Court Opinion

ID: 9425613
Source: CourtListenerOpinion
Date Created: 2023-08-02 23:15:14.837758+00
Date Added: 2024-06-11T17:22:56.603163
License: Public Domain

*277Mr. Justice Rehnquist,
dissenting.
I
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.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 . . . .”
Appellant Evaro moved from New Mexico to Arizona in June 1971, suffering from a “chronic asthmatic and bronchial illness.” In July 1971 he experienced a respiratory attack, and obtained treatment at the facilities of appellant Memorial Hospital, a privately operated *278institution. The hospital sought to recover its expenses from appellee Maricopa County under the provisions of Ariz. Rev. Stat. Ann. § 11-297A (Supp. 1973-1974), asserting that Evaro was entitled to receive county care. Since he did not satisfy the eligibility requirements discussed above,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.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.”
Unlike many traditional government services, such as police or fire protection, the provision of health care has commonly been undertaken by private facilities and personnel. But as strains on private services become greater, and the costs of obtaining care increase, federal, state, and local governments have been pressed to assume a larger role. Reasonably enough, it seems to me, those governments which now find themselves in the hospital business seek to operate that business primarily for those *279persons dependent on the financing locality both by association and by need.
Appellants in this case nevertheless argue that the State’s efforts, admirable though they may be, are simply not impressive enough. But others excluded by eligibility requirements certainly could make similar protests. Maricopa County residents of many years, paying taxes to both construct and support public hospital facilities, may be ineligible for care because their incomes are slightly above the marginal level for inclusion. These people have been excluded by the State, not because their claim on limited public resources is without merit, but because it has been deemed less meritorious than the claims of those in even greater need. Given a finite amount of resources, Arizona after today’s decision may well conclude that its indigency threshold should be elevated since its counties must provide for out-of-state migrants as well as for residents of longer standing. These more stringent need requirements would then deny care to additional persons who until now would have qualified for aid.
Those presently excluded because marginally above the State’s indigency standards, those who may be excluded in the future because of more stringent indi-gency requirements necessitated by today’s decision, and appellant Evaro, all have a plausible claim to government-supported medical care. The choice between them necessitated by a finite amount of resources is a classic example of the determination of priorities to be accorded conflicting claims, and would in the recent past have been thought to be a matter particularly within the competence of the state legislature to decide. As this Court stated in Dandridge v. Williams, 397 U. S. 471, 487 (1970), “the Constitution does not empower this Court to second-guess state officials charged with the difficult *280responsibility of allocating limited public welfare funds among the myriad of potential recipients.”
The Court holds, however, that the State was barred from making the choice it made because of the burden its choice placed upon Evaro’s “right to travel.” Although the Court’s definition of this “right” is hardly precise, the Court does state: “[T]he right of interstate travel must be seen as insuring new residents the same right to vital government benefits and privileges in the States to which they migrate as are enjoyed by other residents.” This rationale merits further attention.
II
The right to travel throughout the Nation has been recognized for over a century in the decisions of this Court.4 See Crandall v. Nevada, 6 Wall. 35 (1868). But the concept of that right has not been static. To see how distant a cousin the right to travel enunciated in this case is to the right declared by the Court in Crandall, reference need only be made to the language of Mr. Justice Miller, speaking for the Court:
“But if the government has these rights on her own account, the citizen also has correlative rights. He has the right to come to the seat of government to assert any claim he may have upon that government, or to transact any business he may have with it. To seek its protection, to share its offices, to engage in administering its functions. He has a right to free access to its sea-ports, through which all the operations of foreign trade and commerce are *281conducted, to the sub-treasuries, the land offices, the revenue offices, and the courts of justice in the several States, and this right is in its nature independent of the will of any State over whose soil he must pass in the exercise of it.” Id., at 44.
The Court in Crandall established no right to free benefits from every State through which the traveler might pass, but more modestly held that the State could not use its taxing power to impede travel across its borders.5
Later cases also defined this right to travel quite conservatively. For example, in Williams v. Fears, 179 U. S. 270 (1900), the Court upheld a Georgia statute taxing “emigrant agents” — persons hiring labor for work outside the State — although agents hiring for local work went untaxed. The Court recognized that a right to travel existed, stating:
“Undoubtedly the right of locomotion, the right to remove from one place to another according to inclination, is an attribute of personal liberty, and the right, ordinarily, of free transit from or through the territory of any State is a right secured by the Fourteenth Amendment and by other provisions of the Constitution.” Id., at 274.
The Court went on, however, to decide that the statute, despite the added cost it assessed against exported labor, affected freedom of egress “only incidentally and remotely.” Ibid.6
*282The leading earlier case, Edwards v. California, 314 U. S. 160 (1941), provides equally little support for the Court’s expansive holding here. In Edwards the Court invalidated a California statute which subjected to criminal penalties any person “that brings or assists in bringing into the State any indigent person who is not a resident of the State, knowing him to be an indigent person.” Id., at 171. Five members of the Court found the statute unconstitutional under the Commerce Clause, finding in the Clause a “prohibition against attempts on the part of any single State to isolate itself from difficulties common to all of them by restraining the transportation of persons and property across its borders.” Id., at 173. Four concurring Justices found a better justification for the result in the Fourteenth Amendment’s protection of the “privileges of national citizenship.”7
Regardless of the right’s precise source and definition, it is clear that the statute invalidated in Edwards was specifically designed to, and would, deter indigent persons from entering the State of California. The imposition of criminal penalties on all persons assisting the entry of an indigent served to block ingress as surely as if the State had posted guards at the border to turn indigents away. It made no difference to the operation of the statute that the indigent, once inside the State, would be supported by federal payments.8 Furthermore, *283the statute did not require that the indigent intend to take up continuous residence within the State. The statute was not therefore an incidental or remote barrier to migration, but was in fact an effective and purposeful attempt to insulate the State from indigents.
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,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.
Since those older cases discussing the right to travel are unhelpful to Evaro’s cause here, reliance must be placed elsewhere. A careful reading of the Court’s opinion discloses that the decision rests almost entirely on two cases of recent vintage: Shapiro v. Thompson, 394 U. S. 618 (1969), and Dunn v. Blumstein, 405 U. S. 330 (1972). In Shapiro the Court struck down statutes requiring one year’s residence prior to receiving welfare benefits. In Dunn the Court struck down a statute requiring a year’s residence before receiving the right to vote. In placing reliance on these two cases, the Court *284must necessarily distinguish or discredit recent cases of this Court upholding statutes requiring a year’s residence for lower in-state tuition.10 The important question for this purpose, according to the Court’s analysis, is whether a classification “ 'operates to' penalize those persons . . . who have exercised their constitutional right of interstate migration.’ ” (Emphasis in Court’s opinion.)
Since the Court concedes that “some 'waiting-period[s] . . . may not be penalties,’ ” ante, at 258-259, one would expect to learn from the opinion how to distinguish a waiting period which is a penalty from one which is not. Any expense imposed on citizens crossing state lines but not imposed on those staying put could theoretically be deemed a penalty on travel; the toll exacted from persons crossing from Delaware to New Jersey by the Delaware Memorial Bridge is a “penalty” on inter-, state travel in the most literal sense of all. But such charges,11 as well as other fees for use of transportation facilities such as taxes on airport users,12 have been upheld by this Court against attacks based upon the right to travel. It seems to me that the line to be derived from our prior cases is that some financial impositions on interstate travelers have such indirect or inconsequential impact on travel that they simply do not constitute the type of direct purposeful barriers struck down in Edwards and Shapiro. Where the impact is that remote, a State can reasonably require that the citizen bear some proportion of the State’s cost in its facilities. I would think that this standard is not only supported by this Court’s decisions, but would be *285eminently sensible and workable. But the Court not only rejects this approach, it leaves us entirely without guidance as to the proper standard to be applied.
The Court instead resorts to ipse dixit, declaring rather than demonstrating that the right to nonemergency medical care is within the class of rights protected by Shapiro and Dunn:
“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, 264 (1970) ; Sniadach v. Family Finance Corp., 395 U. S. 337, 340-342 (1969).” Ante, at 259. (Emphasis added; footnotes omitted.)
However clear this conclusion may be to the majority, it is certainly not clear to me. The solicitude which the Court has shown in cases involving the right to vote,13 and the virtual denial of entry inherent in denial of welfare benefits — “the very means by which to live,” Goldberg v. Kelly, 397 U. S. 254, 264 (1970) — ought not be so casually extended to the alleged deprivation here. Rather, the Court should examine, as it has done in the past, whether the challenged requirement erects a real and purposeful barrier to movement, or the threat of such a barrier, or whether the effects on travel, viewed realistically, are merely incidental and remote. As the above discussion has shown, the barrier here is hardly *286a counterpart to the barriers condemned in earlier cases. That being so, the Court should observe its traditional respect for the State's allocation of its limited financial resources rather than unjustifiably imposing its own preferences.
Ill
The Court, in its examination of the proffered state interests, categorically rejects the contention that those who have resided in the county for a fixed period of time may have a greater stake in community facilities than the newly arrived. But this rejection is accomplished more by fiat than by reason. One of the principal factual distinctions between Starns v. Malkerson, 326 F. Supp. 234 (Minn. 1970), aff’d, 401 U. S. 985 (1971), and Vlandis v. Kline, 412 U. S. 441 (1973), both of which upheld durational residence requirements for in-state university tuition,14 and Shapiro, which struck them down for welfare recipients, is the nature of the aid which the State or county provides. Welfare benefits, whether in cash or in kind, are commonly funded from current tax revenues, which may well be supported by the very newest arrival as well as by the longtime resident. But universities and hospitals, although demanding operating support from current revenues, require extensive capital facilities which cannot possibly be funded out of current tax revenues. Thus, entirely apart from the majority’s conception of whether nonemergency health care is more or less important than continued education, *287the interest of longer established residents in capital facilities and their greater financial contribution to the construction of such facilities seems indisputable.15
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 . . . .” 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.
The Court likewise rejects all arguments based on *288administrative objectives. Refusing to accept the assertion that a one-year waiting period is a “convenient rule of thumb to determine bona fide residence,” the majority simply suggests its own alternatives. Similar analysis is applied in rejecting the appellees’ argument based on the potential for fraud. The Court’s declaration that an indigent applicant “intent on committing fraud, could as easily swear to having been a resident of the county for the preceding year as to being one currently” ignores the obvious fact that fabricating presence in the State for a year is surely more difficult than fabricating only a present intention to remain.
The legal question in this case is simply whether the State of Arizona has acted arbitrarily in determining that access to local hospital facilities for nonemergency medical care should be denied to persons until they have established residence for one year. The impediment which this quite rational determination has placed on appellant Evaro’s “right to travel” is so remote as to be negligible: so far as the record indicates Evaro moved from New Mexico to Arizona three years ago and has remained ever since. The eligibility requirement has not the slightest resemblance to the actual barriers to the right of free ingress and egress protected by the Constitution, and struck down in cases such as Crandall and Edwards. And, unlike Shapiro, it does not involve an urgent need for the necessities of life or a benefit funded from current revenues to which the claimant may well have contributed. It is a substantial broadening of, and departure from, all of these holdings, all the more remarkable for the lack of explanation which accompanies the result. Since I can subscribe neither to the method nor the result, I dissent.

 Ariz. Rev. Stat. Ann. § 11-297A (Supp. 1973-1974) reads as follows:
“Except in emergency cases when immediate hospitalization or medical care is necessary for the preservation of life or limb no person shall be provided hospitalization, medical care or outpatient relief under the provisions of this article without first filing with a member of the board of supervisors of the county in which he resides a statement in writing, subscribed and sworn to under oath, that he is an indigent as shall be defined by rules and regulations of the state department of economic security, an unemployable totally dependent upon the state or county government for financial support, or an employable of sworn low income without sufficient funds to provide himself necessary hospitalization and medical care, and that he has been a resident of the county for the preceding twelve months-.”

 The parties stipulated that Mr. Evaro was “an indigent who recently changed his residence from New Mexico to Arizona and who has resided in the state of Arizona for less than twelve months.” App. 10. Therefore Mr. Evaro failed to meet only the third requirement discussed in the text.

 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, 33 (1973).

 Although the right to travel has been recognized by this Court for over a century, the origin of the right still remains somewhat obscure. The majority opinion in this case makes no effort to identify the source, simply relying on recent cases which state such a right exists.

 The tax levied by the State of Nevada was upon every person leaving the State. As this Court has since noted, the tax was a direct tax on travel and was not intended to be a charge for the use of state facilities. See Evansville Airport v. Delta Airlines, 405 U. S. 707 (1972).

 The Court also rejected an equal protection argument, concluding: “We are unable to say that such a discrimination, if it existed, *282did not rest on reasonable grounds, and was not within the discretion of the state legislature.” 179 U. S., at 276.

 See the concurring opinions of MR. Justice Douglas (with whom Mr. Justice Black and Mr. Justice Murphy joined), 314 U. S., at 177, and Mr. Justice Jackson, id., at 181.

 The Court in Edwards observed: “After arriving in California [the indigent] was aided by the Farm Security Administration, which ... is wholly financed by the Federal government.” 314 U. S., at 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).

 See Ariz. Rev. Stat. Ann. § 46-233 (Supp, 1973-1974), which provides that an eligible recipient of general assistance must have “established residence at the time of application.”

 See Starns v. Malkerson, 326 F. Supp. 234 (Minn. 1970), aff’d, 401 U. S. 985 (1971); Vlandis v. Kline, 412 U. S. 441 (1973).

 See, e. g., Interstate Busses Corp. v. Blodgett, 276 U. S. 245 (1928); Hendrick v. Maryland, 235. U. S. 610 (1915).

 See Evansville Airport v. Delta Airlines, 405 U. S. 707 (1972).

 See, e. g., Evans v. Cornman, 398 U. S. 419 (1970); Cipriano v. City of Houma, 395 U. S. 701 (1969).

 In Vlandis, while striking down a Connecticut statute that in effect prevented a new state resident from obtaining lower tuition rates for the full period of enrollment, we stated that the decision should not “be construed to deny a State the right to impose on a student, as one element in demonstrating bona fide residence, a reasonable durational residency requirement, which can be met while in student status.” 412 U. S., at 452. Starns was cited as support for this position.

 This distinction may be particularly important in a State such as Arizona where the Constitution provides for limitations on state and county debt. See Ariz. Const., Art. 9, § 5 (State); Art. 9, §8 (County). See generally Comment, Dulling the Edge of Husbandry: The Special Fund Doctrine in Arizona, 1971 L. & Soc. O. (Ariz. St. L. J.) 555.

 The appellees in this case filed an affidavit indicating that acceptance of appellants’ position would impose an added burden on property taxpayers in Maricopa County of over $2.5 million in the first year alone. App. 12-17.