The Supplemental Security Income (SSI) program, which is part of
the Social Security Act, provides a subsistence allowance to needy
aged, blind, and disabled persons. Inmates of public institutions
are generally excluded from this program, except that, under §
1611(e)(1)(B) of the Act, a reduced amount of SSI benefits are
provided to otherwise eligible persons in a hospital, extended care
facility, nursing home, or intermediate care facility receiving
Medicaid funds for their care. Appellees, aged 21 through 64 and
residing in public mental institutions that do not receive Medicaid
funds for their care, brought a class action in Federal District
Court challenging their exclusion from the reduced SSI benefits.
The District Court held such exclusion unconstitutional as
violative of the equal protection guarantees of the Due Process
Clause of the Fifth Amendment on the ground that the "mental
health" classification could not withstand judicial scrutiny
because it did not have a "substantial relation" to the object of
the legislation in light of its "primary purpose."
Held: Appellees' rights to equal protection were not
violated by denying them SSI benefits. Pp.
450 U. S.
230-239.
(a) In § 1611(e)(1)(B), Congress made a distinction not between
the mentally ill and a group composed of nonmentally ill, but
between residents in public institutions receiving Medicaid funds
for their care and residents in such institutions not receiving
such funds. To the extent that the statute has an indirect impact
upon the mentally ill as a subset of publicly institutionalized
persons, the record in this case presents no statistical support
for a contention that the mentally ill as a class are burdened
disproportionately to any other class affected by the
classification. The indirect deprivation worked by this legislation
upon appellees' class, whether or not the class is considered
"suspect," does not, in the absence of any evidence that Congress
deliberately intended to discriminate against the mentally ill,
move this Court to regard it with a heightened scrutiny. Pp.
450 U. S.
230-234.
(b) The classification employed in § 1611(e)(1)(B) is to be
judged under the rational basis standard, which does not allow this
Court to
Page 450 U. S. 222
substitute its personal notions of good public policy for those
of Congress. Under this standard, and based on the legislative
history, it was not irrational for Congress to elect, in view of
budgetary constraints, to shoulder only part of the burden of
supplying a "comfort money" allowance, leaving the States with the
primary responsibility for making such an allowance available to
those residents in state-run institutions, and to decide that it is
the Medicaid recipients in public institutions who are the most
needy and deserving of the SSI benefits. Pp.
450 U. S.
234-239.
478
F. Supp. 1046, reversed.
BLACKMUN, J., delivered the opinion of the Court, in which
BURGER, C.J., and STEWART, WHITE, and REHNQUIST, JJ., joined.
POWELL, J., filed a dissenting opinion, in which BRENNAN, MARSHALL,
and STEVENS, JJ., joined,
post, p.
450 U. S.
239.
JUSTICE BLACKMUN delivered the opinion of the Court.
The issue in this case is whether Congress constitutionally may
decline to grant Supplemental Security Income benefits to a class
of otherwise eligible individuals who are excluded because they are
aged 21 through 64 and are institutionalized in public mental
institutions that do not receive Medicaid funds for their care. The
United States District Court for the Northern District of Illinois
held unconstitutional, under
Page 450 U. S. 223
the Due Process Clause of the Fifth Amendment, that portion of
the Social Security Act, as amended, that excludes these otherwise
eligible persons from the supplemental benefits. The Secretary of
Health and Human Services has taken a direct appeal to this Court
under 28 U.S.C. § 1252.
I
In October, 1972, Congress amended the Social Security Act (Act)
to create the federal Supplemental Security Income (SSI) program,
effective January 1, 1974. 86 Stat. 1465, 42 U.S.C. § 1381
et
seq. This program was intended "[t]o assist those who cannot
work because of age, blindness, or disability," S.Rep. No. 92-1230,
p. 4 (1972), by "set[ting] a Federal guaranteed minimum income
level for aged, blind, and disabled persons,"
id. at 12.
[
Footnote 1]
The SSI program provides a subsistence allowance, under federal
standards, to the Nation's needy aged, blind, and disabled.
[
Footnote 2] Included within
the category of "disabled" under the program are all those
"unable to engage in any substantial gainful activity by reason
of any medically determinable physical or mental impairment which
can be expected to
Page 450 U. S. 224
result in death or which has lasted or can be expected to last
for a continuous period of not less than twelve months."
§ 1614(a)(3)(A) of the Act, 42 U.S.C. § 1382c(a)(3)(A).
Although the SSI program is broad in its reach, its coverage is
not complete. From its very inception, the program has excluded
from eligibility anyone who is an "inmate of a public institution."
§ 1611(e)(1)(A) of the Act, as amended, 42 U.S.C. § 1382(e)(1)(A).
[
Footnote 3] Also from the
program's inception, Congress has made a partial exception to this
exclusion by providing a small amount of money (not exceeding $300
per year) to any otherwise eligible person in
"a hospital, extended care facility, nursing home, or
intermediate care facility receiving payments (with respect to such
individual or spouse) under a State plan approved under subchapter
XIX [Medicaid]. . . ."
§ 1611(e)(1)(B), as amended, 42 U.S.C. § 1382(e)(1)(B).
[
Footnote 4] Congress thus,
while excluding
Page 450 U. S. 225
generally any person residing in a public institution,
explicitly has tied eligibility for a reduced amount of SSI
benefits to residence in an institution receiving Medicaid benefits
for the care of the eligible individual.
Appellees brought this suit to challenge this resulting detail
of Congress' having conditioned the limited assistance grant on
eligibility for Medicaid: a person between the ages of 21 through
64 who resides in a public mental institution is not eligible to
receive this small stipend, even though that person meets the other
eligibility requirements for SSI benefits, because treatment in a
public mental institution for a person in this age bracket is not
funded under Medicaid. [
Footnote
5]
Page 450 U. S. 226
Appellees attack this statutory classification as violative of
the equal protection component of the Fifth Amendment's Due Process
Clause. [
Footnote 6] Their
challenge, successful in the District Court, is twofold. First,
they argue that the exclusion of their class of mentally ill (and
therefore disabled) persons bears no rational relationship to any
legitimate objective of the SSI program. They assert, in fact, that
their class was excluded inadvertently because of its political
powerlessness. Brief for Appellees 6, 32. Second, they insist that,
because the statute classifies on the basis of mental illness, a
factor that
Page 450 U. S. 227
greatly resembles other characteristics that this Court has
found inherently "suspect" as a means of legislative
classification, special justification should be required for the
congressional decision to exclude appellees.
II
This case has had a somewhat complex procedural history. It
initially was instituted in December, 1973, as a class action for
injunctive and declaratory relief to challenge the federal and
Illinois assistance schemes that prevailed prior to the effective
date of the SSI program.
See Wilson v. Edelman, 542 F.2d
1260, 1263-1266 (CA7 1976). The then-existing state assistance
program, for which federal funds were received, excluded from
eligibility any person who was residing in a public mental or
tuberculosis institution or who was confined in a penal
institution.
Id. at 1263, n. 2. The plaintiffs later
amended their complaint to include a challenge to the SSI
exclusion, which by then had come into effect.
Id. at
1266. A three-judge court was convened under 28 U.S.C. §§ 2281 and
2282 (1970 ed.) (since repealed by Pub.L. 94381, §§ 1 and 2, 90
Stat. 1119). The case was consolidated with another that challenged
the exclusion from SSI benefits of any pretrial detainee. Relying
on
Weinberger v. Salfi, 422 U. S. 749
(1975), the court granted the Secretary's motion to dismiss both
cases for lack of subject matter jurisdiction on the ground that
the plaintiffs had failed to exhaust the administrative remedies
provided for by § 1631(c)(3) of the Act, as amended, 42 U.S.C. §
1383(c)(3).
See 542 F.2d at 1267-1268. [
Footnote 7]
On appeal, appellees abandoned their claims under the prior
federal statutes.
Id. at 1271. The United States Court
of
Page 450 U. S. 228
Appeals for the Seventh Circuit reversed the dismissal, holding
that the Secretary (then Patricia Harris) had waived any
requirement of exhaustion by her submission of the case to the
District Court for summary disposition. [
Footnote 8]
Id. at 1272. Because the
plaintiffs had dropped their request for injunctive relief, the
case was remanded to the single-judge District Court.
Id.
at 1269. That court, on remand, certified the class [
Footnote 9] and granted appellees' motion for
summary judgment, holding that 1382(e)'s exclusion of the class
members violated the equal protection guarantee of the Due Process
Clause of the Fifth Amendment.
Sterling v.
Harris, 478 F.
Supp. 1046 (ND Ill.1979). [
Footnote 10] The District Court reasoned that the statute
"creates three classifications: (1) age, and (2) residence in a
public, (3) mental health hospital."
Id. at 1050. It ruled
that Congress' use of the first two factors need be justified only
by
Page 450 U. S. 229
demonstration of their "rational relationship" to "a legitimate
state interest."
Ibid. Under that standard, these
classifications withstood scrutiny. Congress' use, however, of a
"mental health" classification was deemed to require a closer
examination because "mental health classifications possess the
significant indicia of the suspect classifications recognized in
other cases."
Id. at 1052. Although recognizing that the
mentally ill as a group do not demonstrate all the characteristics
this Court has considered as denoting inherently suspicious
classifications, such as race and national origin, [
Footnote 11] the District Court believed
that the mentally ill were "a politically impotent, insular
minority" that "have been subject to a
history of unequal
protection.'" Ibid. The court therefore concluded that
Congress could legislatively disfavor the mentally ill, as §
1611(e) did, only if the statutory classification passes an
"intermediate level of judicial scrutiny," id. at 1053,
that is, only if the "classification bears a substantial relation"
to the object of the legislation evaluated "in light of the primary
purpose" of the scheme of which it is a part. Ibid. The
court adjudged that the "primary purpose" of the small monthly
stipend was to enable the needy to purchase comfort items not
provided by the institution. Rejecting the Secretary's proposed
justifications for the exclusion, [Footnote 12] the District Court held that the
classification could not withstand scrutiny.
Page 450 U. S. 230
The legislative history, it said, revealed no intent to exclude
appellees' class; the court could conceive of no "possible
unexpressed purpose for the exclusion"; and the court reasoned that
"aged blind and disabled inmates of all public institutions would
have similar needs."
Ibid. Upon the Secretary's direct
appeal from this judgment, we noted probable jurisdiction.
Harris v. Wilson, 446 U.S. 964 (1980).
III
A
The equal protection obligation imposed by the Due Process
Clause of the Fifth Amendment is not an obligation to provide the
best governance possible. This is a necessary result of different
institutional competences, and its reasons are obvious. Unless a
statute employs a classification that is inherently invidious or
that impinges on fundamental rights, areas in which the judiciary
then has a duty to intervene in the democratic process, this Court
properly exercises only a limited review power over Congress, the
appropriate representative body through which the public makes
democratic choices among alternative solutions to social and
economic problems.
See San Antonio School District v.
Rodriguez, 411 U. S. 1 (1973).
At the minimum level, this Court consistently has required that
legislation classify the persons it affects in a manner rationally
related to legitimate governmental objectives.
See, e.g.,
Dandridge v. Williams, 397 U. S. 471
(1970);
Mathews v. De Castro, 429 U.
S. 181 (1976). Appellees assert that the particular
grant of federal benefits under review here, however should "be
subjected to a heightened standard of review," Brief for Appellees
39, because the mentally ill
"historically have been subjected to purposeful unequal
treatment; they have been relegated to a position of political
powerlessness; and prejudice against them curtails their
participation in the pluralist political system and strips them of
political protection against discriminatory legislation."
(Footnote omitted.)
Id. at 41.
Page 450 U. S. 231
We have no occasion to reach this issue because we conclude that
this statute does not classify directly on the basis of mental
health. [
Footnote 13] The
SSI program distinguishes among three groups of persons, all of
whom meet the basic eligibility requirements: persons not in a
"public institution" may receive full benefits; persons in a
"public institution" of a certain nature ("hospital, extended care
facility, nursing home, or intermediate care facility
receiving
payments (with respect to such individual or spouse) . . .
under [Medicaid])" (emphasis added), § 1611(e)(1)(B), may receive
reduced benefits; and persons in any other "public institution" may
not receive any benefits. The statute does not isolate the mentally
ill or subject them, as a discrete group, to special or subordinate
treatment. At the most, this legislation incidentally denies a
small monthly comfort benefit to a certain number of persons
suffering from mental illness; but in so doing, it imposes
equivalent deprivation on other groups who are not mentally ill,
while at the same time benefiting substantial numbers of the
mentally ill.
The group thus singled out for special treatment by § 1611(e)
does not entirely exclude the mentally ill. In fact, it includes,
in a sizable proportion to the total population receiving SSI
benefits, large numbers of mentally ill people. [
Footnote 14]
Page 450 U. S. 232
Further, the group excluded is not congruent with appellees'
class. Among those excluded are the inmates of any other nonmedical
"public institution," such as a prison other penal institution, and
any other publicly funded residential program the State may
operate; [
Footnote 15]
persons residing in a tuberculosis institution; and residents of a
medical institution not certified as a Medicaid provider. [
Footnote 16] Although not by the
same subsection, Congress also chose to exclude from SSI
eligibility persons afflicted with alcoholism or drug addiction and
not undergoing treatment, § 1611(e)(3)(A), and persons who spend
more than a specified time outside the United States, § 1611(f).
See Califano v. Aznavorian, 439 U.
S. 170 (1978) (upholding constitutionality of §
1611(f));
Califano v. Torres, 435 U. S.
1 (1978) (upholding constitutionality of Congress'
exclusion from SSI eligibility of residents of Puerto Rico). Thus,
in § 1611(e), Congress made a distinction not between the mentally
ill and a group composed of nonmentally ill, but between residents
in public institutions receiving Medicaid
Page 450 U. S. 233
funds for their care and residents in such institutions not
receiving Medicaid funds.
To the extent that the statute has an indirect impact upon the
mentally ill as a subset of publicly institutionalized persons,
this record certainly presents no statistical support for a
contention that the mentally ill, as a class, are burdened
disproportionately to any other class affected by the
classification. The exclusion draws a line only between groups
composed (in part) of mentally ill individuals: those in public
mental hospitals and those not in public mental hospitals. These
groups are shifting in population, and members of one group can,
and often do, pass to the other group. [
Footnote 17]
We also note that appellees have failed to produce any evidence
that the intent of Congress as to classify on the
Page 450 U. S. 234
basis of mental health. Appellees admit that no such evidence
exists; indeed, they rely on the absence of explicit intent as
proof of Congress' "inattention" to their needs and, therefore, its
prejudice against them. Brief for Appellees 39. As in
Jefferson
v. Hackney, 406 U. S. 535
(1972), the indirect deprivation worked by this legislation upon
appellees' class, whether or not the class is considered "suspect,"
does not, without more, move us to regard it with a heightened
scrutiny.
Cf. Personnel Administrator of Massachusetts v.
Feeney, 442 U. S. 256
(1979).
B
Thus, the pertinent inquiry is whether the classification
employed in § 1611(e)(1)(B) advances legitimate legislative goals
in a rational fashion. The Court has said that, although this
rational basis standard is "not a toothless one,"
Mathews v.
Lucas, 427 U. S. 495,
427 U. S. 510
(1976), it does not allow us to substitute our personal notions of
good public policy for those of Congress:
"In the area of economics and social welfare, a State does not
violate the Equal Protection Clause [and correspondingly the
Federal Government does not violate the equal protection component
of the Fifth Amendment] merely because the classifications made by
its laws are imperfect. If the classification has some 'reasonable
basis,' it does not offend the Constitution simply because the
classification 'is not made with mathematical nicety or because, in
practice, it results in some inequity.'
Lindsley v. Natural
Carbonic Gas Co., 220 U. S. 61,
220 U. S.
78."
Dandridge v. Williams, 397 U.S. at
397 U. S.
485.
The Court also has said:
"This inquiry employs a relatively relaxed standard reflecting
the Court's awareness that the drawing of lines that create
distinctions is peculiarly a legislative task and an unavoidable
one. Perfection in making the necessary classifications is neither
possible nor necessary."
Massachusetts Bd. of Retirement v. Muria, 427 U.
S. 307,
Page 450 U. S. 235
427 U. S. 314
(1976).
See also United States Railroad Retirement Bd. v.
Fritz, 449 U. S. 166
(1980). As long as the classificatory scheme chosen by Congress
rationally advance a reasonable and identifiable governmental
objective, we must disregard the existence of other methods of
allocation that we, as individuals, perhaps would have
preferred.
We believe that the decision to incorporate the Medicaid
eligibility standards into the SSI scheme must be considered
Congress' deliberate, considered choice. The legislative record,
although sparse, appears to be unequivocal. Both House and Senate
Reports on the initial SSI bill noted the exclusion in no uncertain
terms. The House Report stated:
"People who are residents of certain public institutions, or
hospitals or nursing homes which are getting Medicaid funds, would
get benefits of up to $25 a month (reduced by nonexcluded income).
For these people, most subsistence needs are met by the
institution, and full benefits are not needed. Some payment to
these people, though, would be needed to enable them to purchase
small comfort items not supplied by the institution. No assistance
benefits will be paid to an individual in a penal institution."
H.R.Rep. No. 92-231, p. 150 (1971). The Senate Report followed
the House's language almost identically.
See S.Rep. No.
92-1230, p. 386 (1972). We find these passages, at the very least,
to be a clear expression of Congress' understanding that the
stipend grant was to be limited to a group smaller than the total
population of otherwise eligible, institutionalized people. That
the bill's section-by-section analysis contained in the House
Report laid out the terms of the exclusion precisely supports the
conclusion that Congress was aware of who was included in that
limited group.
See H.R.Rep. No. 92-231, at 334.
The limited nature of Medicaid eligibility did not pass
unnoticed by the enacting Congress. In the same bill that
established the SSI program, Congress considered, and passed,
Page 450 U. S. 236
amendment to Medicaid, providing coverage of inpatient services
to a large number of the juvenile needy in public mental
institutions. [
Footnote 18]
See § 1905 (h) of the ,Act, 42 U.S.C. § 1396d(h); S.Rep.
No. 92-1230 at 280-281; H.R.Conf.Rep. No. 92-1605, p. 65 (1972).
Also, a Senate proposal for demonstration projects on the
feasibility of extending Medicaid to cover all inpatient services
provided in public mental institutions was simultaneously defeated.
See S.Rep. No. 92-1230 at 281; H.R.Conf.Rep. No. 92-1605
at 65. Congress was in the process of considering the wisdom of
these limitations at the time it chose to incorporate them into the
SSI provisions. The decision to do so did not escape controversy.
The Committee hearings contained testimony advocating extension of
both Medicaid and SSI benefits to all needy residents in public
mental institutions.
See Social Security Amendments of
1971, Hearings on H.R. 1 before the Senate Committee on Finance,
92d Cong., 1st and 2d Sess., 2180, 2408-2410, 2479-2485, 3257, 3319
(1972). This legislative history shows that Congress was aware,
when it added § 1611(e) to the Act, of the limitations in the
Medicaid program that would restrict eligibility for the reduced
SSI benefits; we decline to regard such deliberate action as the
result of inadvertence or ignorance.
See Maine v.
Thiboutot, 448 U. S. 1,
448 U. S. 8
(1980). Having found the adoption of the Medicaid standards
intentional, we deem it logical to infer from Congress' deliberate
action an intent to further the same subsidiary purpose that lies
behind the Medicaid exclusion, which, as no party denies, was
adopted because Congress believed the States to have a
"traditional" responsibility to care for those
institutionalized
Page 450 U. S. 237
in public mental institutions. [
Footnote 19] The Secretary, emphasizing the then-existing
congressional desire to economize in the disbursement of federal
funds, argues that the decision to limit distribution of the
monthly stipend to inmates of public institutions who are receiving
Medicaid funds
"is rationally related to the legitimate legislative desire to
avoid spending federal resources on behalf of individuals whose
care and treatment are being fully provided for by state and local
government units"
and
"may be said to implement a congressional policy choice to
provide supplemental financial assistance for only those residents
of public institutions who already receive significant federal
support in the form of Medicaid coverage."
Brief for Appellant 27-28. We cannot say that the belief that
the States should continue to have the primary responsibility for
making this small "comfort money" allowance available to those
residing in state-run institutions is an irrational basis for
withholding from them federal general welfare funds. [
Footnote 20]
Page 450 U. S. 238
Although we understand and are inclined to be sympathetic with
appellees' and their supporting
amici's assertions as to
the beneficial effects of a patient's receiving the reduced
stipend, we find this a legislative, and not a legal, argument.
Congress rationally may elect to shoulder only part of the burden
of supplying this allowance, and may rationally limit the grant to
Medicaid recipients, for whose care the Federal Government already
has assumed the major portion of the expense. [
Footnote 21] The limited gratuity represents a
partial solution to a far more general problem, [
Footnote 22] and Congress legitimately may
assume that the States would, or should, provide an equivalent,
either in funds or in basic care.
See Baur v. Mathews, 578
F.2d 228, 233 (CA9 1978). This Court has granted a "strong
presumption of constitutionality" to legislation conferring
monetary benefits,
Mathews v. De Castro, 429 U.S. at
429 U. S. 185,
because it believes that Congress should have discretion in
deciding how to expend necessarily limited resources. Awarding this
type of benefits inevitably involves the kind of line-drawing that
will leave some comparably needy person outside the favored circle.
[
Footnote 23] We cannot
say
Page 450 U. S. 239
that it was irrational of Congress, in view of budgetary
constraints, [
Footnote 24]
to decide that it is the Medicaid recipients in public institutions
that are the most needy and the most deserving of the small monthly
supplement.
See, e.g., Califano v. Boles, 443 U.
S. 282,
443 U. S. 296
(1979);
Califano v. Jobst, 434 U. S.
47,
434 U. S. 53
(1977);
Weinberger v. Salfi, 422 U.
S. 749,
422 U. S.
768-770 (1975);
Richardson v. Belcher,
404 U. S. 78,
404 U. S. 83 84
(1971).
We conclude that Congress did not violate appellees' rights to
equal protection by denying them the supplementary benefit. The
judgment of the District Court is reversed.
It is so ordered.
[
Footnote 1]
The SSI program, Title XVI of the Social Security Act, largely
replaced the prior system of federal grants to state-run assistance
programs for the aged, blind, and disabled contained in Titles I,
X, XIV, and XVI of the Act, that is, Old Age Assistance, 49 Stat.
620, as amended, 42 U.S.C. § 301
et seq.; Aid to the
Blind, 49 Stat. 645, as amended, 42 U.S.C. § 1201
et seq.;
Aid to the Permanently and Totally Disabled, 64 Stat. 555, as
amended, 42 U.S.C. § 1351
et seq.; and Aid to the Aged,
Blind, or Disabled, 76 Stat.197, 42 U.S.C. § 1381
et seq.
(1970 ed.).
See Califano v. Aznavorian, 439 U.
S. 170,
439 U. S. 171
(1978);
Califano v. Torres, 435 U. S.
1,
435 U. S. 2
(1978).
[
Footnote 2]
To be eligible for SSI benefits, a person must be "aged," that
is, 65 or older, or "blind," or "disabled," as those terms are
defined in § 1614 of the Act, as amended, 42 U.S.C. § 1382c, and
his income and resources must be below the levels specified in §
1611(a), as amended, 42 U.S.C. § 1382(a).
[
Footnote 3]
Section 1611(e)(1)(A), as amended, provides:
"(e) Limitation on eligibility of certain individuals"
"(1)(A) Except as provided in subparagraph (B) and (C), no
person shall be an eligible individual or eligible spouse for
purposes of this subchapter with respect to any month if throughout
such month he is an inmate of a public institution."
[
Footnote 4]
Section 1611(e)(1)(B), as amended, modifying § 1611(e)(1)(A), as
amended, states:
"(B) In any case where an eligible individual or his eligible
spouse (if any) is, throughout any month, in a hospital, extended
care facility, nursing home, or intermediate care facility
receiving payments (with respect to such individual or spouse)
under a State plan approved under title XIX, the benefit under this
title for such individual for such month shall be payable -- "
"(i) at a rate not in excess of $300 per year (reduced by the
amount of any income not excluded pursuant to section 1612(B)) in
the case of an individual who does not have an eligible
spouse;"
"(ii) in the case of an individual who has an eligible spouse,
if only one of them is in such a hospital, home or facility
throughout such month, at a rate not in excess of the sum of --
"
"(I) the rate of $300 per year (reduced by the amount of any
income, not excluded pursuant to section 1612(B), of the one who is
in such hospital, home, or facility), and"
"(II) the applicable rate specified in subsection (B)(1)
(reduced by the amount of any income, not excluded pursuant to
section 1612(B), of the other); and"
"(iii) at a rate not in excess of $600 per year (reduced by the
amount of any income not excluded pursuant to section 1612(B)) in
the case of an individual who has an eligible spouse, if both of
them are in such a hospital, home, or facility throughout such
month."
Subsection (C) of § 1611(e)(1), not implicated in this case,
further modifies § 1611(e)(1)(A), as amended, by providing:
"(C) As used in subparagraph (A), the term 'public institution'
does not include a publicly operated community residence which
serves no more than 16 residents."
Added in 1976 by Pub.L. 9566, § 505(a), 90 Stat. 2686, this
subsection met objections that § 1611(e) impeded reform efforts to
deinstitutionalize certain groups of handicapped individuals, such
as the mentally retarded. Congress determined to encourage the
establishment of state-run group homes for such people by making
residents in these institutions eligible for SSI benefits.
See S. Rep No. 94-1265, p. 29 (1976); H.R.Conf.Rep. No.
94-1745, pp. 27-28 (1976).
[
Footnote 5]
Federal funds are available under the Medicaid program to pay
for the following "residential" services: "inpatient hospital
services (other than services in an institution for tuberculosis or
mental diseases)," § 1905(a)(1), 42 U.S.C. § 1396d(a)(1); "skilled
nursing facility services (other than services in an institution
for tuberculosis or mental diseases) for individuals 21 years of
age or older," § 1905(a)(4)(A); "inpatient hospital services,
skilled nursing facility services, and intermediate care facility
services for individuals 65 years of age or over in an institution
for tuberculosis or mental diseases," § 1905(a)(14); "intermediate
care facility services (other than such services in an institution
for tuberculosis or mental diseases) for individuals . . . in need
of such care," § 1905(a) (15); certain "inpatient psychiatric
hospital services for individuals under age 21," §§ 1905(a)(16) and
(h). Subsection (17)(B) of § 1905(a), which provides for funding of
any other medical or remedial care recognized under state law,
specifically excludes
"payments with respect to care or services for any individual
who has not attained 65 years of age and who is a patient in an
institution for tuberculosis or mental diseases."
In 1950, when it first enacted federal grants for medical
assistance, Congress excluded "any individual . . . who is a
patient in an institution for . . . mental diseases" from
eligibility. 64 Stat 558. This exclusion was incorporated into the
Medicaid statute in 1965, 79 Stat. 352, but exceptions were made
for the needy aged in mental institutions, and for the care of
mentally ill persons in general medical facilities.
Ibid.
In 1972, in the bill enacting the SSI program, Congress further
broadened Medicaid benefits for the mentally ill to include most
children in mental institutions. 86 Stat. 1461. A Senate proposal
for demonstration projects to investigate the possibility of
extending Medicaid benefits to the mentally ill between the ages of
21 through 64 in mental hospitals was defeated at that time.
See S.Rep. No. 92-1230, p. 281 (1972); H.R.Conf.Rep. No.
92-1605, p. 65 (1972).
[
Footnote 6]
This Court repeatedly has held that the Fifth Amendment imposes
on the Federal Government the same standard required of state
legislation by the Equal Protection Clause of the Fourteenth
Amendment.
See, e.g., Weinberger v. Salfi, 422 U.
S. 749,
422 U. S.
768-770 (1975);
Richardson v. Belcher,
404 U. S. 78,
404 U. S. 81
(1971).
[
Footnote 7]
The three-judge court also found that the state statute
classified on the basis of age, not mental health, and that it was
rational and constitutional. The Court of Appeals declined to
review that constitutional holding on the ground that review from
the three-judge court could be had only in this Court.
Wilson
v. Edelman, 542 F.2d at 1276-1282.
[
Footnote 8]
The Court of Appeals also held that only two of the named
plaintiffs, Maudie Simmons and John Kiernan Turney, had satisfied
the minimum, nonwaivable requirement of 42 U.S.C. § 405(g) that a
party may seek review only of a "final decision of the Secretary"
denying, terminating, or suspending benefits under the SSI program.
The other named plaintiffs, including Charles Wilson, were eligible
for, or had sought and been denied, benefits only under the prior
cooperative state-federal programs, and therefore they were
dismissed as parties. We have retained Wilson as a named party in
the caption of this case, however, as did the District Court on
remand, for the sake of uniformity.
[
Footnote 9]
The class was defined as
"all persons residing in HEW Region V who have been terminated
from benefits under Title XVI, or who have applied for Supplemental
Security Income benefits under Title XVI and have been denied such
benefits, on or after January 1, 1974, solely because they are
between the ages of 21 and 65 and hospitalized in a public mental
institution."
App. to Juris.Statement 21a.
[
Footnote 10]
The District Court denied, however, the claim of the pretrial
detainees to the monthly stipend, applying a "rational relation"
standard and finding the exclusion rational because
"[t]he detainee status is necessarily temporary in nature, and
the [Secretary] could legitimately wish to withhold these
extra-subsistence payments while the detainee is housed in a public
institution and until his future status is determined."
478 F.
Supp. at 1055.
[
Footnote 11]
The District Court noted that a person's mental health problem,
especially one that has led to institutionalization, is likely to
"
bear [a] relation to ability to perform or contribute to
society.'" Id. at 1051-1052, quoting Frontiero v.
Richardson, 411 U. S. 677,
411 U. S. 686
(1973). The court also acknowledged that "[i]t is debatable whether
and to what extent the mental illness is an `immutable
characteristic determined solely by the accident of birth.'" 478 F.
Supp. at 1052, again quoting Frontiero, 411 U.S. at
411 U. S.
686.
[
Footnote 12]
The Secretary argued that the statutory exclusion has three
purposes:
"1) the conservation of federal resources; 2) the concern that
federal funds be received on behalf of residents of qualified
institutions; and 3) the fact that plaintiffs are not 'similarly
situated' with Medicaid patients in terms of federal interest and
control."
478 F. Supp. at 1053.
[
Footnote 13]
We therefore intimate no view as to what standard of review
applies to legislation expressly classifying the mentally ill as a
discrete group.
[
Footnote 14]
Social Security Administration statistics show that 30.7% of all
blind and disabled adult persons awarded SSI benefits in 1975
(109,509 persons) were deemed disabled by mental disorders, and the
Administration has concluded that "[m]ental illness was the most
common cause of disability in 1975." Kochhar, Blind and Disabled
Persons Awarded Federally Administered SSI Payments, 1975, Social
Security Bulletin 13, 15 (June 1979). Half of this number suffered
from mental illness, rather than mental retardation, and these
statistics did not include any persons with prior entitlement to
benefits.
Ibid.
Further, as a recent study also indicates, a substantial number
of mentally ill people in institutions actually receive SSI
benefits. Social Security Administration, Representative Payments
under the SSI Program, August, 1977, Research and Statistics Note
No. 9 (Sept. 16, 1980). This study established that 15% of the
total population receiving SSI benefits (for all reasons, including
age, blindness, and disability) had "representative payees" (a
person "appointed to manage the benefits of an adult beneficiary"
because of "the adult beneficiary's inability to manage his own
funds").
Id. at 1. Out of a total of 184,133
institutionalized persons who were receiving SSI benefits in
August, 1977, through such "representative payees," 76,494, or
approximately 41%, were institutionalized because of mental
disorders.
Id. at 7 (Table 6) and 2 (Table 1). Thus, even
on this incomplete data, a sizable number of SSI recipients were
persons institutionalized for mental illness.
[
Footnote 15]
Appellees appear to concede the rationality of Congress' general
exclusion of publicly institutionalized persons from full SSI
benefits.
[
Footnote 16]
An otherwise eligible person does not receive SSI benefits if he
is receiving long-term treatment in a medical facility that is not
certified under Medicaid standards as a provider.
See §
1861 of the Act, 42 U.S.C. § 1395x. These strict standards exclude
many facilities, but work to the ultimate benefit of those
receiving Medicaid.
Cf. O'Bannon v. Town Court Nursing
Center, 447 U. S. 773
(1980).
[
Footnote 17]
The average inpatient stay in public mental hospitals is short.
Recently collected data for 1975 reveal a median stay in state and
county mental hospitals of only 25.5 days. Witkin, Characteristics
of Admissions to Selected Mental Health Facilities, 1975: An
Annotated Book of Charts and Tables, National Institute of Mental
Health 93, DHHS Publication No. (ADM) 80-1005 (1981). This study
also showed that young and elderly patients had longer periods of
stay than patients in the middle-age group.
Id. at 95. The
rapidity with which inpatients are released from public
institutions has increased since the 1950's. In 1971, 75% of all
patients admitted to state mental hospitals were released within
the first three months, while 87% were released within the first
six months. Ozarin, Redick, & Taube, A Quarter Century of
Psychiatric Care, 1950-1974: A Statistical Review, 27 Hospital
& Community Psychiatry 515, 516 (1976). Data from the National
Institute of Mental Health show that the proportion of "patient
care episodes" (admissions during a year plus residents at the
beginning of the year) attributable to inpatient treatment at state
and county hospitals declined from 49% in 1955 to 9% in 1977. This
dramatic decrease in the percentage of persons admitted to these
hospitals was paralleled by a growth in treatment through
outpatient and community mental health facilities; that percentage
grew from 23% in 1955 to 76% in 1977. Witkin, Trends in Patient
Care Episodes in Mental Health Facilities, 1955-1977, National
Institute of Mental Health, Mental Health Statistical Note No. 154,
p. 3 (Sept.1980). At the same time, the total number of "patient
care episodes" increased four-fold, from approximately 1.7 million
in 1955 to 6.9 million in 1977.
Id. at 1.
[
Footnote 18]
To be eligible for Medicaid reimbursement for inpatient
services, mentally ill persons under the age of 21 being treated in
mental institutions must be receiving "active treatment" that meets
standards prescribed by the Secretary and that
"can reasonably be expected to improve the condition, by reason
of which such services are necessary, to the extent that eventually
such services will no longer be necessary."
§ 1905(h)(1)(B) of the Act, 42 U.S.C. § 1396d(h)(1)(B).
[
Footnote 19]
The Medicaid limitation was based on Congress' assumption that
the care of persons in public mental institutions was properly a
responsibility of the States.
See H.R.Rep. No. 1300, 81st
Cong., 1st Sess., 42 (1949) (enacting federal funding for services
to the needy aged, blind, and disabled provided in public medical
institutions, but excluding assistance to those in "public or
private institutions for mental illness and tuberculosis, since the
States have generally provided for medical care of such cases");
S.Rep. No. 404, 89th Cong., 1st Sess., pt. 1, pp. 144-147 (1965)
(enactment of Medicaid providing coverage only to the aged needy in
mental or tuberculosis institutions; noting that "[t]he reason for
this exclusion was that long-term care in such hospitals had
traditionally been accepted as a responsibility of the States,"
id. at 144). This exclusion was upheld in
Legion v.
Richardson, 354 F.
Supp. 456 (SDNY),
summarily aff'd sub nom. Legion v.
Weinberger, 414 U.S. 1058 (1973), and
Kantrowitz v.
Weinberger, 388 F.
Supp. 1127 (DC 1974),
aff'd, 174 U.S.App.D.C. 182, 530
F.2d 1034,
cert. denied, 429 U.S. 819 (1976), and
appellees disavow any intention to dispute that holding. Brief for
Appellees 26-27; Tr. of Oral Arg.19.
[
Footnote 20]
Whether a State chooses to elect or not to elect to provide an
equivalent monthly stipend to institutionalized mental patients
does not alter the rationality of Congress' decision.
[
Footnote 21]
The Secretary has interpreted § 1611(e)(1)(B) to require that at
least 50% of the cost of services be reimbursed by Medicaid before
the reduction of benefits becomes effective. 20 CFR §
416.231(B)(5)(1980).
[
Footnote 22]
Congress continues to investigate other more general solutions
and to propose alterations in § 1611(e).
See H.R.Rep. No.
96-451, pt. 1, p. 153 (1979); 125 Cong.Rec. 31349-31350,
31354-31355, 31356 (1979) (remarks of Rep. Corman, Rep. Pepper, and
Rep. Bingham) (proposing amendment to § 1611(e) to forestall
reduction of benefits until after eligible individual has been
institutionalized in a Medicaid institution for three months);
Staff of the Senate Committee on Finance, The Supplemental Security
Income Program, 95th Cong., 1st Sess., 109-115 (Comm.Print 1977)
(advocating legislative amendments standardizing the monthly
stipend to institutionalized persons).
[
Footnote 23]
"When a legal distinction is determined, as no one doubts that
it may be, between night and day, childhood and maturity, or any
other extremes, a point has to be fixed or a line has to be drawn,
or gradually picked out by successive decisions, to mark where the
change takes place. Looked at by itself, without regard to the
necessity behind it, the line or point seems arbitrary. It might as
well or nearly as well be a little more to one side or the other.
But when it is seen that a line or point there must be, and that
there is no mathematical or logical way of fixing it precisely, the
decision of the legislature must be accepted unless we can say that
it is very wide of any reasonable mark."
Louisville Gas Co. v. Coleman, 277 U. S.
32,
277 U. S. 41
(1928) (Holmes, J., dissenting).
[
Footnote 24]
The amount of money and the number of people potentially
involved are not inconsiderable. Although the appellees do not
agree, the Secretary estimates that the annual cost of implementing
the District Court's order nationwide would approximate $30
million. Reply Memorandum for Appellant 3. In 1979, a total of
almost 2.2 million people were receiving SSI benefits for
disabilities, an increase of over 900,000 from January, 1974.
See Social Security Bulletin 49 (Table M-24) (June, 1979).
Further, of all the disabled adults who applied for benefits
between January, 1974, and July, 1975, 1.1% were denied eligibility
by reason of their residence in a public institution.
See
S.Rep. No. 95-1312, p. 7 (table) (1978).
JUSTICE POWELL, with whom JUSTICE BRENNAN, JUSTICE MARSHALL, and
JUSTICE STEVENS join, dissenting.
The Court holds that Congress rationally has denied a small
monthly "comfort allowance" to otherwise eligible people solely
because, previously, it rationally denied them Medicaid benefits.
In my view, Congress thoughtlessly has applied
Page 450 U. S. 240
a statutory classification developed to further legitimate goals
of one welfare program to another welfare program serving entirely
different needs. The result is an exclusion of wholly dependent
people from minimal benefits, serving no Government interest. This
irrational classification violates the equal protection component
of the Due Process Clause of the Fifth Amendment.
I
The Supplemental Security Income (SSI) program is a
comprehensive federal program of minimal cash welfare benefits for
the indigent blind, aged, and disabled. 86 Stat. 1465, 42 U.S.C. §
1381
et seq. See generally Califano v.
Aznavorian, 439 U. S. 170,
439 U. S. 171
(1978). Section 1611(e)(1)(A) of the Act, 42 U.S.C. §
1382(e)(1)(A), operates to reduce substantially, to $25 per month,
the SSI benefits available to otherwise eligible persons who reside
in public institutions. The reason for this reduction of benefit is
understandable:
"For these people, most subsistence needs are met by the
institution, and full benefits are not needed. Some payment to
these people, though, would be needed to enable them to purchase
small comfort items not supplied by the institution."
H.R.Rep. No. 92-231, p. 150 (1971).
See also S.Rep. No.
92-1230, p. 386 (1972). This comfort allowance is provided to
institution residents only if the qualified person resides in a
public hospital or institution that receives Medicaid funds on his
behalf. 42 U.S.C. § 1382(e)(1)(B). Thus, no comfort allowance will
be paid to an individual unless the form of institutionalized
treatment he receives is compensable under the separate Medicaid
program.
Appellees are indigent people disabled by mental illness, and
thus otherwise are eligible for SSI payments under 42 U.S.C. §§
1382c(a)(3)(A), (C). As residents of public mental institutions
between the ages of 21 and 65, however, they are ineligible to
receive Medicaid benefits for their
Page 450 U. S. 241
treatment. 1396a(a)(17)(B). [
Footnote 3/1] For this reason, and none other, appellees
may not receive the reduced monthly SSI payments available to
inmates of other medical institutions, including patients in public
medical hospitals and private mental institutions. [
Footnote 3/2]
The refusal to pay for treatment in public mental institutions
has a lengthy history in the development of the federal medical
assistance programs.
See Legion v.
Richardson, 354 F.
Supp. 456 (SDNY),
summarily aff'd sub nom. Legion v.
Weinberger, 414 U.S. 1058 (1973). Initially, Congress broadly
refused federal aid to individuals diagnosed as mentally ill, ch.
809, §§ 303(a), 343(a), 351, 64 Stat. 549, 554, 557-558. Subsequent
enactments, however, have extended Medicaid coverage to treatment
of mental illness in public or private medical hospitals or nursing
homes, 42 U.S.C. §§ 1396d(a)(1), (4) (1976 ed. and Supp. III), and
to treatment of mental illness of those under 21 and 65 or over in
public mental institutions, § § 1396d(a)(14), (16). Moreover,
Congress has defined "public institution" not to include a publicly
operated community residence center serving no more than 16
residents. § 132(e)(1)(C). Thus, federal medical benefits have been
extended to the mentally ill for
Page 450 U. S. 242
treatment in various contexts. The residual exclusion of large
state institutions for the mentally ill from federal financial
assistance rests on two related principles: States traditionally
have assumed the burdens of administering this form of care, and
the Federal Government has long distrusted the economic and
therapeutic efficiency of large mental institutions.
See
S.Rep. No. 404, 89th Cong., 1st Sess., 20 (1965).
See also
42 U.S.C. § 1396d(h)(1)(B) (persons under 21 receive Medicaid
benefits for treatment in mental institutions only when standards
of utility are met).
The legislative history of § 1611(e) sheds no light on why
Congress made the exclusion from reduced SSI benefits coextensive
with the exclusion from Medicaid payments. [
Footnote 3/3] The Secretary argues that Congress might
rationally have concluded that the States have the primary
responsibility for making payments of comfort allowances to
appellees because they already bear the responsibility for paying
for their treatment. Brief for Appellant 27. In accepting this
justification, the Court adds that whether the States do, ever
have, or ever will provide this benefit to residents of large
mental institutions is irrelevant to the rationality of Congress'
supposed judgment.
Ante at
450 U. S. 237,
n. 20.
II
A
Social and economic legislation that does not employ suspect
classifications or impinge on fundamental rights must be upheld
under the equal protection component of the Fifth Amendment when
the legislative means are rationally related to a legitimate
Government purpose.
United States Railroad Retirement Bd. v.
Fritz, 449 U. S. 166
(1980).
See San Antonio
Independent
Page 450 U. S. 243
School District v. Rodriguez, 411 U. S.
1,
411 U. S. 17
(1973);
Dandridge v. Williams, 397 U.
S. 471 (1970). This simply stated test holds two firmly
established principles in tension. The Court must not substitute
its view of wise or fair legislative policy for that of the duly
elected representatives of the people,
Vance v. Bradley,
440 U. S. 93,
440 U. S. 109
(1979);
Dandridge, supra at
397 U. S. 485
486, but the equal protection requirement does place a substantive
limit on legislative power. At a minimum, the legislature cannot
arbitrarily discriminate among citizens.
E.g., Johnson v.
Robison, 415 U. S. 361,
415 U. S.
374-375 (1974);
James v. Strange, 407 U.
S. 128,
407 U. S. 140
(1972);
Weber v. Aetna Casualty & Surety Co.,
406 U. S. 164,
406 U. S. 175
(1972). Enforcing this prohibition while avoiding unwarranted
incursions on the legislative power presents a difficult task. No
bright line divides the merely foolish from the arbitrary law.
[
Footnote 3/4] Given this
difficulty, legislation properly enjoys a presumption of
rationality, which is particularly strong for welfare legislation
where the apportionment of scarce benefits in accordance with
complex criteria requires painful but unavoidable line-drawing.
Mathews v. De Castro, 429 U. S. 181,
429 U. S. 185
(1976).
The deference to which legislative accommodation of conflicting
interests is entitled rests in part upon the principle that the
political process of our majoritarian democracy responds to the
wishes of the people. Accordingly, an important touchstone for
equal protection review of statutes is how readily a policy can be
discerned which the legislature intended
Page 450 U. S. 244
to serve.
See, e.g., United States Dept. of Agriculture v.
Moreno, 413 U. S. 528,
413 U. S.
536-538 (1973);
McGinnis v. Royster,
410 U. S. 263,
410 U. S. 270
(1973). When a legitimate purpose for a statute appears in the
legislative history or is implicit in the statutory scheme itself,
a court has some assurance that the legislature has made a
conscious policy choice. Our democratic system requires that
legislation intended to serve a discernible purpose receive the
most respectful deference.
See Harris v. McRae,
448 U. S. 297
(1980);
Maher v. Roe, 432 U. S. 464,
432 U. S. 479
(1977);
Weinberger v. Salfi, 422 U.
S. 749 (1975). Yet the question of whether a statutory
classification discriminates arbitrarily cannot be divorced from
whether it was enacted to serve an identifiable purpose. When a
legislative purpose can be suggested only by the ingenuity of a
government lawyer litigating the constitutionality of a statute, a
reviewing court may be presented not so much with a legislative
policy choice, as its absence. [
Footnote 3/5]
In my view, the Court should receive with some skepticism
post hoc hypotheses about legislative purpose, unsupported
by the legislative history. [
Footnote
3/6] When no indication of legislative
Page 450 U. S. 245
purpose appears other than the current position of the
Secretary, the Court should require that the classification bear a
"fair and substantial relation" to the asserted purpose.
See F.
S. Royster Guano Co. v. Virginia, 253 U.
S. 412,
253 U. S. 415
(1920). This marginally more demanding scrutiny indirectly would
test the plausibility of the tendered purpose, and preserve equal
protection review as something more than "a mere tautological
recognition of the fact that Congress did what it intended to do."
Fritz, supra at
449 U. S. 180
(STEVENS, J., concurring in judgment).
B
Neither the structure of § 1611 nor its legislative history
identifies or even suggests any policy plausibly intended to be
served by denying appellees the small SSI allowance. As noted
above, the only purpose identified in the House and Senate Reports
is the irrelevant goal of depriving inmates of penal institutions
of all benefits.
See n
3,
supra. The structure of the statute offers no guidance
as to purpose, because § 1611(e) is drawn in reference to the
policies of Medicaid, rather than to the policies of SSI. By
mechanically applying the criteria developed for Medicaid, Congress
appears to have avoided considering what criteria would be
appropriate for deciding in which public institutions a person can
reside and still be eligible for some SSI payment. The importation
of eligibility criteria from one statute to another creates
significant risks that irrational distinctions will be made between
equally needy people.
See United States Dept. of Agriculture v.
Murry, 413 U. S. 508,
413 U. S. 514
(1973);
Medora v. Colautti, 602 F.2d 1149 (CA3 1979).
The Secretary argues, and the Court agrees, that the
exclusion
"is rationally related to the legitimate legislative desire to
avoid spending federal resources on behalf of individuals whose
care and treatment are being fully provided for by state and local
government units."
Brief for Appellant 27. The Secretary does not argue that
appellees are not
Page 450 U. S. 246
in present need of the comfort allowance; indeed, he concedes
that "the statutory classification does not exclude [appellees]
because they were thought to be less needy."
Id. at 32.
[
Footnote 3/7] Nor does the
Secretary suggest that, because a State provides health care and
the necessities of life to inmates of mental hospitals, the State
also will provide the inmate with a comfort allowance. Indeed, the
probability that a State will pay a patient a comfort allowance
does not increase when the Federal Government refuses to relieve it
of part of the cost of the patient's medical care. The Court
apparently recognizes this, as it states that whether or not a
State actually provides a comfort allowance is irrelevant.
Ante at
450 U. S. 237,
n. 20. Appellees simply are denied a benefit provided to other
institutionalized, disabled patients.
But, it is argued, Congress rationally could make the judgment
that the States should bear the responsibility for any comfort
allowance because they already have the responsibility for
providing treatment and minimal care. There is no logical link,
however, between these two responsibilities.
See U.S. Dept. of
Agriculture v. Murry, supra. Residence in a public mental
hospital is rationally related to whether the Congress should pay
for the patient's treatment.
Legion v.
Richardson, 354 F.
Supp. 456 (SDNY),
summarily aff'd sub nom. Legion v.
Weinberger, 414 U.S. 1058 (1973). The judgment whether the
Federal Government should subsidize care for the mentally ill in
large public institutions involves difficult questions of medical
and economic policy.
Supra at
450 U. S.
241-242. But residence in a
public mental
institution, as opposed to residence in a state
medical
hospital or a
private mental hospital, bears no relation
to any policy of the SSI program. The monthly $25 allowance pays
for small personal expenses, beyond the minimal care and treatment
provided
Page 450 U. S. 247
by Medicaid or "other programs." H.R.Rep. No. 96-451, pt. 1, p.
153 (1979). If SSI pays a cash benefit relating to personal needs
other than maintenance and medical care, it is irrelevant whether
the State or the Federal Government is paying for the maintenance
and medical care; the patients' need remains the same; the
likelihood that the policies of SSI will be fulfilled remains the
same.
I conclude that Congress had no rational reason for refusing to
pay a comfort allowance to appellees while paying it to numerous
otherwise identically situated disabled indigents. This unexplained
difference in treatment must have been a legislative oversight. I
therefore dissent.
[
Footnote 3/1]
Other classes of institutionalized people denied the reduced SSI
allowance include patients in tubercular institutions and prison
inmates.
[
Footnote 3/2]
The Court too quickly dispatches the argument that § 1611(e)
classifies on the basis of mental illness. While it is true that
not all mentally ill people are denied the benefit, and that some
people denied the benefit are not mentally ill, it is inescapable
that appellees are denied the benefit because they are patients in
mental institutions. Only the mentally ill are treated in mental
institutions. While I would agree that there is no indication that
Congress intended to punish or slight the mentally ill, the history
of Medicaid demonstrates Congress' disinclination to involve the
Federal Government in state treatment of mental illness in public
institutions.
See infra at this page and
450 U. S. 242.
Because I find the classification irrational, I do not reach the
question whether classifications drawn in part on the basis of
mental health require heightened scrutiny, as appellees suggest
.
[
Footnote 3/3]
The only indication of congressional intent states: "No
assistance benefits will be paid to an individual in a penal
institution." H.R.Rep. No. 92-231, p. 150 (1971). A mental hospital
is not a penal institution. Neither the Secretary nor the Court
argues that the exclusion of appellees from the comfort allowance
rationally furthers this purpose.
[
Footnote 3/4]
The Court has employed numerous formulations for the "rational
basis" test.
United States Railroad Retirement Bd. v.
Fritz, 449 U. S. 166,
449 U. S.
176-177, n. 10 (1980). Members of the Court continue to
hold divergent views on the clarity with which a legislative
purpose must appear,
see id. at
449 U. S.
180-181 (STEVENS, J., concurring in judgment);
id. at
449 U. S.
187-188 (BRENNAN, J., dissenting), and about the degree
of deference afforded the legislature in suiting means to ends,
compare Lindsley v. Natural Carbonic Gas Co., 220 U. S.
61,
220 U. S. 78-79
(1911),
with F. S. Royster Guano Co. v. Virginia,
253 U. S. 412,
253 U. S. 416
(1920).
[
Footnote 3/5]
Congress' failure to make policy judgments can distort our
system of separation of powers by encouraging other branches to
make essentially legislative decisions.
See Cannon v.
University of Chicago, 441 U. S. 677,
441 U. S. 743
(1979) (POWELL, J., dissenting).
[
Footnote 3/6]
Some of our cases suggest that the actual purpose of a statute
is irrelevant,
Flemming v. Nestor, 363 U.
S. 603,
363 U. S. 612
(1960), and that the statute must be upheld "if any state of facts
reasonably may be conceived to justify" its discrimination,
McGowan v. Maryland, 366 U. S. 420,
366 U. S. 426
(1961). Although these cases preserve an important caution, they do
not describe the importance of actual legislative purpose in our
analysis. We recognize that a legislative body rarely acts with a
single mind, and that compromises blur purpose. Therefore, it is
appropriate to accord some deference to the executive's view of
legislative intent, as similarly we accord deference to the
consistent construction of a statute by the administrative agency
charged with its enforcement.
E.g., Udall v. Tallman,
380 U. S. 1,
380 U. S. 16
(1965). Ascertainment of actual purpose to the extent feasible,
however, remains an essential step in equal protection.
[
Footnote 3/7]
This concession makes it difficult to accept the Court's
conclusion that Congress rationally could have decided that
"Medicaid recipients in public institutions . . . are the most
needy and the most deserving of the small monthly supplement."
Ante at
450 U. S.
239.