- The U.S. Supreme Court upheld a federal COVID-19 vaccination requirement for healthcare workers at facilities receiving Medicare and Medicaid funds nationwide on Thursday, while blocking the Occupational Safety and Health Administration's mandate for large employers.
- In a 5-4 decision, the court's liberal justices were joined by Chief Justice John Roberts in declaring CMS has the authority to enforce the mandate. "Ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm," they wrote.
- Provider groups like the American Hospital Association said they will work to help hospitals comply while balancing staffing challenges, and are thankful for an extended compliance deadline and some enforcement discretion from the agency.
Healthcare facilities will have to comply with CMS' vaccination requirements for employees after a whirlwind of legal challenges that came to a head Thursday with the high court's decision, which comes as the omicron variant is raging and hospitals are once again stretched to the brink.
Under the CMS rule, hospitals, ambulatory surgery centers, nursing homes and other healthcare facilities must ensure staff are fully vaccinated or risk losing Medicare and Medicaid funding.
CMS regularly imposes prescriptive, costly requirements for hospitals and other providers as a condition of their Medicaid and Medicare participation, Brian Fletcher, the administration's principal deputy solicitor general told the court during expedited oral arguments Friday.
Those conditions have long included requirements that providers maintain and enforce infection prevention and control programs, the justices upholding CMS' mandate wrote in their decision. At the same time, the Medicare and Medicaid programs are responsible for some of the most vulnerable patients.
They also wrote that healthcare workers are routinely required to be vaccinated against other diseases, and the health organizations have supported the mandate.
The global pandemic has posed immense challenges and "such unprecedented circumstances provide no grounds for limiting the exercise of authorities the agency has long been recognized to have," they wrote.
Meanwhile those dissenting argued the agency overstepped its bounds in issuing the requirement and that CMS has never used its power to mandate vaccinations before.
Justices Samuel Alito, Clarence Thomas, Neil Gorsuch and Amy Coney Barrett wrote in their dissent, "Even if the Federal Government has the authority to require the vaccination of healthcare workers, it did not have the authority to impose that requirement in the way it did."
"These cases are not about the efficacy or importance of COVID–19 vaccines," Thomas wrote in his dissent.
"They are only about whether CMS has the statutory authority to force healthcare workers, by coercing their employers, to undergo a medical procedure they do not want and cannot undo," he wrote.
Dozens of states have sued the Biden administration over the rules.
The CMS rule was first challenged in a November lawsuit brought by the attorneys general of Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming, when a federal judge in the eastern district of Missouri granted a preliminary injunction halting the federal agency from enforcing its mandate in those states, arguing CMS does not have the authority to enact such regulations.
Then Republican lawmakers from Alabama, Arizona, Georgia, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Montana, Ohio, Oklahoma, South Carolina, Utah and West Virginia challenged the CMS rule, also arguing the agency lacked the authority to enact the mandate, and in the lawsuit also expressed how a mandate could exacerbate worsening labor strains, especially in rural areas.
A federal judge granted a preliminary injunction in that case too, and said the scope would be nationwide.
But HHS soon after filed an appeal, and a federal appeals court halted the nationwide injunction on CMS' vaccine mandate granted in that suit brought by 14 states, limiting the scope of that injunction to those specific states only.
The Supreme Court consolidated both cases.
Major provider groups including the American Medical Association and Association of American Medical Colleges support requiring healthcare worker vaccinations. Amid the uncertainty brought by the legal challenges though, some health systems that implemented their own mandates pulled back.