As of Monday, there are mainly three types of health care workers in Montana. Those with at least one dose of a COVID-19 vaccine, those with an exemption because of their religious belief or medical condition, and those without a job.
Feb. 14 is the date when medical facilities in the state that receive federal funding must be in compliance with the new coronavirus vaccine requirements from the Centers for Medicaid and Medicare (CMS), an infection-control strategy that punches a major hole in Montana’s sweeping ban on vaccine mandates and differential treatment based on vaccination status. Health care employees must be fully vaccinated, not including booster shots, by March 15.
The U.S. Supreme Court in early January decided CMS could begin enforcing the new rule while the case works through the lower courts, with five of the court’s members agreeing that an “infection problem of this scale and scope,” i.e., COVID-19, justifies the use of CMS’s authority.
While the U.S.-approved COVID-19 vaccines have been found to decrease spread of previous variants, scientists are still working to understand how vaccines affect the transmissibility of omicron, the current dominant variant. Recent data already shows that people who are vaccinated and boosted have substantially less risk of becoming seriously ill or hospitalized from omicron.
Montana, along with several other states, has fought CMS’ vaccine mandate for health care workers and staff since November, along with other Biden administration attempts to boost vaccination rates in several parts of the economy. The CMS mandate directly conflicts with the intent of House Bill 702, making hospitals and other eligible health care facilities some of the first entities in Montana to implement a vaccine mandate for employees.
The CMS rule requires hospitals to develop a system to ensure employees are vaccinated, document and track employee vaccinations, and provide exemptions for medical conditions or a sincerely held religious belief. Hospitals have leeway in how they put those systems in place — including vetting religious exemptions — as long as those policies are consistent with federal law.
“The key here is really ensuring that whatever you adopt as your policies, that they are compliant with the CMS rule. And that’s what hospitals are doing,” said Rich Rasmussen, president and CEO of the Montana Hospital Association, in a January interview.
For health care facilities, the stick in the equation is the threat of withholding Medicaid funding. MHA estimates that 70% of spending at Montana hospitals comes from CMS payments, money that then rolls into hospitals’ overall budgets for general staffing and health services.
The threat of lost funding is not the only concern health care facilities are navigating. With workforces already strained, understaffed and burned out, hospitals may lose more staff members on Monday who have not been vaccinated and have not been cleared for exemptions.
The anticipated impact is hard to pin down. Montana hospital administrations have been tight-lipped about how many employees are vaccinated, exempted, or have already resigned because of the mandate.
In late January, with roughly two weeks to go until the Feb. 14 deadline, a spokesman for Billings Clinic said about 94% of the hospital’s staff were in compliance with the CMS requirements and that “the large majority” of that compliance is due to vaccination. A spokeswoman for Bozeman Health also did not provide exact numbers on exemptions, but said in January that more than 80% of its staff was vaccinated and that the organization was “on track to meet the 100% requirement.” On Friday, a spokesperson for St. Peter’s Health in Helena said roughly 85% of its employees were vaccinated, but did not answer when asked how many exemptions the facility had granted.
In late January, the state Department of Public Health and Human Services issued guidance about the CMS mandate and a template for employees seeking a religious exemption, which the department encouraged hospitals to accept. Gov. Greg Gianforte highlighted the exemption form again Thursday, telling health care workers that the state “simply can’t afford to lose you, your colleagues, your experience, and your compassionate, dedicated care due to President Biden’s vaccine mandate.”
On Friday, press secretary Brooke Stroyke said the governor has spoken with seven different hospital administrators across the state who reported employees using the exemption form. Collectively, Stroyke said, those administrators tallied more than 2,000 employees who had so far received a religious exemption.
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But not all unvaccinated hospital staff will be exempted from the requirement, as some administrators have bluntly explained in internal communications with staff. In a Jan. 14 email obtained by Montana Free Press, Benefis Health Systems CEO John Goodnow told staff members that about 7.8% of employees remained unvaccinated and unexempted, for a total of 258 people who could lose their positions come Monday.
“We will talk individually to all of those 258 employees beginning early next week to determine if they will get vaccinated by the date required by CMS or if they will be leaving BHS,” Goodnow wrote.
In a statement Monday, Benefis spokesperson Whitney Bania confirmed that the organization “has experienced some employee departures” related to the CMS mandate, but did not provide a number.
“[W]e are continuing to operate as normal and our primary focus remains providing our patients with high quality care,” Bania said.
Reached on Friday, one Benefis employee told MTFP she had only recently been vaccinated because of Monday’s looming deadline. Speaking on the condition of anonymity for fear of retribution, the employee said she was not afraid of the vaccine, but felt she didn’t need its protection from COVID-19 because she does not have other health issues. Not qualifying for a religious or medical exemption, she considered leaving her job rather than get vaccinated. Eventually, she decided to stay, even as some of her unvaccinated colleagues did not.
“We are all very frustrated with administration,” the employee said. “I mean, we all worked through all of this pandemic, and we took care of all of these patients that were super sick or dying … and now you’re telling us that we either need to get vaccinated or we leave? We just don’t feel appreciated at all.”
While Republican attorneys general challenging the CMS mandate have warned that the new requirements will deal a devastating blow to hospital staffing, particularly in rural areas where vaccination rates remain well below the national average, economists and labor advocates have not signaled the same impending consequences. In Montana, they say, strict vaccination requirements are unlikely to undercut the health care workforce more than the steady barrage of the pandemic itself.
“We’re basically in a race,” said economist Bryce Ward, co-founder of ABMJ Consulting, “between how many people are quitting because they’re burned out … and how many people are going to quit because they’re forced to get vaccinated.” Ward also pointed to vaccine mandates that have rolled out in other states, localities and businesses that have been effective in boosting vaccination rates, even as a small percentage of employees threaten to quit or file lawsuits.
Vicky Byrd, president of the Montana Nurses Association, agreed that the threat of exhausted and undervalued workers dropping out of the health care field should be front of mind for administrators and elected officials. The CMS mandate, she said, is far from the leading factor in losing health care workers.
“Vaccine requirements, until recently in Montana, were a routine feature of being in the health care profession,” Byrd said. “The staffing issues our members are experiencing are related to wages and working conditions … and a global pandemic that has injured them physically, financially, emotionally, and spiritually.”
MHA’s Rasmussen said the CMS mandate would have some impact on Montana’s health care labor force, but that hospitals would work hard to weather any tumult as they have done continuously over the last two years. If a significant portion of employees do leave their jobs, he said, “hospitals would step back and evaluate” the spectrum of services they’re able to provide.
“It may be that they won’t be able to treat as many patients,” Rasmussen said. “It may be that facilities will look to external partners to help them with their food service or their environmental services.”
“I’m not saying there’s not going to be some disruption,” he added. “But we believe that it will be minimal.”
This story was update Feb. 14, 2022, to include additional comment from Benefis Health Systems.
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