alienage in the same category as classifications based on race, see Korematsu v. United States,
In the Court’s most extensive discussion to date of the Bolling principle, the Court recounted that in Bolling “the Court for the first time explicitly questioned the existence of any difference between the obligations of the Federal Government and the States to avoid racial classifications.” Adarand Constructors, Inc. v. Pena,
This last caveat wаs huge. It turns out that, in the area of immigration and naturalization, the “unthinkable,” Bolling,
From the outset, the Graham rule, simpliciter, was unsupportable. See Adarand,
At the first opportunity, the Court declined to impose the equal protection component of the Fifth Amendment on the federal government. Indeed, the Graham rule, as a mode of equal protection analysis, has never been fully applied to the federal government since Graham. Just five years after Graham, in Mathews v. Diaz, the Court phrased the issue as “whether Congress may condition an alien’s eligibility for participation in a federal medical insurance program on continuous residence in the United States for a five-year period and admission for permanent residence.”
obvious that Congress has no constitutional duty to provide all aliens with the welfare benefits provided to citizens, the party challenging the constitutionality of the particular line Congress has drawn has the burden of advancing principled reasoning that will at once invalidate that line and yet tolerate a different line separating some aliens from others.
Id. at 82,
The same day, the Court decided Hampton v. Mow Sun Wong,
What is odd about the juxtaposition of these two cases is the way in which the Court followed on the one hand, and virtually ignored on the other, the equal protection principles it had previously announced. In Hampton, the Court followed equal protection principles, finding that the federal employment restriсtions were presumptively invalid under Sugarman unless there was a compelling governmental interest and the rules “were expressly mandated by the Congress or the President. ...” Id. at 103,
The curious point for my purposes is not so much whether the Court upheld or struck down the state restrictions in the face of an equal protection challenge, but that the Court did not apply a consistent standard of review.
Ill
This brief history should make us rethink whether Graham’s equal protection analysis alone can explain the Court’s cases. Obviously, I believe that it cannot. But I do believe that Graham’s preemption analysis, not its equal protection analysis, has significant explanatory power here.
A preemption analysis is more securely anchored in the Constitution itself. There can be little question that “[t]he Government of the United States has broad ... power over the subject of immigration and the status of aliens.” Arizona v. United States, — U.S. -,
The Court has frequently employed pre-' emption as its mode of analyzing state restrictions based on alienage. In general, there are three ways Congress may
Even where Congress has not legislated specifically, the Court has enforced a kind of “dormant immigration”
A regulation which imposes onerous, perhaps impossible, conditions on those engaged in active commerce with foreign nations, must of necessity be national in its character. It is more than this; for it may properly be called international. It belongs to that class of laws which concern the exterior relation of thiswhole nation with other nations and governments.
Id. at 273. Accordingly, “[t]he laws which govern the right to land passengers in the United States from other countries” “may be and ought to be, the subject of uniform system or plan.” Id. See Hines,
The Court has recently enforced Congress’s dormant powers where, even though state law does not actually conflict with federal law, it is inconsistent with a national rule or scheme. See Arizona,
In some, even comprehensive, legislative schemes, Congress has expressly authorized states to regulate certain aspects of an alien’s privileges within the state. The Court recently approved state laws that relied on such authorization. In Chamber of Commerce v. Whiting, Congrеss expressly preempted “ ‘any State or local law imposing civil or criminal sanctions (other than through licensing and similar laws) upon those who employ ... unauthorized aliens.’ ”
All of which is to suggest that preemption analysis, not equal protectidn, is the better approach, for preemption analysis
IV
The choice between a pure preemption analysis and a pure equal protection analysis yields very different results in this case.
A
In my view, and consistent with the majority opinion, HawaiTs health insurance program at issue in this case is not expressly preempted by any federal law. Neither does it actually conflict with any federal law, nor does it obstruct in any way the congressional scheme. HawaiTs law most resembles the law at issue in Chamber of Commerce: Hawaii has responded to a congressional authorization, and it has mirrored federal law to make its law consistent with the federal scheme.
As the majority opinion explains, Congress has established three categories of aliens for purposes of federal and state benefits. Maj. Op. at 574-76; see Pimentel v. Dreyfus,
Section 1622(a), as plainly as words can express it, authorizes states to decide whether to make that class of aliens eligible for state benefits. It is, as in Chamber of Commerce, express non-preemption. See Chamber of Commerce,
Nor does HawaiTs scheme violate Congress’s dormant immigration powers. There is no reason for federal courts to
B
If we follow a pure equal protection model, it is unlikely that Hawaii’s scheme can muster constitutional scrutiny. Following Graham, Hawaii’s law discriminates between citizens and aliens, and, for that reason (as the district court correctly pointed out), Hawaii must satisfy strict scrutiny. Hawaii will have to show that it has a compelling state interest in treating resident aliens differently from citizens, and even if it can show such an interest, it will have to prove that it has narrowly tailored its program. Hawaii can likely offer two interests. First, it adopted its law because of budgetary reasons. This has never been thought to be a sufficient reason to justify discrimination that is subject to increased judicial scrutiny. See Mem’l Hosp. v. Maricopa Cnty.,
ham,
V
The equal protection principle announced in Graham has proven unsustainable. In the end, I think that preemption analysis will prove more consistent with the text and structure of the Constitution, the Court’s pre-Graham cases, and even with the history of the Fourteenth Amendment itself.
. Even in Yick Wo, where the Court first declared aliens to be "persons” within the scope of the Fourteenth Amendment, the Court cited several sources of authority, including the U.S. treaty with China, the Fourteenth Amendment, and the Civil Rights Act of 1866.
. The only other reference I can locate in which the Court refers to both Bolling and Graham was later in the same Term in Examining Board of Engineers, Architects, and Surveyors v. Flores de Otero, where the Court struck down a Puerto Rico law restricting civil engineers to U.S. citizens.
. Compare Erwin Chemerinsky, Constitutional Law: Principles and Policies § 9.5.3 at 744 (3d ed.2002) (“the Court’s decisions can be criticized for so openly manipulating the level of scrutiny. The Court could have used strict sсrutiny....’’) with David F. Levi, Note, The
. As the Majority notes, Maj. Op. 584 n. 10, the Dissent suggests both that Hawaii’s denial of equal benefits to COFA residents is subject to strict scrutiny, Dissent at 600-02, and that Congress has given the states “broad discretion to discriminate against aliens in the provision of welfare benefits,” Dissent at 605-06, all of which underscores the difficulty of applying a uniform standard of review in cases involving alienage, especially when they involve the intersection of federal schemes and state schemes that have — at least in the
. The distinction between actual conflict preemption and field preemption is not always clear. See, e.g., Arizona,
. See Erin F. Delaney, Note, In the Shadow of Article I: Applying a Dormant Commerce Clause Analysis to State Laws Regulating Aliens, 82 N.Y.U. L.Rev. 1821 (2007); Karl Manheim, State Immigration Laws and Federal Supremacy, 22 Hastings Const. L.Q. 939, 958 (1995) (referring to the "Dormant Immigration Clause”).
. See Compact of Free Association, reprinted at 48 U.S.C. § 1901 note. A citizen of the Marshall Islands or the Federated States of Micronesia may "establish residence as a nonimmigrant in the United States and its territories and possessions.” Compact § 141(a). The Compact further specifies:
The right of such persons to establish habitual residence in a territory or possession of the United States may, however, be subjected to nondiscriminatory limitations provided for:
(1) in statutes or regulations of the Unities States; or
(2) in those statutes or regulations of the territory or possession concerned which are authorized by the laws of the United States.
Compact § 141(b).
. Nothing I have said here should dimmish in any way the fact that aliens are "persons” entitled to the protection of the Due Process and Equal Protection Clauses of the Fourteenth Amеndment and the Due Process Clause — including its equal protection component — of the Fifth Amendment. See Tak-ahashi,
The Fourteenth Amendment, of course, took account of these differences in the Privileges and Immunities Clause, which provided that the "privileges or immunities of citizens of the United States” could not be abridged, and in the Due Process and Equal Protection Clauses, which applied to "any person." The current confusion is due in no small part to the Court's disastrous decision in The SlaughterHouse Cases,
Dissenting Opinion
dissenting:
The Equal Protection Clause of the Fourteenth Amendment provides that “[n]o State shall ... deny to any person within its jurisdiction the equal protection of the laws.” U.S. Const, amend. XIV, § 1. It is • settled law that alienage is a suspect class and that state laws that discriminate against aliens who are lawfully present in this country generally violate the Equal Protection Clause unless they can withstand strict scrutiny.
But the state’s fiscal condition does not provide the compelling justification required under the Equal Protection Clause to justify unequal treatment of aliens. The option given to the states by Congress to decide whether to treat aliens differently was illusory, under established Supreme Court precedent. Congress has broad power, based on its authority over immigration and foreign relations, to decide whether to treat aliens differently than citizens, but Congress does not have the power to assign that discretion to states. As explained by the Supreme Court, “Congress does not have the power to authorize the individual States to violate the Equal Protection Clause.” Graham v. Richardson,
I. Disparity in Expenditure of State Funds
The majority opinion most obviously goes astray when it suggests that Plaintiffs have failed to establish a claim of disparity because they have not claimed that Hawaii’s per capita expenditures of state funds differ as between citizens and COFA Residents. Maj. Op. at 582-84 & n. 8. The majority thus appears to require that, in order to establish a claim of disparate treatment, a class alleging discrimination under the Equal Protection Clause must demonstrate that the state is expending less funds, on a per capita basis, than it is spending on the rest of the population. In effect, the majority requires Plaintiffs to allege (and eventually, I presume, to prove) that they have been shortchanged on a per capita basis. Because Plaintiffs have not so alleged, the majority harbors serious doubts that Plaintiffs have made out a claim of an equal protection violation by the state. That approach is wrong in two separate ways.
First, it treats Medicaid as if it consistеd of two separate programs, one federal and one state, because the program is partially funded by the federal government. But that is not how Medicaid actually works. In Hawaii, as in most states, there is a single plan, administered by the state. The federal government reimburses the state for a significant portion of the cost, and the plan must comply with federal requirements, but it is a state plan. The majority opinion’s own description of the program, at 5, confirms as much. Beneficiaries are not covered by two separate federal and state plans, but rather by one single plan administered by the state.
Second, and more importantly, the approach suggested by the majority opinion runs afoul of bedrock equal protection doctrine dating back at least to Brown v.
The approach of the majority opinion could justify a state reducing benefits provided to members of a particular group on the ground that providing benefits to that group is more expensive than providing the same benefits to the general population. For example, a state could reduce chemotherapy and radiation therapy benefits for African Americans and justify this discrimination by citing African Americans’ increased susceptibility to various types of cancer.
Such a “separate but equal” approach runs counter to the dictates of Brown v. Board of Education. “The point of the equal protection guarantee is not to ensure that facially discriminatory laws yield roughly equivalent outcomes.... Rather, the right to equal protection recognizes that the act of classification is itself invidious and is thus constitutionally acceptable only where it meets an exacting test.” Finch v. Commonwealth Health Ins. Connector Auth.,
I don’t really think the majority opinion is trying to return to the era of separate but equal. Although it denies the existence of a claim of disparity vis-a-vis state action, the majority opinion nevertheless proceeds to assume arguendo the existence of such a claim and subjects Hawaii’s actions to review under the Equal Protection Clause, albeit based on a rational basis standard. See Maj. Op. at 582-84. If there really were no disparity attributable to the State of Hawaii, as the majority argues, the Equal Protection Clause would simply be inapplicable, and no further judicial review would be required. By discussing the equal protection framework established by Graham v. Richardson,
II. Hawaii’s Decision to Reduce Benefits for COFA Residents
The main thrust of the majority opinion, as I understand it, is that Hawaii’s actions are subject only to rational basis review under the Equal Protection Clause, rather than strict scrutiny, because those actions were authorized by Congress. Here
We must decide this ease under the equal protection framework established by the Supreme Court in Graham and Mathews. The equal protection holdings in those cases are clear, and the majority opinion ably summarizes them, at 577-81. In brief, Graham requires that we review state discrimination against aliens under strict scrutiny, while Mathews requires that we review federal disсrimination against aliens under rational basis review, because of the federal government’s broad powers in the area of immigration and foreign relations. • The question this case thus turns on is whether the denial of equal benefits to COFA Residents is ultimately the responsibility of the state or of Congress.
I conclude that it is the State of Hawaii that is ultimately responsible. The majority reaches a different conclusion, permitting it to uphold Hawaii’s program under rational basis review, by obscuring the role states play within the statutory framework established by Congress.
The majority repeatedly emphasizes that Hawaii is following the federal- direction and that states are given only limited discretion to decide which aliens to provide benefits to under the Welfare Reform Act. But there is no federal direction regarding how to treat COFA Residents and others within what the majority describes as the Welfare Reform Act’s third category of aliens. The statute gives states discretion to decide whether or not to provide health benefits to persons within that category.
In making the decision not to provide equal benefits to COFA Residents, Hawaii has necessarily made a distinction on the basis of alienage: a similarly situated citizen is eligible to receive more benefits. Because Hawaii has classified COFA Residents on the basis of alienage, the Equal Protection Clause requires that we strictly scrutinize Hawaii’s actions to ensure that they are “narrowly tailored measures that further compelling governmental interests.” Johnson v. California,
That federal discrimination against aliens would be subject only to rational basis review is irrelevant. We are presented with a case not of federal discrimination, but one of state discrimination. It is undisputed that COFA Residents are not eligible for federal benefits and that Hawaii thus cannot obtain federal reimbursements for expenses incurred to cover COFA Residents under Hawaii’s Medicaid programs.
In effect, through the Welfare Reform Act, I think Congress has given states a lit firecracker, at risk of exploding when a state exercised its discretion to discriminate on the basis of alienage. It was Hawaii’s decision not to cover COFA Residents under its Medicaid programs that effected the discrimination in this case. “Insofar as state welfare policy is concerned, there is little, if any, basis for treating persons who are citizens of another State differently from persons who are citizens of another country.” Mathews,
III. A Tale of Three Clauses: Equal Protection, Preemption, and the Immigration and Naturalization Power
The principles just articulated lead me to the majority’s final reason for upholding Hawaii’s discriminatory actions: its conflation of the Supreme Court’s equal protection holdings in Graham and Mathews with the distinct preemption holding in Graham. As explained above, in the equal protection arena, Graham stands for the proposition that strict scrutiny applies to state laws classifying on the basis of alien-age, and Mathews stands for the proposition that rational basis review applies to similar federal laws. As a case interpreting the Supremacy Clause, Graham is part of the line of cases that establishes federal supremacy in the area of immigration and naturalization, as the concurrence by Judge Bybee explains, at 581-85. See Graham,
In this case, no one argues that Hawaii’s actions are preempted by the Welfare Reform Act. Preemption doctrine has no bearing on the outcome here. Congress has authorized Hawaii to exclude COFA Residents from the state Medicaid programs, see 8 U.S.C. § 1622, so there is no, conflict between the state’s action and the Welfare Reform Act.
The crux of the question is not whether Hawaii has adhered to the requirements prescribed by Congress in the Welfare Reform Act — it has, and no one argues that it has not — but rather whether Hawaii could constitutionally take the action it took “as part and parcel of the federal welfare scheme.” Maj. Op. at 584 n. 10. I submit that we should answer this question- in the negative, following precedent
Graham stated that:
Although the Federal Government admittedly has broad constitutional power to determine what aliens shall be admitted to the United States, the period they may remain, and the terms and conditions of their naturalization, Congress does not have the power to authorize the individual States to violate the Equal Protection Clause. Shapiro v. Thompson,394 U.S., at 641 ,89 S.Ct., at 1335 . Under Art. I, § 8, cl. 4, of the Constitution, Congress’ power is to ‘establish an uniform Rule of Naturalization.’ A congressional enactment construed so as to permit state legislatures to adopt divergent laws on the subject of citizenship requirements for federally supported welfare programs would appear to contravene this explicit constitutional requirement of uniformity.
We previously relied on this passage in holding that a federal statute that requires states to grant benefits to citizens and certain aliens while also requiring states to deny benefits to other aliens did not authorize the states to violate the Equal Protection Clause, because “Congress ha[d] enacted a uniform policy regarding the eligibility of [certain aliens] for welfare benefits.” Sudomir v. McMahon,
Both the Supreme Court and this court recognize that uniformity is required for any congressional enactment regulating immigration and the status of aliens, because Congress’s power over immigration and naturalization matters derives from the Naturalization Clause, which grants Congress the power “[t]o establish an uniform Rule of Naturalization.” U.S. Const, art. I, § 8, cl. 4. The majority opinion makes an effort to argue that the uniformity requirement is inapplicable here because the original motivations for the Naturalization Clause centered around avoiding a scenario that had plagued the Articles of Confederation, whereby a naturalization decision made by one state with respect to aliens within its territory was binding on other states. Maj. Op. at 580-82 (citing Soskin v. Reinertson,
The majority minimizes the significance of the divergent Medicaid eligibility requirements allowed through the discretion the Welfare Reform Act gives to the states. See id. at 580 (“The limited discretion authorized ... does not undermine the uniformity requirement of the Naturalization Clause.”); id. at 581 (“[A] state’s limited discretion to implement a plan ... does not defeat or undermine uniformity.”). In reaching this conclusion, the majority relies on the Supreme Court’s reading of the Bankruptcy Clause’s uniformity requirement. See id. at 581-83.
Unfortunately, the majority’s analogy to the Bankruptcy Clause does not fit. The
The grants of power in Article I with respect to naturalization and bankruptcy are very similar. Indeed, the Naturalization Clause and the Bankruptcy Clause are listed together in a single clause within Article I, section 8, which grants Congress the power “[t]o establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States.” U.S. Const, art. I, § 8, cl. 4. It is also true that the Supreme Court has interpreted the uniformity requirement in the Bankruptcy Clause to allow for the incorporation of divergent state laws within the Bankruptcy Act. See Maj. Op. at 581-82 (citing, among others, Hanover National Bank v. Moyses,
The Naturalization Clause and the Bankruptcy Clause are simply grants of power to Congress, however. They do not require Congress to pass federal naturalization and bankruptcy laws. The first federal naturalization law, Act of Mar. 26, 1790, ch. 3, 1 Stat. 103, was passed right away, by the First Congress, likely to avoid the serious difficulties presented by the states’ divergent laws on the , subject under the Articles of Confederation. The first federal bankruptcy law was not passed for moré than a decade, until 1800, Act of Apr. 4, 1800, ch. 19, 2 Stat. 19.
That the majority relies so heavily on the constitutional grants of power contained in Article I is thus particularly problematic. If there were no federal bankruptcy law (as was the case for the first eleven years of our nation’s Constitution), it is clear that the states could adopt their own bankruptcy laws, crafting their creditor-debtor relationships as they wished, advantaging some creditors and debtors over others, so long as the states’ laws were rational.
■ Not so for immigration and naturalization. It would not be the case that, if there were no federal immigration and naturalization laws dealing with the United States’ relations with aliens, the states would be free to craft their own laws, advantaging citizens and some aliens over other aliens. The Equal Protection Clause would prevent them from doing so, given the strict scrutiny applied to distinctions by states between aliens and citizens under Graham.
It is this crucial interaction between the Article I grant of power and the Equal Protection Clause that the majority opinion neglects, which leads it to its unpersuasive conclusion that the discretion given to the states by the Welfare Reform Act does not undermine uniformity. That conclusion rests on the separate preemption doctrine that is not part of this case and does not come to grips with the dictates of the Equal Protection Clause.
Consider the following hypothetical. Congress passes and the President signs a new law, the Alien Discrimination Act. In it, Congress authorizes states to classify aliens in any manner that is not wholly irrational. To justify the Act, Congress articulates a uniform policy of devolving more traditionally state police powers to the states.
The “limited” nature of the discretion to discriminate the states are given under the Welfare Reform Act is irrelevant: the Act still authorizes states to discriminate against some aliens in the provision of some welfare benefits, and thus authorizes them to violate the Equal Protection Clause. Therefore, in this case as in the hypothetical above, strict scrutiny must apply.
My conclusion does not detract from Sudomir’s requirement that states cannot be compelled to replace federal funding where the federal statute requires states to discriminate against aliens.
In this case, though, there is no federal direction for states to follow. The ultimate decision is left up to each state. Congress articulated what the majority argues are uniform policies in the Welfare Reform Act, including a policy “to assure that aliens be self-reliant in accordance with national immigration policy,” 8 U.S.C. § 1601(5), and “to remove the incentive for illegal immigration provided by the availability of public benefits,” id. § 1601(6). Those policies would presumably support a .flat prohibition on providing benefits to aliens or to a specified group of aliens. Congress did not enact a prohibition, though. The decision as to how a given group of aliens is to be treated is simply left to each state. In light of the broad discretion it gives to the states, the Act simply does not provide a federal directiоn with regard to COFA Residents and others in the third category of aliens. It does not require or forbid the states to do anything.
Although the majority opinion argues, at 583, that Hawaii followed a federal direction by shunting COFA Residents into the BHH program, it could also be said that Hawaii followed a federal direction during the fourteen years when it included COFA Residents in its Medicaid programs. A federal “direction” that points in two opposite ways is not a direction. We have already recognized as much. See Pimentel v. Dreyfus,
In the Welfare Reform Act, Congress itself recognized that, far from providing a uniform federal direction, it was giving states broad discretion to discriminate against aliens in the provision of welfare benefits. This recognition comes through in Congress’s statement of policy emphasizing that the states exercising their discretion to determine some aliens’ eligibility for welfare benefits “shall be considered to have chosen the least restrictive means available for achieving the compelling governmental interest of assuring that aliens be self-reliant in accordance with national immigration policy.” 8 U.S.C. § 1601(7). But Congress does not have the power to give states discretion to discriminate.
IV. Conclusion
Though the majority opinion asserts that I am inviting a circuit split, I note that it is the majority opinion that is contrary to the opinions of a majority of courts that have considered this question. Only one other circuit has spoken, in Soskin v. Reinertson,
Even though in my view Plaintiffs should prevail, I acknowledge there is something paradoxical and more than a little unfair in my conclusion that the State of Hawaii has discriminated against COFA Residents. The state responded to an option given to it by Congress, albeit an option that I don’t think Congress had the power to give. Hawaii provided full Medicaid benefits to COFA Residents for many years, entirely out of its own treasury, because the federal government declined to bear any part of that cost. Rather than terminate benefits completely in 2010, Hawaii offered the BHH program to COFA Residents, again from its own pocket. The right of COFA Residents to come to Hawaii in the first place derives from the Compacts of Free Association that were
But the federal government is permitted to discriminate against aliens in a way that the state government is not. Because established precedent should require us to apply strict scrutiny to Hawaii’s exclusion of COFA Residents from the Medicaid programs, and no one seriously contends that Hawaii’s actions can withstand such strict scrutiny, I respectfully dissent.
. See Graham v. Richardson,
. See, e.g., Cancer and African Americans, U.S. Dep’t of Health & Human Servs. Office of Minority Health, http://minorityhealth.hhs. gov/templates/content.aspx?ID=2826 (last updated Sept. 11,2013).
. In fact, the statute gives discretion regarding how to treat aliens within the second category as well, notwithstanding the majority’s description of that category as that of “aliens for whom states must not provide any state benefits,” Maj. Op. at 580 (emphases added). The Welfare Reform Act allows states to provide benefits to this category of aliens "through the enactment of a State law after August 22, 1996, which affirmatively provides for [those aliens’] eligibility.” 8 U.S.C. § 1621(d).
. “Medicaid programs” refers to the managed care programs Hawaii has operated since 1993, pursuant to a waiver approved by the federal government under section 1115 of the Social Security Act. These programs include QUEST, QUEST-Net, QUEST Adult Coverage Expansion, and QUEST Expanded Access.
. Because the BHH program has a capped enrollment, HAR § 17-1722.3-10, and more COFA Residents were moved from the Medicaid programs to BHH than would normally be allowed under the cap, new COFA Residents moving to Hawaii after 2010 may not be covered under any state medical welfare program.
. This uniform federal policy would follow the principle of "New Federalism,” a principle which also underlies the Welfare Reform Act. See, e.g., Steven D. Schwinn, Toward a More Expansive Welfare Devolution Debate, 9 Lewis & Clark L.Rev. 311, 312-13 (2005).
. The majority opinion also states that I am asking the wrong question, but its own language underscores its confusion as to whether this is an equal protection or a preemption case. The majority would have me ask "not whether Congress may authorize-Hawaii to violate the Equal Protection Clause but rather 'what constitutes such a violation when Congress has (clearly) expressed its will regarding a matter relating to aliens.’ " Maj. -Op. at 583 (quoting Soskin, 353 F.3datl254). I know of no equal protection doctrine that turns on whether “Congress has (clearly) expressed its will." That is instead the language of preemption analysis. See, e.g., Wyeth v. Levine,
. Although Finch speaks in terms of the Massachusetts Constitution's right to equal protection, the Massachusetts Supreme Judicial Court has interpreted that state provision to be coextensive with the federal Equal Protection Clause in matters concerning aliens. See, e.g., Doe v. Comm'r of Transitional Assistance,
