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Filed Date: Nov. 10, 2021
Case Ongoing
Clearinghouse coding complete
COVID-19 Summary: In this case, several states sued to block the federal vaccine mandate which required Medicare- and Medicaid-certified providers and suppliers to become vaccinated prior to December 6, 2021. The judge granted the preliminary injunction on November 29, 2021, which enjoined the defendants from implementing the vaccination requirements in the states party to the lawsuit. The defendants appealed to the Eighth Circuit and moved for a stay of the injunction, which was denied by the district and circuit courts. The defendants then appealed to the Supreme Court for a stay of the preliminary injunction pending appeal, which was granted on January 13, 2022. The defendants' appeal in the Eighth Circuit remains pending.
This case is about whether the federal government can require Medicare- and Medicaid-certified providers and suppliers to receive a COVID-19 vaccination. President Joe Biden announced in September 2020 that the Department of Health and Human Services (HHS) would issue a rule requiring vaccination for all employees in Medicare- and Medicaid- participating facilities. The Centers for Medicare and Medicaid (CMS), which is an HHS component, issued a rule to that effect. On November 10, 2021, the States of Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota, and New Hampshire sued the United States, President Joseph Biden, HHS, CMS, and several other federal officials in the U.S. District Court for the Eastern District of Missouri.
The states presented several statutory and constitutional claims for relief. They argued that the rule was arbitrary and capricious and therefore in violation of the Administrative Procedure Act (APA). The states contended CMS failed to engage in reasoned decision-making and arbitrarily failed to account for the economic impacts of the mandate on the healthcare industry and the costs to the states and instead simply followed the directions of the President. The states also claimed that CMS violated the APA by acting in excess of its statutory authority, arguing that CMS lacks the power to mandate vaccinations and that its dong so violated Title 18 of the Social Security Act by authorizing federal officials to exercise supervision or control over the selection and tenure of persons providing health services. The states also claimed that CMS failed to abide by the notice and comment requirements for federal rule-making, in violation of the APA and the Social Security Act. In addition, the states argued that the vaccine mandate violated 42 U.S.C. § 1395z due to CMS's failure to consult with the appropriate state agencies and violated 42 U.S.C. § 1302 due to HHS's failure to prepare a regulatory impact analysis on the mandate's effect on rural hospitals.
In addition to the claims of statutory violations, the states also made constitutional and federalism arguments. They stated that the vaccine mandate violated the Spending Clause of the U.S. Constitution by putting an unconstitutional condition on the states' receipt of federal funds and by using the federal government's spending power to conscript state agencies for federal purposes. The states also contended that the mandate violated the anti-commandeering doctrine by compelling states to administer federal regulatory programs. Lastly, the states argued that the federal government violated the Tenth Amendment and the principles of federalism by exercising power beyond what was delegated to it through the Constitution and U.S. Congress and by interfering with the states' police power, which includes the authority to adopt public health regulations.
The states sought a preliminary and permanent injunction against enforcement of the mandate and a declaration that the mandate is unconstitutional and unlawful. The case was assigned to Judge Matthew T. Schelp.
On November 12, 2021, the states moved for a preliminary injunction. On November 29, the court granted the motion and enjoined CMS from implementing and enforcing the vaccine mandate. 2021 WL 5564501. The court ruled that the plaintiffs had demonstrated a likelihood of success on the merits of their case. The court found that, while Congress gave HHS the general authority to enact regulations for the administration of Medicare and Medicaid and the health and safety of recipients, the nature and breadth of the CMS mandate required clear authorization from Congress, which had not occurred. The court noted the vast economic and political significance of the mandate and the significant alteration of the balance between federal and state power that the mandate entailed. The court also found no clear indication of Congress's intent to authorize CMS to enact such a substantial and significant mandate and thus concluded that Congress likely did not grant CMS the authority to mandate the vaccine.
The court also found a likelihood that CMS improperly bypassed the notice and comment requirements of the APA and the Social Security Act. The court noted that while the requirements may be bypassed if the agency has good cause, CMS's own delay in mandating vaccination undermined its emergency justification argument for dispensing with the requirements. The court stated that given the unprecedented, controversial, and health-related nature of the mandate, good cause was even more important than usual. The court also noted that the failure to take and respond to comments would likely exacerbate vaccine hesitancy.
The court also determined that the states were likely to succeed in establishing that the vaccine mandate is arbitrary and capricious. The court held that CMS lacked evidence showing that vaccination status has a direct impact on COVID-19 spread in healthcare facilities. Furthermore, the court found that CMS had improperly rejected alternatives to the mandate, such as periodic testing or exemptions for individuals with natural immunity from COVID-19 due to a prior infection. The court also found a likelihood of a finding that the mandate is arbitrary and capricious due to its broad scope. Specifically, the court noted that the mandate applies to all covered facilities equally, regardless of the dangers of COVID-19 infection in each respective facility. The court also concluded that CMS had failed to adequately explain its sudden change in policy, from encouraging to forcing vaccination. The court also determined that when CMS weighed the benefits and risks of the mandate to the healthcare industry, it failed to properly consider all reliance interests, particularly the interests of those opposed to the mandate.
Next, the court held that the plaintiffs had shown a likelihood of irreparable harm in the absence of preliminary relief. The court found that the states had shown that mandate would irreparably harm their sovereign interests because they would be unable to enforce their own laws surrounding vaccination mandates and proof of vaccination. Next, the court determined that the states' quasi-sovereign interests were likely to suffer irreparable harm absent a preliminary injunction. These quasi-sovereign interests include the health and well-being of the residents of the plaintiff states. The court found that the plaintiffs had filed adequate support to show that their citizens would be physically and economically harmed by the mandate. These harms stem from the likelihood that the mandate would exacerbate already-existing staffing shortages, which would likely cause a reduction in quality of care, a decrease in the variety of services offered, and possible closures of some facilities, entirely. The court also found that the negative effects on the economies of the plaintiff states would also be irreparable due to sovereign immunity against monetary damages for federal agencies. The court further determined that the plaintiffs would likely face irreparable harm to their proprietary interests absent preliminary relief. These proprietary interests include the general financial health of the plaintiffs' facilities.
Next, the court held that the balance of equities tipped in favor of the plaintiff states and that the public had an interest in an injunction. The court found that the public would suffer little, if any, harm from maintaining the status quo throughout the litigation. The court noted that the effectiveness of the vaccine to prevent disease transmission was unknown, while the evidence submitted by the plaintiff states showed a likelihood of crippling effects on significant numbers of healthcare facilities.
On November 30, 2021, the defendants appealed the district court's preliminary injunction to the Eighth Circuit (USCA Case # 21-3725). On the same day, the defendants moved to stay the preliminary injunction pending their appeal in the district court and in the Eighth Circuit. On December 1, the district court denied the defendant's motion for a stay. 2021 WL 5631736. The court determined that the defendants were not likely to prevail on the merits of their appeal for the same reasons that the court found that the plaintiffs were likely to succeed on the merits of their case. While the defendants argued that hundreds or thousands of lives would be lost each month without a vaccine mandate in place, the court noted CMS's conclusion that the effectiveness of vaccines to prevent disease transmission by those who are vaccinated is currently unknown. The court therefore concluded that the defendants had not shown a likelihood of irreparable harm absent a stay. The court further concluded that facilities in the plaintiff states would likely face operational crises if a stay were granted. Lastly, the court reiterated its earlier finding that an injunction is in the public's interest. On December 13, the Eighth Circuit also denied the defendants' motion for a stay pending appeal.
On December 16, 2021, the defendants applied to the Supreme Court for a stay of the preliminary injunction pending appeal. On December 22, the defendants filed a consent motion to stay proceedings in the district court pending appeal, which the district court granted on the same day.
On January 13, 2022, the Supreme Court stayed the district court's injunction pending the defendants' appeal in the Eighth Circuit. 142 S. Ct. 647. In a per curiam opinion, the Court analyzed two preliminary injunctions against CMS's mandate: the injunction issued by the Eastern District of Missouri in this case and the injunction issued in Louisiana v. Becerra. See 2021 WL 5609846. First, the Court held that the mandate fell within the authorities that Congress conferred on HHS, including the ability to impose conditions on the receipt of Medicaid and Medicare funds if the department finds the conditions necessary in the interest of the health and safety of individuals receiving services through Medicare and Medicaid. The Court found that requiring providers to take steps to avoid transmitting COVID-19 was consistent with this statutory authorization. The Court noted the longstanding practice of HHS to condition Medicare and Medicaid funds on a host of conditions that address the safe and effective provision of healthcare, including conditions of participation that relate to the qualifications and duties of healthcare workers.
The Supreme Court also held that the mandate was not arbitrary and capricious. The Court stated that the plaintiff states had not shown that CMS had failed to examine the relevant data and articulate a satisfactory explanation for its decisions to impose the vaccine mandate instead of a testing mandate; require vaccination of employees with natural immunity; and to depart from the agency's prior approach of encouraging, rather than mandating, vaccination. The Court also concluded that CMS had good cause to delay notice and comment, since it found that the promulgation of the rule in advance of the winter flu season would reduce COVID-19 infections, hospitalizations, and deaths. Justice Thomas filed a dissenting opinion in the case, which was joined by Justices Alito, Gorsuch, and Barrett. Justice Alito also filed a dissenting opinion, which was joined by Justices Thomas, Gorsuch, and Barrett.
On February 23, 2022, the plaintiff states filed an amended complaint back in the district court and moved to lift the stay of the district court proceedings that had started on December 22, 2021. On March 23, 2022, the court struck the plaintiffs' amended complaint, since the time had passed to amend their complaint by right and since they had not received leave of court or the defendants' written consent to file the amended complaint. The court also denied the plaintiffs' motion to lift the stay, finding that such a move was not warranted since briefing on appeal in the Eighth Circuit had already concluded.
The case is ongoing.
Summary Authors
Nicholas Gillan (4/22/2022)
See docket on RECAP: https://www.courtlistener.com/docket/60864699/missouri-state-of-v-biden/
Last updated Sept. 2, 2022, 3:03 a.m.
State / Territory: Missouri
Case Type(s):
Presidential/Gubernatorial Authority
Special Collection(s):
Key Dates
Filing Date: Nov. 10, 2021
Case Ongoing: Yes
Plaintiffs
Plaintiff Description:
10 U.S. states
Plaintiff Type(s):
Public Interest Lawyer: No
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Defendants
President of the United States of America (- United States (national) -), Federal
United States of America (- United States (national) -), Federal
Centers for Medicaid and Medicare (- United States (national) -), Federal
United States Department of Health and Human Services (- United States (national) -), Federal
Case Details
Causes of Action:
Social Security (Title XX), 42 U.S.C. §§ 1397 et seq.
Administrative Procedure Act, 5 U.S.C. §§ 551 et seq.
Ex parte Young (federal or state officials)
Constitutional Clause(s):
Federalism (including 10th Amendment)
Availably Documents:
Injunctive (or Injunctive-like) Relief
Outcome
Prevailing Party: None Yet / None
Nature of Relief:
Preliminary injunction / Temp. restraining order
Source of Relief:
Content of Injunction: