Hospitals still struggling to vaccinate all workers received good news on Jan. 13, when the U.S. Supreme Court ruled the federal government can enforce its COVID-19 vaccine mandate for healthcare workers. Justices threw out two lawsuits representing more than 20 states, ruling that mandating COVID-19 vaccination of healthcare workers is within the limits of federal law.
“Vaccination requirements are a common feature of the provision of healthcare in America: Healthcare workers around the country are ordinarily required to be vaccinated for diseases such as hepatitis B; influenza; and measles, mumps, and rubella,” the high court ruled. “The challenges posed by a global pandemic do not allow a federal agency to exercise power that Congress has not conferred upon it. At the same time, such unprecedented circumstances provide no grounds for limiting the exercise of authorities the agency has long been recognized to have.”1
The same day, the court struck down the federal vaccine mandate for employers with at least 100 workers. This mandate was to be enforced by OSHA, but the court ruled the action goes beyond the agency’s authority.
“It is telling that OSHA, in its half-century of existence, has never before adopted a broad public health regulation of this kind — addressing a threat that is untethered, in any causal sense, from the workplace,” the ruling stated.2 This “lack of historical precedent,” coupled with the breadth of authority that the secretary now claims, is a “telling indication that the mandate extends beyond the agency’s legitimate reach.”
In the healthcare cases, led by Missouri and Louisiana, the states’ argued the vaccine mandate will create an exodus of healthcare workers that will ultimately endanger patients in chronically understaffed facilities.
The Missouri suit also was signed by the attorneys general of Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota, and New Hampshire. The Louisiana suit was signed by Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, and West Virginia.
The federal law requiring mandated vaccination in healthcare will be enforced by the Centers for Medicare & Medicaid Services (CMS). CMS has asserted its authority to establish health and safety standards in healthcare under its Conditions of Participation, noting those who fail to comply with the vaccination rule face the full gamut of penalties. These include fines, denial of payment for new admissions, or “termination of the Medicare/Medicaid provider agreement.”3
Referring to states that have established laws against vaccine mandates, CMS cited the Supremacy Clause in the Constitution in arguing federal regulations will pre-empt such state laws. Although more legal wrangling may be on the way, the Supreme Court ruling is expected to take primacy over state laws banning vaccine mandates in Arkansas, Georgia, Indiana, Montana, Tennessee, Texas, and Montana. Another 21 states and Washington, DC, have already mandated vaccines for healthcare workers.
Regarding booster doses, the CDC previously defined “fully vaccinated” as completing the standard two-shot series of the mRNA vaccines. However, on Jan. 5, the CDC recommended “that people remain up to date with their vaccines, which includes additional doses for individuals who are immunocompromised or booster doses at regular time points.”4
Thus, under this CDC standard of care and the Supreme Court’s ruling, hospitals should be able to require boosters as well, but it remains to be seen if further court challenges will occur.
REFERENCES
- Supreme Court of the United States. Joseph R. Biden, Jr., President of the United States, et al v. Missouri, et al. Xavier Becerra, Secretary of Health and Human Services, et al v. Louisiana, et al. Jan. 13, 2022.
- Supreme Court of the United States. National Federation of Independent Business, et al v. Department of Labor, Occupational Safety and Health Administration, et al. Ohio, et al v. Department of Labor, Occupational Safety and Health Administration, et al. Jan. 13, 2022.
- Centers for Medicare & Medicaid Services. Medicare and Medicaid programs; omnibus COVID-19 health care staff vaccination. Federal Register. Nov. 5, 2021.
- Centers for Disease Control and Prevention. Stay up to date with your vaccines. Jan. 5, 2022.
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