Ten states sued the federal government Wednesday challenging its mandate for employees at Medicare and Medicaid-participating healthcare facilities to receive COVID-19 vaccines, saying the requirement will exacerbate workforce shortages.
The lawsuit, filed in the U.S. District Court for the Eastern District of Missouri, asks the court to permanently stop the Centers for Medicare and Medicaid Services interim final rule that created the mandate.
Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire predict in their complaint that the mandate will devastate healthcare systems, especially in rural areas.
"Vaccination requirements are matters that depend on local factors and conditions. Whatever might make sense in New York City, St. Louis, or Omaha could be decidedly counterproductive and harmful in rural communities like Memphis, Missouri or McCook, Nebraska," the complaint said.
While CMS acknowledged workforce concerns in its interim final rule, it said unvaccinated employees could get jobs in healthcare fields not covered under the mandate, like physician and dental offices, according to the lawsuit.
"It does not suggest that the healthcare worker shortage will disappear but only that shortages will be further concentrated among the healthcare facilities covered by the CMS mandate," the complaint said.
The lawsuit also took issue with CMS' decision not to let employees choose regular COVID-19 testing instead of vaccination or opt out if they've previously had the virus, saying this ignores personal liberty considerations as well as workforce concerns. That decision also creates a conflict with the Occupational Safety and Health Administration's related requirement.
The states claim the rule directly harms them because it requires state-run healthcare facilities and surveyors to enforce the mandate, leading to increased enforcement costs.
"Yet again, this lawsuit is not about whether people should get vaccinated. Instead, it is about federal overreach and the federal government using an unconstitutional mandate to force front-line healthcare workers to choose between a vaccination or unemployment," North Dakota Attorney General Wayne Stenehjem said in a statement.
The states argue public health matters, including vaccine mandates, should be regulated by the states. They claim CMS' rulemaking authority doesn't allow it to impose such a broad mandate not authorized by Congress, and the provisions CMS laid out in its own justification of the rule aren't sufficient. The states further argue CMS is violating laws that prevent federal agencies from controlling the selection or tenure of people providing health services.
Prior to the lawsuit's filing, legal scholars said CMS' authority to impose the mandate was pretty concrete. James Hodge, director of the Center for Public Health Law and Policy at Arizona State University, told Modern Healthcare last week CMS has the broad ability to tie policy to the receipt of federal funds.
Several states, including those suing CMS, have also filed lawsuits against the OSHA mandate.
