NEW YORK – Father Enrique Camacho’s grandmother died Feb. 2, after long battles with dementia and metastatic cancer. She didn’t get Supplemental Security Income (SSI) benefits and the family couldn’t afford 24-hour homecare nurses, so Camacho’s aunt quit her job and, for the last two years, slept in the hallway adjacent to the grandmother’s room to provide care.

Camacho’s grandfather, also deceased, was a World War II veteran who worked more than 30 years for the U.S. army in Fort Buchanan Military Base in Guaynabo, Puerto Rico. He didn’t receive SSI benefits in his elder years, either.

Camacho told Crux his family’s story to illuminate the need for people in Puerto Rico to get SSI benefits and the hardships people go through without them, after the Supreme Court on April 21 declined to mandate that Congress extend the federal disability benefits to residents of Puerto Rico.

He said the decision from the nation’s high court was surprising and saddens him greatly.

“It is not constitutional to give some U.S. citizens benefits and not others. The Constitution is for everybody,” said Camacho, a lifelong resident of Puerto Rico and the executive director of Caritas Puerto Rico. “We are people. We are families. We are suffering. It’s something really important, especially when you’re elderly and when you’re handicapped to receive help.”

SSI is a federal program that provides monthly payments to adults and children with a disability or blindness below certain financial limits, as well as people aged 65 and older without disabilities who meet certain financial requirements.

The program extends to people who live in one of the 50 states, Washington D.C., or the Northern Mariana Islands. An exception is made for children of military parents assigned to permanent duty outside of the U.S., and certain students temporarily abroad. It does not extend to residents of other U.S. territories, even though they are U.S. citizens.

The Supreme Court had an opportunity to change that on April 21, and ensure residents of Puerto Rico receive SSI benefits, but in an 8-1 ruling in the case United States v. Vaello Madro – a case that challenges the constitutionality of excluding residents of Puerto Rico from the program – the justices chose to leave the decision in the hands of Congress.

“The constitution affords Congress substantial discretion over how to structure federal tax and benefits programs for residents of the Territories,” said the opinion of the court, delivered by Justice Brett Kavanaugh.

“Exercising that discretion, Congress may extend [SSI] benefits to residents of Puerto Rico … But the limited question before the court is whether, under the Constitution, Congress must extend [SSI] to residents of Puerto Rico to the same extent as residents of the States,” the opinion continued. “The answer is no.”

Kavanaugh also reasoned that the opposite decision from the court would have “potential far reaching consequences.” He noted that Congress currently exempts residents of Puerto Rico from most federal income, gift, estate, and excise taxes, and likewise hasn’t extended every federal benefits program, including SSI to them, either.

Therefore, Kavanaugh argued that if this decision went the other way Congress would likely have to extend other federal benefits and programs to residents of territories in the same way that those programs cover the states, which could lead citizens of the states to counter and insist that federal income taxes be imposed on residents of Puerto Rico and other territories. This could “inflict significant new financial burdens on residents of Puerto Rico, with serious implications for the Puerto Rican people and the Puerto Rican economy,” the justice noted.

In the lone dissenting opinion, Justice Sonia Sotomayor, whose parents are Puerto Rican-born, argued that the “constitutional command does not permit Congress to ignore the equally weighty constitutional command that it treat United States citizens equally.”

“Equal treatment of citizens should not be left to the vagaries of the political process,” Sotomayor argued. “Because residents of Puerto Rico do not have voting representation in Congress, they cannot rely on their elected representatives to remedy the punishing disparities suffered by citizen residents of Puerto Rico under Congress’ unequal treatment.”

Camacho said part of the shock of the Supreme Court ruling was its 8-1 nature, especially considering the decision was about “humanity” and “mercy,” and some of the justices that ruled against extending the SSI benefits are Christian or Catholic.

Camacho noted, however, that because the decision is ultimately in the hands of Congress he’s still hopeful one day residents of Puerto Rico will receive SSI benefits. He challenges both the Supreme Court justices and federal lawmakers to visit Puerto Rico and see the hardship people experience for themselves.

“Every day I see a lot of people who are elderly who are completely alone living in subhuman conditions,” Camacho said. “We see houses that are really dirty with nothing in the refrigerator, and when you see old people like that it’s hurtful and I see it very often.”

“If they see what families go through, they could change their minds, because it isn’t about a party, or politics, it’s about giving people what they deserve because we are part,” he added.

The Biden administration has signaled its support for residents of Puerto Rico receiving SSI benefits. With the ball in Congress’s court, though, Camacho said the most important thing is for residents of Puerto Rico to share their stories and those of their families.

“I think people like me should share their stories because people on the mainland should know what’s really happening,” Camacho said. “It’s really something that people should share their reality because this is my story but there are a lot more like mine or worse.”

Follow John Lavenburg on Twitter: @johnlavenburg