Biden v. Missouri

Background

A federal health agency led by the Secretary of Health and Human Services issued an interim final rule on November 5, 2021 requiring staff at facilities that accept Medicare and Medicaid funding to be vaccinated against COVID-19, with medical and religious exemptions and excluding staff who telework full-time. The rule warned of fines, denial of payment for new admissions, and possible termination of a facility’s participation. Two state-led lawsuits in Missouri and Louisiana led district courts to block enforcement of the rule.

Reasoning

The Supreme Court granted an emergency stay of those injunctions and allowed enforcement while the government appeals. The Court said the Secretary has long-standing authority to set conditions aimed at protecting patient health and safety and found the agency’s conclusion—that unvaccinated staff increase transmission risks for especially vulnerable Medicare and Medicaid patients—was supported by the record. The Court also found the agency’s expedited rulemaking and other procedural objections did not warrant blocking the rule at this stage.

Real world impact

The ruling permits the vaccine requirement to be enforced while appeals and any Supreme Court review proceed, affecting staff in hospitals, nursing homes, and other covered facilities. Noncompliant workers could face job loss and facilities could face penalties, but this stay is an interim procedural step, not a final decision on the lawfulness of the mandate. The stay will end automatically if the Court denies review, or upon final judgment if review is granted.

Dissents or concurrances

Several Justices dissented. Justice Thomas argued the statute does not clearly authorize such a broad nationwide vaccine mandate and would deny the stay; Justice Alito separately argued the agency failed to justify skipping public notice-and-comment.