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In two separate rulings, the U.S. Supreme Court on Thursday blocked the government from enforcing a rule designed to boost COVID-19 vaccine rates for employees of large businesses, while allowing another Biden administration vaccine mandate for more than 10 million health care workers to go into effect.

Both cases will continue to be debated in lower federal circuit courts.

The decisions came less than a week after the Supreme Court heard oral arguments on the rules generated by the Occupational Health and Safety Administration and the Centers for Medicare and Medicaid, respectively. Montana was one of more than two dozen plaintiff states, alongside businesses and labor groups, that filed a barrage of lawsuits against the orders last year. 

The justices ruled in favor of the health care mandate in a 5-4 decision, with Chief Justice John Roberts and Justice Brett Kavanaugh joining the court’s three liberal members. All six conservative justices ruled against the regulation for large employers, with the court’s three liberals dissenting.

The vaccine requirement for health care workers at facilities that accept federal funding is the more stringent of the two rules. While the OSHA emergency standard would have allowed for employees to receive regular testing instead of the vaccine, there is no such option for health care workers. 

In its ruling, the high court decided that Secretary of Health and Human Services Xavier Becerra has the authority, vested by Congress, to add conditions to the receipt of federal funds, pointing to existing regulations that govern safety and health standards at medical facilities.

“Of course the vaccine mandate goes further than what the Secretary has done in the past to implement infection control. But he has never had to address an infection problem of this scale and scope before,” the decision reads. “In any event, there can be no doubt that addressing infection problems in Medicare and Medicaid facilities is what [the Secretary] does.”

The court also pointed to arguments from the federal government that as many as 35% of health care staff remain unvaccinated in many medical facilities and that “those staff, the Secretary explained, pose a serious threat to the health and safety of patients.”

But the court’s conservative majority did not agree that the federal government has the authority to require vaccinations or testing as a workplace safety condition for roughly 84 million employees — measures it classified as beyond the scope of occupational safety.

While OSHA may be able to issue COVID-19 related regulations for specific types of workplaces where there is a higher likelihood of contagion, the court said, the emergency standard as written was overbroad and would have the effect of significantly expanding the agency’s powers.

“Of course the vaccine mandate goes further than what the [Health and Human Services Secretary] has done in the past to implement infection control. But he has never had to address an infection problem of this scale and scope before.”

U.S. Supreme Court decision in Biden v. Missouri

“OSHA’s indiscriminate approach fails to account for this crucial distinction — between occupational risk and risk more generally — and accordingly the mandate takes on the character of a general public health measure, rather than an ‘occupational safety or health standard,’” the ruling said.

President Biden said he was “disappointed” by the court’s ruling in the OSHA case, saying, “it is now up to States and individual employers to determine whether to make their workplaces as safe as possible for employees.” He simultaneously praised the court’s other ruling, saying the health care worker vaccine mandate “will save lives” of patients and employees at 76,000 facilities nationwide.

In a statement Thursday afternoon, Montana Hospital Association President and CEO Rich Rasmussen said it is “essential” that providers across the state comply with the new mandate to avoid compromising federal funding.

“Noncompliance with this federal requirement could lead to termination from the Medicare and Medicaid programs,” Rasmussen said. “The loss of care would have a negative impact on the health of all Montanans, because payments received from Medicare and Medicaid help support services available to all of us.”

Alternatively, Montana Attorney General Austin Knudsen criticized the court’s decision for health care workers, reiterating the argument that vaccine requirements will exacerbate a worker shortage by causing employees to quit rather than receive the vaccine.

“The decision to allow the mandate for healthcare workers to go into effect while the case is fully decided is as nonsensical as it is disappointing. Its effect on Montana’s rural medical facilities will be irreversible and devastating,” Knudsen said. “Today’s decisions do not mean either case is over – I will continue our fight to protect Montanans’ rights and strike down President Biden’s unlawful mandates for good.”

This story was updated Jan. 13, 2022, to include a statement from the Montana Hospital Association.

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Mara writes about health and human services stories happening in local communities, the Montana statehouse and the court system. She also produces the Shared State podcast in collaboration with MTPR and YPR. Before joining Montana Free Press, Mara worked in podcast and radio production at Slate and WNYC. She was born and raised in Helena, MT and graduated from Seattle University in 2016.