Judge halts enforcement of federal COVID-19 vaccine mandate for health workers in Iowa and nine other states

Navy Seaman Milan Torres prepares a dose of the COVID-19 vaccine at Walter Reed National Military Medical Center, Dec. 14, 2020. — Lisa Ferdinando/Department of Defense

On Monday, a federal judge in Missouri issued a preliminary injunction stopping the Biden administration from enforcing the mandate requiring workers at healthcare facilities that receive Medicare and Medicaid dollars to be vaccinated against COVID-19. The injunction only applies to the 10 states who filed the lawsuit against the mandate. Iowa is one of those states.

Gov. Kim Reynolds announced on Nov. 10 she was joining the Republican governors of Missouri, Alaska, Arkansas, Kansas, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming in suing the Centers for Medicare and Medicaid (CMS) to stop healthcare facilities that rely on funding from those programs from complying with its rules on COVID-19 vaccinations in the same way they have to comply with other CMS rules.

At the time, Reynolds called the requirement for workers, including those working with vulnerable populations in nursing homes, to be vaccinated against the virus “an attack on individual liberties.” The same day the governor made that statement, the Iowa Department of Public Health reported ongoing COVID-19 outbreaks in 29 Iowa nursing homes.

IDPH uses a very restrictive definition for COVID-19 outbreaks in nursing homes compared to other states — and more restrictive than its own definition of a flu outbreak at a nursing home — which has allowed the department to not publicly identify all cases of COVID-19 in nursing homes. Still, by the time Reynolds joined the lawsuit against the CMS mandate, there had already been more than 500 outbreaks in the state’s nursing homes.

The governor also cited the possibility that requiring healthcare workers to be vaccinated against COVID-19 may make it harder to find workers for already understaffed healthcare facilities as a reasoning for suing to stop the mandate. That claim is also at the center of a separate lawsuit brought by the state of Florida against the CMS mandate, and last week a federal judge in Florida rejected the state’s request for a preliminary injunction.

The judge found that CMS was within its established authority to issue the mandate — a point most legal analysts agree with — and rejected Florida’s claims that it would cause a shortage of workers as just “projections” by state officials without data to back it up.

In his ruling on Monday, Judge Matthew Schelp of the U.S. District Court for the Eastern District of Missouri took a very different approach.

Schelp found the projections showing vaccination mandates could contribute to staffing shortages to be convincing, while rejecting the CMS evidence that vaccinating healthcare workers would limit virus spread.

“CMS lacks evidence showing that vaccination status has a direct impact on spreading COVID in the mandate’s covered healthcare facilities,” Schelp wrote.

The judge, appointed by President Trump in 2020, said the data used by CMS to show the impact of vaccinations on stopping virus spread came from nursing homes, where patients are at heightened risk of contracting COVID-19, and was therefore inappropriate to use to justify a mandate that applies to all healthcare facilities.

Schelp also decided CMS lacks the authority to create a vaccination mandate for all healthcare facilities without “clear authorization from Congress,” even in cases of national emergencies such as the pandemic.

The judge seemed unconvinced there was a pressing need for taking action.

“The public has an interest in stopping the spread of COVID,” Schelp wrote. “No one disputes that. But the Court concludes that the public would suffer little, if any, harm from maintaining the ‘status quo’ through the litigation of this case.”

Schlep issued the preliminary injunction the day after Canadian health officials confirmed the first two cases of the Omicron variant in North America.

Following the judge’s ruling, the governor’s office put out a written statement.

“Iowa is fighting back against the Biden Administration’s attack on individual liberties and I applaud the court’s decision to enjoin the vaccine mandate rule for Medicare and Medicaid certified providers and suppliers,” Reynolds said.

Responding to questions from reporters about the injunction on Monday, White House Press Secretary Jen Psaki said, “We’re obviously going to abide by the law and fight any efforts in courts to prevent health-care facilities from protecting their workforces.”

Although the injunction prevents CMS from taking action in Iowa and the nine other states to enforce the mandate, which requires all covered workers to be vaccinated by Jan. 4, 2022, it has no impact on the vaccine requirements imposed by employers in the healthcare field, such as clinics, hospitals and nursing homes.

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