Source: https://supreme.justia.com/cases/federal/us/415/250/
Timestamp: 2019-04-23 15:57:38+00:00

Document:
Held: The durational residence requirement, in violation of the Equal Protection Clause, creates an "invidious classification" that impinges on the right of interstate travel by denying newcomers "basic necessities of life." Shapiro v. Thompson, 394 U. S. 618. Pp. 415 U. S. 253-270.
(a) Such a requirement, since it operates to penalize indigents for exercising their constitutional right of interstate migration, must be justified by a compelling state interest. Shapiro v. Thompson, supra; Dunn v. Blumstein, 405 U. S. 330. Pp. 415 U. S. 253-262.
(b) The State has not shown that the durational residence requirement is "legitimately defensible" in that it furthers a compelling state interest, and none of the purposes asserted as justification for the requirement -- fiscal savings, inhibiting migration of indigents generally, deterring indigents from taking up residence in the county solely to utilize the medical facilities, protection of longtime residents who have contributed to the community particularly by paying taxes, maintaining public support of the county hospital, administrative convenience in determining bona fide residence, prevention of fraud, and budget predictability -- satisfies the State's burden of justification and insures that the State, in pursuing its asserted objectives, has chosen means that do not unnecessarily impinge on constitutionally protected interests. Pp. 415 U. S. 262-269.
opinion, post, p. 415 U. S. 270. REHNQUIST, J., filed a dissenting opinion, post, p. 415 U. S. 277.
The trial court held the residence requirement unconstitutional as a violation of the Equal Protection Clause. In a prior three-judge federal court suit against Pinal County, Arizona, the District Court had also declared the residence requirement unconstitutional, and had enjoined its future application in Pinal County. Valencano v. Bateman, 323 F.Supp. 600 (Ariz.1971). [Footnote 4] Nonetheless, the Arizona Supreme Court upheld the challenged requirement. To resolve this conflict between a federal court and the highest court of the State, we noted probable jurisdiction, 410 U.S. 981 (1973), and we reverse the judgment of the Arizona Supreme Court.
Id. at 394 U. S. 627. The Court found that, because this classification impinged on the constitutionally guaranteed right of interstate travel, it was to be judged by the standard of whether it promoted a compelling state interest. [Footnote 6] Finding such an interest wanting, the Court held the challenged residence requirements unconstitutional.
its ultimate scope, however, the right to travel was involved in only a limited sense in Shapiro. The Court was there concerned only with the right to migrate, "with intent to settle and abide," [Footnote 8] or, as the Court put it, "to migrate, resettle, find a new job, and start a new life." Id. at 394 U. S. 629. Even a bona fide residence requirement would burden the right to travel, if travel meant merely movement. But, in Shapiro, the Court explained that "[t]he residence requirement and the one-year waiting-period requirement are distinct and independent prerequisites" for assistance, and only the latter was held to be unconstitutional. Id. at 394 U. S. 636. Later, in invalidating a durational residence requirement for voter registration on the basis of Shapiro, we cautioned that our decision was not intended to "cast doubt on the validity of appropriately defined and uniformly applied bona fide residence requirements." Dunn v. Blumstein, 405 U. S. 330, 405 U. S. 342 n. 13 (1972).
intrastate travel, a question we do not now consider, such a distinction would not support the judgment of the Arizona court in the case before us. Appellant Evaro has been effectively penalized for his interstate migration, although this was accomplished under the guise of a county residence requirement. What would be unconstitutional if done directly by the State can no more readily be accomplished by a county at the State's direction. The Arizona Supreme Court could have construed the waiting-period requirements to apply to intrastate, but not interstate, migrants; [Footnote 9] but it did not do so, and "it is not our function to construe a state statute contrary to the construction given it by the highest court of a State." O'Brien v. Skinner, 414 U. S. 524, 414 U. S. 531 (1974).
Id. at 394 U. S. 629. Second, the Court considered the extent to which the residence requirement served to penalize the exercise of the right to travel.
"Shapiro did not rest upon a finding that denial of welfare actually deterred travel. Nor have other 'right to travel' cases in this Court always relied on the presence of actual deterrence. In Shapiro, we explicitly stated that the compelling state interest test would be triggered by 'any classification which serves to penalize the exercise of that right [to travel]. . . .'"
Finally, appellees seek to distinguish Shapiro as involving a partially federally funded program. Maricopa County has received federal funding for its public hospital, [Footnote 18] but, more importantly, this Court has held that whether or not a welfare program is federally funded is irrelevant to the applicability of the Shapiro analysis. Pease v. Hansen, 404 U. S. 70 (1971); Graham v. Richardson, 403 U. S. 365 (1971).
determine whether these satisfy the appellees' heavy burden of justification, and insure that the State, in pursuing its asserted objectives, has chosen means that do not unnecessarily burden constitutionally protected interests. NAACP v. Button, 371 U. S. 415, 371 U. S. 438 (1963).
First, a State may not protect the public fisc by drawing an invidious distinction between classes of its citizens, Shapiro, supra at 394 U. S. 633, so appellees must do more than show that denying free medical care to new residents saves money. The conservation of the taxpayers' purse is simply not a sufficient state interest to sustain a durational residence requirement which, in effect, severely penalizes exercise of the right to freely migrate and settle in another State. See Rivera v. Dunn, 329 F.Supp. 554 (Conn.1971), aff'd, 404 U.S. 1054 (1972).
Ibid. An indigent who considers the quality of public hospital facilities in entering the State is no less deserving than one who moves into the State in order to take advantage of its better educational facilities. Id. at 394 U. S. 631-632.
by private hospitals, the costs of caring for indigents must be passed on to paying patients and "at a rather inconvenient time" -- adding to the already astronomical costs of hospitalization which bear so heavily on the resources of most Americans. [Footnote 24] The financial pressures under which private nonprofit hospitals operate have already led many of them to turn away patients who cannot pay or to severely limit the number of indigents they will admit. [Footnote 25] And, for those indigents who receive no care, the cost is, of course, measured by their own suffering.
Shapiro, 394 U.S. at 394 U. S. 632-633 (footnote omitted).
394 U.S. at 394 U. S. 634-635 (footnote omitted). Whatever the difficulties in projecting how many newcomers to a jurisdiction will require welfare assistance, it could only be an even more difficult and speculative task to estimate how many of those indigent newcomers will require medical care during their first year in the jurisdiction. The irrelevance of the one-year residence requirement to budgetary planning is further underscored by the fact that emergency medical care for all newcomers and more complete medical care for the aged are currently being provided at public expense regardless of whether the patient has been a resident of the County for the preceding year. See Shapiro, supra, at 394 U. S. 635.
E.g., Weber v. Aetna Cas. & Surety Co., 406 U. S. 164, 406 U. S. 173 (1972); Dunn v. Blumstein, 405 U. S. 330, 405 U. S. 335 (1972).
394 U.S. at 394 U. S. 634. See also id. at 394 U. S. 642-444 (STEWART, J., concurring).
Dunn v. Blumstein, supra; Shapiro v. Thompson, 394 U. S. 618 (1969); see Wyman v. Lopez, 404 U.S. 1055 (1972); Oregon v. Mitchell, 400 U. S. 112, 400 U. S. 237 (1970) (separate opinion of BRENNAN, WHITE, and MARSHALL, JJ.), 400 U. S. 285-286 (STEWART, J., concurring and dissenting, with whom BURGER, C.J., and BLACKMUN, J., joined); Wyman v. Bowens, 397 U. S. 49 (1970); United States v. Guest, 383 U. S. 745, 383 U. S. 757-759 (1966); cf. Griffin v. Breckenridge, 403 U. S. 88, 403 U. S. 105-106 (1971); Demiragh v. DeVos, 476 F.2d 403 (CA2 19 73). See generally Z. Chafee, Three Human Rights in the Constitution of 1787, pp. 171-181, 187 et seq. (1956).
See King v. New Rochelle Municipal Housing Auth., 442 F.2d 646, 648 n. 5 (CA2 1971); Cole v. Housing Authority of the City of Newport, 435 F.2d 807, 811 (CA1 1970); Wellford v. Battaglia, 343 F.Supp. 143, 147 (Del.1972); cf. Truax v. Raich, 239 U. S. 33, 239 U. S. 39 (1915); Note, Shapiro v. Thompson: Travel, Welfare and the Constitution, 44 N.Y.U.L.Rev. 989, 1012 (1969).
Appellees argue that the County should be able to apply a durational residence requirement to preserve the quality of services provided its longtime residents because of their ties to the community and the previous contributions they have made, particularly through past payment of taxes. It would seem inconsistent to argue that the residence requirement should be construed to bar longtime Arizona residents, even if unconstitutional as applied to persons migrating into Maricopa County from outside the State. Surely, longtime residents of neighboring counties have more ties with Maricopa County and equity in its public programs, as through past payment of state taxes, than do migrants from distant States. This "contributory" rationale is discussed infra at 415 U. S. 266.
See Vlandis v. Kline, 412 U. S. 441, 412 U. S. 452-453, n. 9 (1973).
"imply no view of the validity of waiting period or residence requirements determining eligibility [inter alia] to obtain a license to practice a profession, to hunt or fish, and so forth."
Dept. of Health, Education, and Welfare (HEW) Report on Medical Resources Available to Meet the Needs of Public Assistance Recipients, House Committee on Ways and Means, 86th Cong., 2d Sess., 74 (Comm.Print 1961). Similarly, President Nixon has observed: "
t is health which is real wealth,' said Ghandi, and not pieces of gold and silver.'" Health, Message from the President, 92d Cong., 1st Sess., H.R.Doc. No. 92-49, p. 18 (1971). See also materials cited at n 4, supra.
since those students are characteristically transient, 412 U.S. at 412 U. S. 452. There is no such ambiguity about whether appellant Evaro is a bona fide resident of Maricopa County.
See HEW, Hill-Burton Project Register, July 1, 1947-June 30, 1967. HEW Publication No. (HSM) 72011, p. 37. Maricopa County has received over $2 million in Hill-Burton (42 U.S.C. § 291 et seq.) funds since 1947.
Medicaid, the primary federal program for providing medical care to indigents at public expense, does not permit participating States to apply a durational residence requirement as a condition to eligibility, 42 U.S.C. § 1396a(b)(3), and "this conclusion of coequal branch of Government is not without significance." Frontiero v. Richardson, 411 U. S. 677, 411 U. S. 687-688 (1973). The State of Arizona does not participate in the Medicaid program.
Shapiro v. Thompson, 394 U.S. at 394 U. S. 629.
See Cantor, The Law and Poor People's Access to Health Care, 35 Law & Contemp.Prob. 901, 909-914 (1970); cf. Catholic Medical Center v. Rockefeller, 305 F.Supp. 1256 and 1268 (EDNY 1969), vacated and remanded, 397 U. S. 820, aff'd on remand, 430 F.2d 1297, appeal dismissed, 400 U.S. 931 (1970).
The legal and economic aspects of medical care [Footnote 2/1] are enormous, and I doubt if decisions under the Equal Protection Clause of the Fourteenth Amendment are equal to the task of dealing with these matters. So far as interstate travel per se is considered, I share the doubts of my Brother REHNQUIST. The present case, however, turns for me on a different axis. The problem has many aspects. The therapy of Arizona's atmosphere brings many there who suffer from asthma, bronchitis, arthritis, and tuberculosis. Many coming are indigent, or become indigent after arrival. Arizona does not deny medical help to "emergency" cases "when immediate hospitalization or medical care is necessary for the preservation of life or limb," Ariz.Rev.Stat.Ann. § 11-297A (Supp. 1973-1974). For others, it requires a 12-month durational residence.
What Arizona has done, therefore, is to fence the poor out of the metropolitan counties, such as Maricopa County (Phoenix) and Pima County (Tucson) by use of a durational residence requirement. We are told that eight Arizona counties have no county hospitals, and that most indigent care in those areas exists only on a contract basis. In San Antonio Independent School Dist. v. Rodriguez, 411 U. S. 1, we had a case where Texas created a scheme by which school districts with a low property tax base, from which they could raise only meager funds, offered a lower quality of education to their students than the wealthier districts. That system was upheld against the charge that the state system violated the Equal Protection Clause. It was a closely divided Court, and I was in dissent. I suppose that, if a State can fence in the poor in educational programs, it can do so in medical programs. But to allow Arizona freedom to carry forward its medical program, we must go one step beyond the San Antonio case. In the latter, there was no legal barrier to movement into a better district. Here a one-year barrier to medical care, save for "emergency" care, is erected around the areas that have medical facilities for the poor.
of Hill-Burton facilities. The regulations contain conditions that the facility to be constructed or modernized with the funds "will be made available to all persons residing in the territorial area of the applicant," and that the applicant will render "a reasonable volume of services to persons unable to pay therefor." [Footnote 2/2] The conditions of free services for indigents, however, may be waived if "not feasible from a financial viewpoint."
And, as we held in Thorpe v. Housing Authority, 393 U. S. 268; Mourning v. Family Publications Service, 411 U. S. 356, these federal conditions attached to federal grants are valid when "reasonably related to the purposes of the enabling legislation." 393 U.S. at 393 U. S. 280-281.
It is difficult to impute to Congress approval of the durational residence requirement, for the implications of such a decision would involve weighty equal protection considerations by which the Federal Government, Bolling v. Sharpe, 347 U. S. 497, as well as the States, are bound.
of Elections, 383 U. S. 663, not the right to travel interstate, is, in my view, the critical issue.
See appendix to this opinion, post, p. 415 U. S. 274.
The State of Arizona provides free medical care for indigents. Confronted, in common with its 49 sister States, with the assault of spiraling health and welfare costs upon limited state resources, it has felt bound to require that recipients meet three standards of eligibility. [Footnote 3/1] First, they must be indigent, unemployable, or unable to provide their own care. Second, they must be residents of the county in which they seek aid. Third, they must have maintained their residence for a period of one year. These standards, however, apply only to persons seeking nonemergency aid. An exception is specifically provided for "emergency cases when immediate hospitalization or medical care is necessary for the preservation of life or limb. . . ."
institution. The hospital sought to recover its expenses from appellee Maricopa County under the provisions of Ariz.Rev.Stat.Ann. § 297A (Supp 1973-1974), asserting that Evaro was entitled to receive county care. Since he did not satisfy the eligibility requirements discussed above, [Footnote 3/2] appellee declined to assume responsibility for his care, and this suit was then instituted in the State Superior Court.
Appellants did not, and could not, claim that there is a constitutional right to nonemergency medical care at state or county expense or a constitutional right to reimbursement for care extended by a private hospital. [Footnote 3/3] They asserted, however, that the state legislature, having decided to give free care to certain classes of persons, must give that care to Evaro as well. The Court upholds that claim, holding that the Arizona eligibility requirements burdened Evaro's "right to travel."
Id. at 73 U. S. 44.
The statute in the present case raises no comparable barrier. Admittedly, some indigent persons desiring to reside in Arizona may choose to weigh the possible detriment of providing their own nonemergency health care during the first year of their residence against the total benefits to be gained from continuing location within the State, but their mere entry into the State does not invoke criminal penalties. To the contrary, indigents are free to live within the State, to receive welfare benefits necessary for food and shelter, [Footnote 3/9] and to receive free emergency medical care if needed. Furthermore, once the indigent has settled within a county for a year, he becomes eligible for full medical care at county expense. To say, therefore, that Arizona's treatment of indigents compares with California's treatment during the 1930's would border on the frivolous.
"Whatever the ultimate parameters of the Shapiro penalty analysis, it is at least clear that medical care is as much'a basic necessity of life' to an indigent as welfare assistance. And governmental privileges or benefits necessary to basic sustenance have often been viewed as being of greater constitutional significance than less essential forms of governmental entitlements. See, e.g., Shapiro, supra; Goldberg v. Kelly, 397 U. S. 254, 397 U. S. 264 (1970); Sniadach v. Family Finance Corp., 395 U. S. 337, 395 U. S. 340-342 (1969)."
Other interests advanced by the State to support its statutory eligibility criteria are also rejected virtually out of hand by the Court. The protection of the county economies is dismissed with the statement that "[t]he conservation of the taxpayers' purse is simply not a sufficient state interest. . . ." [Footnote 3/16] The Court points out that the cost of care, if not borne by the Government, may be borne by private hospitals such as appellant Memorial Hospital. While this observation is doubtless true in large part, and is bound to present a problem to any private hospital, it does not seem to me that it thus becomes a constitutional determinant. The Court also observes that the State may, in fact, save money by providing nonemergency medical care, rather than waiting for deterioration of an illness. However valuable a qualified cost analysis might be to legislators drafting eligibility requirements, and however little this speculation may bear on Evaro's condition (which the record does not indicate to have been a deteriorating illness), this sort of judgment has traditionally been confided to legislatures, rather than to courts charged with determining constitutional questions.
This Court has noted that citizens have no constitutional right to welfare benefits. See, e.g., Dandridge v. Williams, 397 U. S. 471 (1970); San Antonio Independent School Dist. v. Rodriguez, 411 U. S. 1, 411 U. S. 33 (1973).
179 U.S. at 179 U. S. 276.
See the concurring opinions of MR. JUSTICE DOUGLAS (with whom Mr. Justice Black and Mr. Justice Murphy joined), 314 U.S. at 314 U. S. 177, and Mr. Justice Jackson, id. at 314 U. S. 181.
314 U.S. at 314 U. S. 175. The Court did not express a view at that time as to whether a different result would have been reached if the State bore the financial burden. But cf. Shapiro v. Thompson, 394 U. S. 618 (1969).
412 U.S. at 412 U. S. 452. Starns was cited as support for this position.

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