By Gary Evans, Medical Writer
Hospitals still struggling to get workers fully vaccinated received good news on Jan. 13, 2022, when the U.S. Supreme Court ruled the federal government can enforce its mandate that healthcare workers receive COVID-19 vaccine unless granted medical or religious exemptions. The U.S. Supreme Court 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.1 “ … 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.”
The same day, the court effectively nullified the federal mandate that employers with at least 100 workers mandate COVID-19 vaccination or weekly testing. This mandate was to be enforced by the Occupational Safety and Health Administration (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 [of Health and Human Services] 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, respectively, the states’ argued the vaccine mandate will create an exodus of healthcare workers that ultimately will endanger patients in chronically understaffed facilities.
The Missouri suit also was signed by the respective attorneys general of Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota, and New Hampshire. The Louisiana suit also 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 and Medicaid Services (CMS). CMS has asserted its authority to establish health and safety standards in healthcare under its Conditions of Participation, saying 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 also cited the Supremacy Clause in the Constitution in arguing federal regulations will preempt such state laws. Although there may be more legal wrangling, 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, already have mandated vaccines for healthcare workers.
Regarding booster doses, the Centers for Disease Control and Prevention (CDC) previously defined fully vaccinated as having the standard two-shot series of the messenger ribonucleic acid vaccines. However, on Jan. 5, 2022, 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.
- Supreme Court of the United States. Joseph R. Biden, Jr., President of the United States, et al., Applicants 21a240 v. Missouri, et al.; Xavier Becerra, Secretary of Health and Human Services, et al., Applicants 21a241 v. Louisiana, et al. on Applications for Stays. Jan. 13, 2022. https://www.supremecourt.gov/opinions/21pdf/21a240_d18e.pdf
- Supreme Court of the United States. National Federation of Independent Business, et al., Applicants 21a244 v. Department of Labor, Occupational Safety and Health Administration, et al.; Ohio, et al., Applicants 21a247 v. Department of Labor, Occupational Safety and Health Administration, et al. on Applications for Stays. Jan. 13, 2022. https://www.supremecourt.gov/opinions/21pdf/21a244_hgci.pdf
- 86 Fed Reg 61555 (2021)
- Centers for Disease Control and Prevention. Stay up to date with your vaccines. Updated Jan. 16, 2022: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#:~:text=CDC%20recommends%20that%20people%20remain,shot%20and%20a%20booster%20shot
