Masked man in blue shirt receives vaccine

As expected, the Supreme Court on Thursday upheld a federal mandate requiring 20 million healthcare workers get vaccinated against COVID-19, but blocked a separate mandate that required workers at private businesses to get vaccinated or tested weekly.

The conservative majority argued that while the Occupational Safety and Health Administration has the power to regulate occupational dangers, it doesn’t have the power to regulate public health more broadly.

“Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category,” the majority wrote.

Associations representing home care agencies and senior service nonprofits immediately weighed in on the rulings.

“Today’s decisions from the U.S. Supreme Court brings home care a step closer to the essential clarity that is needed to determine what is required for compliance,” National Association for Home Care & Hospice President William Dombi said. “The OSHA rule is blocked from implementation and enforcement for the moment. The [Centers for Medicare & Medicaid Services] rule can full take effect for the moment. Both cases return to the lower courts for further adjudication. The administration has further options option to it. We strongly encourage both Congress and the Administration to quickly reach a conclusion so that affected health care businesses can focus on providing care. Infection control in patient care and staffing is an essential responsibility in all of healthcare. Home care is committed to protecting its patients and its staff from COVID-19.“

Meanwhile, Katie Smith Sloan, president and CEO of senior service nonprofit LeadingAge, encouraged all workers to get vaccinated, despite the ruling.

“While mandates can sometimes make it harder for employers to keep or find qualified workers — especially as omicron surges and workforce challenges are growing — we encourage all members, regardless of care setting or community type, to ensure staff get vaccinated,” Sloan said. “Many LeadingAge providers implemented mandates months before the federal government announced its plans, and a recent poll of our mission-driven members reveals the vast majority are ready to move forward on the CMS healthcare worker mandates.” 

The Biden administration issued the two separate mandates last November — one from CMS that applied to healthcare workers employed by facilities that receive federal funding, and a second from the Labor Department’s OSHA that applied to private businesses that employed more than 100 workers.

Both immediately became tangled in court challenges leading up to the recent hearings before the Supreme Court. In mid-November, 14 states challenged the CMS mandate in Louisiana federal court, followed by another 10 states, which filed the injunction in Missouri. In December, the 5th Circuit Court ruled the stay could only apply to the 24 states that filed suit; the remaining 26 would have to comply with the CMS mandate.

The OSHA mandate was challenged by numerous lawsuits that were consolidated into a single case that went before the 6th Circuit Court. That court dissolved a previous stay on the mandate.

Both mandates were set to go into effect this month. OSHA was planning to begin issuing citations for noncompliance as of Monday. CMS said it will start enforcing its mandate on Jan. 27, when all workers in facilities participating in the Medicare and Medicaid programs are expected to have received their first shots.  

Chiquita Brooks-LaSure, administrator of CMS, said Thursday afternoon that she was pleased with the Supreme Court’s decision regarding the CMS mandate.

“CMS is already implementing its healthcare worker vaccination rule in 25 states and territories that were not covered by preliminary injunctions,” she said in a statement. “Today’s decision will enable us to fully implement this rule, and we look forward to working with healthcare providers and their workers to protect patients. We will continue our extensive outreach and assistance efforts encouraging individuals working in health care to get vaccinated.”

The workplace rule would have impacted an estimated 80 million Americans. OSHA claimed it would save 6,500 lives and prevent 250,000 hospitalizations within six months.

The Supreme Court’s conservative majority said while Congress has given OSHA the power to regulate occupational dangers, it hasn’t provided the federal agency the power to broadly regulate public health. In writing their dissenting opinion, the three liberal justices argued OSHA was within its authority and expertise to authorize the mandate.

This is a developing story. Please check back frequently for updates.