Case: Florida v. Department of Health and Human Services

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. The State of Florida sued HHS, the United States, and CMS in the U.S. District Court for the Northern District of Florida on November 17, 2021. Florida argued that the the rule was made in violation go the Administrative Procedure Act (APA) because it was issued without consultation with the states and exceeded CMS's statutory authority. Florida also argued that CMS failed to engage in notice and comment as required by the APA and that the agency action was arbitrary and capricious in violation of the APA. Lastly, Florida argued that the mandate violated the Spending Clause of the United States Constitution by conditioning the state's receipt of federal funds on enforcement of the mandate. The state requested that the court enjoin the mandate and declare the federal government's actions unlawful. The case was assigned to Judge Margaret Catharine Rodgers.

On November 17, Florida moved for a preliminary injunction. On November 20, 2021, the court denied the state's motion. The court stated that, under Eleventh Circuit law, even if the plaintiff demonstrates a substantial likelihood of success on the merits, preliminary injunction relief is improper in the absence of a substantial likelihood of irreparable injury. The court found no adequate showing of a likelihood of irreparable injury prior to the December 6, 2021, which is the date that the mandate begins to take affect. While the state submitted affidavits estimating the number of employees who will resign from the state's agencies and institutions due to the mandate, the court found these estimates speculative, rather than actual and imminent, and disregarded the estimates as conclusory. The court also stated that the potential economic loss from the withholding of federal funding from the state for refusal to comply with the mandate is not irreparable since the injury could be undone through monetary remedies. In addition, the court noted that there was no evidence to suggest that the anticipated loss of federal funding from state agencies' noncompliance would occur immediately on December 6. While Florida argued that the state's sovereignty would be irreparably injured through the preemption of its own laws and policies, the court found that this argument lacked merit and that the state failed to reference any established policy in danger or preemption.

On November 23, 2021, the state appealed the court's refusal to grant its motion for a preliminary injunction (USCA Case # 21-14098) and moved in the district court for an emergency motion for an injunction pending the appeal. On November 27, the court denied the state's emergency motion but reinstated Florida's initial request for preliminary injunctive relief. While it denied the emergency motion for the same reasons that it denied the initial motion for a preliminary injunction, the court re-examined the state's argument that the federal mandate interferes with the state's policies, since the state passed a bill on November 18, 2021, which prohibited private and public employer COVID-19 vaccination mandates. The state argued that the conflict between the state and federal laws would irreparably injure the state's sovereignty by precluding the state from enforcing its own law and that it would force public health agency and facility heads to choose which law to follow and which to violate. The state also argued that the federal law would harm state residents working in healthcare and patients who may lose access to healthcare due to the mandate. Due to the passage of the state law, the court reinstated Florida's request for a preliminary injunction.

On November 28, the parties jointly moved to vacate further briefing and hearing on the state's motion for a preliminary injunction. The parties stated that, since the court originally denied the motion for a preliminary injunction and since Florida had already appealed that order, there was at a minimum a substantial doubt as to whether the court divested itself of jurisdiction to reconsider the order. Florida also stated its intent to move for an injunction pending appeal with the Eleventh Circuit on November 29. On November 29, the district court granted the joint motion and partially vacated the November 27 order insofar as it reinstated Florida's motion for a preliminary injunction.

On December 6, 2021, the Eleventh Circuit denied the state's motion for an injunction pending appeal. 19 F.4th 1271. The court noted cases by other states over the federal vaccination mandates, including Missouri v. Biden (No. 4:21-cv-1329) and Louisiana v. Becerra (No. 3:21-cv-03970). In the latter case, the Western District of Louisiana entered a nationwide preliminary injunction, which barred the federal government from enforcing the vaccine mandate in Florida. Despite the fact that the Louisiana case effectively awarded Florida the relief it sought in the district court, the state still urged the Eleventh Circuit to decide its motion for an injunction, based on its expectation that the federal government would seek a stay of the injunction issued in Louisiana. The Eleventh Circuit found that the nationwide injunction did not moot Florida's appeal based on the "capable-of-repetition-yet-evading-review" exception to mootness, which allows a court to review a matter if the challenged action is too short to be fully litigation prior to its expiration, and there is a reasonable expectation that the complaining party will be subjected to the same action again. The court found a reasonable expectation that Florida would be subjected to the vaccine rule again due to the possibility that the Fifth Circuit would not uphold the nationwide aspect of the injunction in Louisiana. The court then turned to the other aspect of the mootness exception: a short timeframe. Since the federal rule was to take effect on December 6 and the federal government requested that the Fifth Circuit decide the appeal in Louisiana by December 5, Florida would be immediately subject to the vaccine mandate if the Fifth Circuit lifted the nationwide injunction. Given that this case met both parts of the "capable-of-repetition-yet-evading-review" exception, the Eleventh Circuit found that the case was not mooted by the injunction in Louisiana.

After finding that the appeal was not moot, the Eleventh Circuit concluded that Florida failed to demonstrate a substantial likelihood of success on the merits of its appeal, failed to demonstrate that it would suffer irreparable injury absent an injunction, and failed to show that the balance of the equities favored an injunction. First, the court found that the state failed to demonstrate that the Secretary of HHS lacked the statutory authority to issue the vaccine mandate because both the Medicare and Medicaid statutes authorize the Secretary to set standards to protect the health and safety of patients and that the rule did not run afoul of 42 U.S.C. § 1395, which prohibits a federal officer from exercising supervision or control over the practice of medicine, the manner in which medical services are provided, or the operation of an institution. Rather, the court construed the Secretary's rule as a regulation of a federal program.

Second, the Eleventh Circuit found that Florida failed to demonstrate a likelihood of success in showing that the Secretary was not permitted to bypass the notice-and-comment requirement of the APA. The court found that the Secretary provided a detailed explanation for why there was good cause for dispensing with the notice-and-comment requirement, including the urgency of the pandemic, the outbreaks caused by the Delta variant, and the upcoming influenza season. Third, the court ruled that Florida failed to demonstrate likelihood of success in showing that the vaccine mandate is arbitrary and capricious. The court found that, rather than the agency's actions being irrational, the federal government offered ample evidence supporting the Secretary's determination that facility staff vaccination will provide important protection for patients.

Moving to the irreparable injury prong of the preliminary injunction analysis, the Eleventh Circuit found that Florida failed to establish that it would face irreparable injury absent injunctive relief. The court noted that the federal government does not invade state sovereignty simply because it passes laws or regulations preempting conflicting state laws. The court stated that a finding of irreparable injury in this case would mean that a state would suffer irreparable injury from any federal law with preemptive effect. The court also found that the state failed to show why the district court erred in finding that Florida's predicted staffing shortages were merely speculative and conclusory. The court also agreed with the district court's finding that Florida does not face an irreparable injury simply because employees working in federally funded facilities are forced to abide by  rules governing the federal program. The court also found that Florida failed to establish that an injunction is in the public interest because enjoining the rule would harm the public's interest in slowing the spread of COVID-19 and protecting the safety or healthcare patients and staff.

On December 10, the parties jointly moved to stay all proceedings in the district court pending appeal. The court granted the motion and stayed the case on December 13, 2021. On January, 11, 2022, the Eleventh Circuit denied Florida's motion for an initial hearing en banc. On January 21, the state moved to voluntarily dismiss the appeal. On January 25, 2022, the Eleventh Circuit granted the motion and dismissed the appeal. 2022 WL 529044. On February 4, 2022, Florida voluntarily dismissed the case in the district court in light of the Supreme Court's decision in Biden v. Missouri, 142 S. Ct. 647 (2022). The case is now closed.