January 13, 2022

Supreme Court Decides Biden v. Missouri

On January 13, 2022, the U.S. Supreme Court issued a per curiam opinion lifting the stay of the vaccine mandate issued by the Secretary of Health and Human Services covering staff at federally funded health facilities, holding that the Secretary had statutory authority to issue the mandate. Biden v. Missouri, Nos. 21A240 and 21A241.

On November 5, 2021, the Secretary issued an interim final rule, without going through notice-and-comment procedures, requiring facilities that participate in Medicare and Medicaid to require their staff to be vaccinated, but to allow medical and religious exemptions. Federal funding for the facilities was made contingent on them imposing the vaccination requirement. The Secretary justified the rule based on findings that unvaccinated workers “pose a serious threat to the health and safety of patients,” most of whom are elderly, disabled, or in poor health conditions. Two groups of states, one led by Louisiana and the other led by Missouri, challenged the rule, and two federal district courts enjoined it. The Supreme Court reviewed the district court decisions directly, ordered expedited briefing, and heard argument on January 7, 2022.

In the per curiam opinion joined by five justices, the Supreme Court lifted the stay of the Secretary’s interim final rule, allowing the vaccine mandate for healthcare staff to take effect. 

First, the Court held that the rule fit “neatly within” statutory language authorizing the Secretary to enact rules he “finds necessary in the interest of the health and safety of individuals who are furnished services.” This language applied to many (but not all) categories of health care facilities, and the Court did not find the gap determinative. The Secretary’s finding that COVID-19 posed a threat to the health of patients and that vaccination reduced the threat brought the rule within the authority. The Court rejected the States’ “narrower view” that the Secretary was limited to rules regarding technical administration of the Medicare and Medicaid programs. 

Second, the Court held that the interim rule is not arbitrary and capricious based on the rule-making record, and that the Secretary’s accelerated promulgation of the rule in advance of the winter flu season to reduce COVID-19 infections was sufficiently specific to forgo notice and comment. 

The per curiam opinion of the Court was joined by Chief Justice Roberts and Justices Breyer, Sotomayor, Kagan, and Kavanaugh. Justice Thomas filed a dissenting opinion, in which Justices Alito, Gorsuch, and Barrett joined. Justice Alito filed a dissenting opinion, in which Justices Thomas, Gorsuch, and Barrett joined.

Download Opinion of the Court

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