Supreme Court: Yes to Health Care COVID-19 Vaccine Mandates, No for Businesses

Ruling in 2 separate cases Thursday, the Supreme Court agreed that HHS could require employees to receive COVID-19 vaccinations in health care facilities that receive federal funding from Medicare or Medicaid, but it rebuffed the Biden administration's vaccine mandate for private businesses.

The decision covers approximately 76,000 health care facilities and more than 17 million health care workers.

The vote in the consolidated health care case, Biden v Missouri and Becerra v Louisiana, was 5 to 4, with Chief Justice John G. Roberts Jr and Justice Brett M. Kavanaugh joining liberal justices to form a majority.

The vote in the employer case was 6 to 3, with liberal justices dissenting.

The Biden administration announced the mandates last fall, and oral arguments on all of the cases were heard last Friday. Part of the employer ruling was set to take effect Monday, with unvaccinated employees supposed to start wearing masks at work. Testing requirements and potential fines were supposed to begin next month.

The requirements were immediately challenged, with Ohio leading a coalition of Republican states; the National Federation of Independent Businesses also sued.

While the court has upheld state vaccine mandates, the cases were the first to reach the bench and challenge whether Congress has authorized the executive branch to institute the requirements.

In agreeing with the Biden administration that the secretary of HHS had the authority for a vaccine mandate, the court wrote "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."

Health care facilities that agree to take Medicare and Medicaid funding have always had to comply with conditions that ensure the safe delivery of care, it noted.

In a dissenting opinion, written by Justice Clarence Thomas and joined by justices Samuel A. Alito, Amy Coney Barrett, and Neil M. Gorsuch, Thomas wrote that the government did not make a clear and convincing case that it has the statutory authority to impose a vaccine mandate on health care facilities.

"These cases are not about the efficacy or importance of COVID–19 vaccines," he wrote.

In the consolidated employer cases, National Federation of Independent Business v Department of Labor and Ohio v Department of Labor, the conservative majority ruled that the administration overstepped its authority by seeking to impose a vaccine-or-test rule through the Occupational Safety and Health Administration (OSHA).

At the time the rule was issued, the Biden administration estimated that the rule would cause 22 million people to get vaccinated and prevent 250,000 hospitalizations.

OSHA “empowers the Secretary to set workplace safety standards, not broad public health measures,” said the unsigned opinion.

Dissenting justices—Stephen Breyer, Sonia Sotomayor, and Elena Kagan—noted that COVID-19 “spreads by person-to-person contact in confined indoor spaces, so causes harm in nearly all workplace environments” as individuals have little ability to control their own environments in the workplace.

In a statement issued after the ruling, President Joe Biden, who earlier in the day made another plea for Americans to get vaccinated, said the decision to allow the health care mandate to stand will “save lives.”

However, he said, he is “disappointed that the Supreme Court has chosen to block common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law. This emergency standard allowed employers to require vaccinations or to permit workers to refuse to be vaccinated, so long as they were tested once a week and wore a mask at work: a very modest burden.”