Biden v. Missouri
595 U. S. ____ (2022) (2022)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
The Secretary of Health and Human Services has the statutory authority to require healthcare facilities that receive Medicare and Medicaid funding to ensure their employees are vaccinated against COVID-19 as a condition of participation, as this falls within the power to impose requirements necessary for patient health and safety.
Facts:
- The Secretary of Health and Human Services (HHS) administers the federal Medicare and Medicaid programs, which provide health insurance for millions of Americans.
- Congress has authorized the Secretary to promulgate regulations for participating healthcare facilities, including such requirements as the Secretary finds 'necessary in the interest of the health and safety' of patients.
- Historically, the Secretary has imposed numerous health and safety conditions on participating facilities, including detailed infection prevention and control programs.
- In November 2021, the Secretary issued an interim final rule requiring facilities participating in Medicare and Medicaid to ensure their staff were vaccinated against COVID-19, with exemptions for medical and religious reasons.
- The Secretary justified the rule by finding that vaccination of healthcare workers was necessary to protect vulnerable Medicare and Medicaid patients, who are often elderly, disabled, or in poor health.
- The Secretary's determination was based on data showing that unvaccinated staff posed a serious threat of transmitting the virus to patients, which could also cause staffing shortages and lead patients to forgo necessary care due to fear of exposure.
Procedural Posture:
- The Secretary of Health and Human Services issued an interim final rule requiring COVID-19 vaccination for staff at covered healthcare facilities.
- Two groups of states, one led by Missouri and one by Louisiana, filed separate lawsuits in federal district courts to block the rule.
- The U.S. District Court for the Eastern District of Missouri entered a preliminary injunction against the rule's enforcement.
- The U.S. District Court for the Western District of Louisiana also entered a preliminary injunction against the rule's enforcement.
- The federal government appealed both injunctions to the U.S. Courts of Appeals for the Eighth and Fifth Circuits, respectively, and moved for stays of the injunctions.
- Both the Eighth Circuit and the Fifth Circuit denied the government's motions to stay the district court injunctions.
- The federal government filed emergency applications with the U.S. Supreme Court asking for stays of the preliminary injunctions issued by the district courts.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does the Secretary of Health and Human Services have the statutory authority to require facilities receiving Medicare and Medicaid funding to ensure their staff are vaccinated against COVID-19?
Opinions:
Majority - Per Curiam
Yes. The Secretary of Health and Human Services has the statutory authority to require facilities receiving Medicare and Medicaid funding to ensure their staff are vaccinated against COVID-19. The rule fits neatly within the language of the statute authorizing the Secretary to impose conditions 'necessary in the interest of the health and safety of individuals who are furnished services.' Ensuring that healthcare providers do not transmit a dangerous virus to their patients is a fundamental aspect of protecting patient health. The Secretary has long imposed a host of other health-related participation conditions, including infection-control measures, so this mandate is a straightforward and predictable use of that established authority in the face of an unprecedented pandemic. The rule was not arbitrary or capricious, as the Secretary adequately examined relevant data and articulated a satisfactory explanation for the policy, including consideration of potential staffing shortages.
Dissenting - Justice Thomas
No. The Secretary of Health and Human Services lacks the statutory authority to impose a nationwide vaccine mandate on healthcare workers. The government has not made a strong showing that Congress, through a hodgepodge of ancillary, definitional, and catchall statutory provisions, delegated this 'power of vast economic and political significance.' Such a sweeping mandate, which intrudes upon the states' traditional police powers, would require a clear and direct authorization from Congress, which is absent here. The general 'health and safety' language, when read in context with the specific administrative requirements surrounding it, does not support a mandate of this kind, which is fundamentally different from typical administrative or sanitation-related rules.
Dissenting - Justice Alito
No. Even if the federal government possessed the statutory authority for the mandate, it did not have the authority to impose it by circumventing required administrative procedures. The agency improperly invoked the 'good cause' exception to the Administrative Procedure Act's notice-and-comment requirements. The agency's own significant delay in issuing the rule—months after vaccines were widely available and nearly two months after the President's announcement—fatally undermines its claim that an emergency justified skipping the crucial step of soliciting and responding to public input. This departure from ordinary rulemaking procedure prevents affected parties from having their views heard and sets a dangerous precedent for future executive action.
Analysis:
This decision affirms the broad authority of a federal agency to use its spending power to set public health conditions on entities that voluntarily participate in federal programs. It distinguishes this power from a broader regulatory power over the general economy, as seen in the companion OSHA case decided the same day. The ruling solidifies the principle that agencies have considerable discretion to address health crises within their statutory domain, even with policies that are politically contentious. The dissents' reliance on the major questions doctrine and procedural objections highlights the ongoing judicial debate over the scope of agency power and the requirement for clear congressional delegation for policies of major national significance.
