Biden v. Missouri

STATUTORY AUTHORIZATION THROUGH MEDICAID

Petitioner the Biden Administration contends that a stay of the injunction is proper because the Administration is statutorily authorized to issue the mandate. Brief for Petitioner, the Biden Administration at 18. Specifically, the Biden Administration argues that the Secretary of the Department of Health and Human Services (“HHS”) possesses the statutory authority to require facilities that participate in the Medicare or Medicaid programs to comply with restrictions that protect patient health and safety. Id. The Biden Administration asserts that the text of the Medicare Act, 42 U.S.C. § 1302(a), unambiguously vests authority in the Secretary of HHS to make rules that “may be necessary and efficient” to the administration of the Medicare and Medicaid programs. Id. at 19. The Biden Administration points to several provisions of the Medicare Act that recognize the HHS Secretary’s broad power to set standards that ensure patient health and safety. Id. The Biden Administration contends that the vaccine mandate is analogous to these provisions and similarly necessary to protecting patient health and safety. Id. at 20. The Biden Administration also posits that science and common sense support the conclusion that requiring healthcare staff to be vaccinated protects patients by reducing the likelihood of patient COVID-19 infection and providing greater assurance to patients that they are less likely to be exposed to the virus. Id. at 20–21. Moreover, the Biden Administration claims that vaccination requirements are consistent with both the history of the Medicare Act and public-health measures generally. Id. at 21–24. Accordingly, the Biden Administration argues that Congress did in fact authorize the mandate and that the district court erred in finding otherwise. Id. at 24–30.

Respondents the State of Missouri and nine other states (collectively “Missouri”) counter that a stay is improper because the mandate unequivocally lacks statutory authorization. Brief for Respondents, the States at 22. Missouri notes that the Biden Administration impermissibly applies an expansive reading to § 1302(a), which Missouri argues only recognizes a general responsibility of the HHS Secretary to maintain the Medicare and Medicaid programs. Id. at 24–25. Missouri claims that the authority recognized in § 1302(a) only permits the Secretary of HHS to promulgate practical rules such as billing procedures and cannot support a far-reaching and consequential vaccine mandate. Id. at 25. Missouri claims that because of the vaccine mandate’s broad and serious implications, Congress needed to provide the centers for Medicare and Medicaid Services with an express grant of authorization and that no such grant exists here. Id. Missouri points to several Supreme Court precedents for the proposition that agency decisions with significant economic and political ramifications must be made consistent with a clear showing that Congress has ordered the action. Id. at 22–23. Missouri asserts that the mandate will affect over two million healthcare staff, will reduce healthcare access for almost all Americans, places billions of dollars of federal funding at risk if facilities do not comply, and endangers the states’ own police power. Id. at 23–24. Accordingly, Missouri contends that the decision to require such widespread vaccination cannot be imposed and enforced without exceedingly clear Congressional authorization. Id. at 24. Furthermore, Missouri posits that even if Congress had authorized the mandate, the mandate is nonetheless unconstitutional under both the Spending Clause and the Non-Delegation Doctrine. Id. at 26–28.

THE ARBITRARY AND CAPRICIOUS STANDARD

The Biden Administration asserts that a stay should issue because the mandate is not arbitrary and capricious but rather is supported by extensive evidence of the efficacy of the vaccination requirement. Brief for Petitioner at 31. The Biden Administration argues that the district court erred when it determined that the Secretary of HHS failed to consider the effects of staff shortages brought on by the mandate. Id. The Biden Administration contends that the HHS Secretary did assess the possibility that some healthcare staff would quit instead of receiving the vaccine but concluded that this concern was not enough to outweigh the benefits of the nationwide vaccine mandate. Id. at 32. For instance, the Biden Administration notes that only 0.6% of the staff at the Houston Methodist Hospital system chose to resign when a vaccine mandate was imposed there. Id. Additionally, the Biden Administration posits that countervailing factors, such as reduced staff absenteeism resulting from COVID-19 infections, would yield a substantial benefit to healthcare facilities. Id. at 32. Moreover, the Biden Administration indicates that the vaccine mandate enjoys widespread support from leading healthcare associations. Id. at 33. The Biden Administration also asserts that the Secretary of HHS considered alternatives to a vaccination requirement, such as repeated testing, and determined that those alternatives would not adequately protect patients. Id. at 34.

Missouri counters that the mandate is arbitrary and capricious because the evidence overwhelmingly counsels against imposing a nationwide vaccine mandate. Brief for Respondents at 28. Missouri notes that the mandate disregards both patient well-being and access to care. Id. Specifically, Missouri argues that Biden Administration downplays the significant staff shortages that will result from mandating the COVID-19 vaccine, and that these shortages will only exacerbate the healthcare crisis that the already nation confronts. Id. at 28–29. Missouri contends that fewer healthcare workers necessarily means that patient care will suffer. Id. at 29. Moreover, Missouri posits that the Biden Administration ignores the particularly detrimental impact that the mandate will have on rural hospitals, which flouts the protections that the Medicare Act provides for rural populations in § 1302(b). Id. Furthermore, Missouri asserts that the Biden Administration does not provide any evidence that alternatives to a vaccine mandate cannot effectively guarantee both patient well-being and ensure access to care. Id. at 30. For instance, Missouri contends that a testing requirement would prevent the staff shortages that a vaccine mandate would generate. Id.

THE BALANCE OF EQUITIES AND IRREPARABLE HARM

The Biden Administration maintains that the balance of equities is in support of a stay because the interests of both the United States and the public will suffer irreparable harm if the mandate remains unenforceable. Brief for Petitioner at 37. The Biden Administration argues that considerations of public health warrant enforcement of the mandate, especially as the nation faces another winter spike in COVID-19 cases. Id. at 38. The Biden Administration contends that staff transmission of COVID-19 to patients can potentially result in thousands of deaths. Id. Moreover, the Biden Administration posits that this threat to human life significantly outweighs any harm that may result from healthcare workers quitting instead of receiving the vaccine. Id. Furthermore, the Biden Administration asserts that the other forms of harm Missouri points to as irreparable are either non-cognizable or outweighed by the Biden Administration’s compelling interest in enforcing the mandate. Id. at 39.

Missouri counters that preventing the Biden Administration from enforcing the mandate will not result in any irreparable harm to the Government or the public, but that irreparable harm will befall the states if the mandate is enforced. Brief for Respondents at 37. Specifically, Missouri argues that it will suffer irreparable harm to their sovereign, quasi-sovereign, and proprietary interests if the mandate is enforced. Id. Additionally, Missouri asserts that, in the mandate, the Biden Administration itself recognizes that the effectiveness of the vaccine in preventing transmission of the virus is not known. Id. at 38. Missouri maintains the Biden Administration’s claim that thousands of patients may die is speculative at best. Id. Moreover, Missouri contends that the mandate will hinder patient care because it will exacerbate staff shortages and potentially lead to the closure of facilities. Id. Accordingly, Missouri argue that the balance of equities supports declining the Biden Administration’s request for a stay of the injunction. Id.