Court decisions delay Biden's COVID-19 vaccine mandate for healthcare workers: Questions and answers

President Joe Biden wanted to have healthcare workers fully vaccinated against COVID-19 by early January, but recent court rulings are posing setbacks to his administration’s plans.

Biden issued an order requiring all healthcare facilities taking Medicare and Medicaid funds to have their employees fully vaccinated by Jan. 4. The rule applies to 17 million workers at about 76,000 facilities. The Biden administration had also directed healthcare facilities to have workers get their first shot of a two-dose vaccine by Dec. 6.

Recent court rulings, including an order issued Tuesday, now raise new questions for healthcare facilities. Here’s a quick rundown on the rulings and their implications.

Q: What’s the most recent decision regarding the vaccine rule for healthcare workers?

A: A federal judge issued a preliminary injunction Tuesday blocking the Biden administration from moving forward with the vaccine mandate for healthcare workers. Judge Terry A. Doughty, of the U.S. District Court of the Western District of Louisiana, said the Centers for Medicare and Medicaid lack the authority to impose the vaccine mandate on healthcare workers. He said legislation should come from Congress.

“It is not clear that even an Act of Congress mandating a vaccine would be constitutional,” Doughty wrote. “Certainly, CMS does not have this authority.”

Q: Is the injunction in effect nationwide?

A: For all intents and purposes, yes. Fourteen states, led by Louisiana, filed a joint suit to block the mandate. Doughty said he considered limiting the scope of his injunction to those 14 states, but ultimately decided it should have a national scope.

“Although this Court considered limiting the injunction to the fourteen Plaintiff States, there are unvaccinated healthcare workers in other states who also need protection,” he wrote.

The ruling by Doughty doesn’t affect 10 states - Alaska, Arkansas, Iowa, Kansas, Missouri, New Hampshire, Nebraska, Wyoming, North Dakota and South Dakota. The reason? On Monday, a federal judge in Missouri issued a ruling blocking the vaccine requirement for healthcare workers in those states.

Doughty was nominated by former President Donald Trump and unanimously confirmed by the U.S. Senate in 2018.

Q: Is this the final say?

The Biden administration has said it expects its vaccine mandates to ultimately prevail against legal challenges, CNBC reported. In his ruling, Doughty acknowledged that he won’t have the final say on the vaccine mandate and the legal battles will continue.

“This matter will ultimately be decided by a higher court than this one,” wrote Doughty. “However, it is important to preserve the status quo in this case. The liberty interests of the unvaccinated requires nothing less.”

Expect the Biden administration to quickly appeal. The American Hospital Association also expects the Biden administration to petition a stay of the injunction, pending appeal.

Q: What about the federal government’s order requiring all employers with at least 100 workers to have their employees vaccinated or undergo regular testing for COVID-19?

A: Last month, a federal appeals court in Louisiana issued a stay blocking that order. If the order mandating vaccinations or tests at private companies is ultimately upheld in court, it would cover 84 million workers. Several states and employers have joined forces in legal challenges to block the broader order covering private employers.

Some healthcare advocacy groups have urged business groups to drop their opposition to the vaccine orders and to get their workers immunized. Some employers are imposing vaccine requirements. A Willis Towers Watson survey issued Nov. 30 found 57% of employers said they require or plan to require workers to get COVID-19 vaccines.

Q: Do healthcare workers have a testing option under the Biden administration’s order?

A: No. That’s the key difference between the order affecting healthcare workers and the separate order affecting most private employers, which does include a testing option. Biden’s order covering healthcare workers offers no option to submit for coronavirus testing; they must be vaccinated.

Q: What is the vaccination rate of healthcare workers?

A: The majority of healthcare workers are vaccinated, but some workers have resisted getting the shots.

Last month, the American Journal of Infection Control published a study that found 70% of healthcare personnel were fully vaccinated as of Sept. 15. The study examined more than 3.3 million healthcare personnel in nearly 2,100 facilities. Since that study is only through mid-September, the vaccination rate likely has changed. Nationwide, 71% of all adults are fully vaccinated, according to The New York Times.

Some hospital systems have implemented their own policies requiring their workers to be vaccinated. More than 2,500 hospitals - 40% of the nation's hospitals - have imposed a vaccine requirement, according to the White House. Some states, including California, New York, Rhode Island and Connecticut, have imposed their own regulations requiring healthcare employees to get vaccinated.

Q: Do vaccine requirements work?

A: While some have argued the mandates will only hurt hospitals and nursing homes that are already struggling to keep workers, some evidence points to the success of vaccine mandates.

The Biden administration required federal employees to get vaccinated by late last month. More than 96% of federal workers have been vaccinated, the administration said. Agencies have been given latitude to convince their last holdouts to get the shots, CNN reported.

A White House report of healthcare organizations, public agencies and private employers found that vaccine requirements led to increases in the vaccination rate of 20 percentage points. In their Nov. 18 letter urging support for vaccine requirements, healthcare groups and other health leaders pointed to the success of those mandates.

“We’ve seen over and over that employer vaccine mandates work to raise vaccination rates, and they don’t cause workforce shortages,” said Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania.