- The U.S. Supreme Court heard expedited arguments Friday in cases challenging the Biden administration's separate vaccination mandates for healthcare facilities and for other employers with 100 or more workers.
- The court's conservative justices seemed skeptical of mainly the workplace safety agency's authority when enacting its mandate for large employers. They were less doubtful of CMS' authority when enacting its mandate for healthcare employers though, and the court's three liberal justices said CMS should especially be allowed to do so.
- The key question in both cases is whether the agencies enacting them — OSHA and CMS — had the authority to do so, or whether that power falls to the states. Two separate coalitions of Republican-led states filed lawsuits against the CMS rule and were both granted preliminary injunctions by federal judges of lower courts. They are now asking the high court to block the mandate from taking effect.
The Biden administration's federal vaccine mandates are still in limbo following Friday's hearings as another COVID-19 variant surges across the country.
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 said Friday during oral arguments.
"I am having a hard time understanding how and why a rule like this is so substantially different than the volumes of rules that CMS has with respect to so many issues involving health and welfare," Justice Elena Kagan said, noting the agency is responsible for some of the most vulnerable people.
"That seems like a pretty basic infection prevention measure, that you can't be the carrier of disease," she said.
The CMS rule up for debate requires hospitals, ambulatory surgery centers, nursing homes and other healthcare facilities to ensure staff are fully vaccinated or risk losing Medicare and Medicaid funding.
It 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 in the arguments heard Friday.
Some states like New York, New Mexico and Maine issued statewide vaccination mandates for healthcare staff and other workers that were challenged in lawsuits but upheld by the Supreme Court.
Other states like Florida, Texas and Arizona have taken the opposite approach, banning such mandates, though some states' rules make exceptions for healthcare workers.
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, such as HCA.
"This current patchwork actually creates the perfect opportunity for the virus to spread and possibly mutate further," Frank Trinity, chief legal officer at the Association of American Medical Colleges, said during a call with reporters Thursday.
"If ever there were a time for a consistent national approach to a national threat, this is that time," he said.