SCOTUS Vaccine Aftermath

In January 2022, the U.S. Supreme Court issued two significant rulings on federal COVID-19 vaccine mandate rules that shaped employer obligations across the country. First, the Court blocked OSHA's Emergency Temporary Standard (ETS) that would have required employers with 100 or more employees to mandate vaccinations or weekly testing. The majority held that OSHA lacked authority under the Occupational Safety and Health Act to impose such a broad public health measure, ruling it exceeded OSHA's regulatory scope. In the same decision, the Court allowed the Centers for Medicare and Medicaid Services (CMS) vaccine mandate for healthcare workers at facilities receiving Medicare and Medicaid funding to go into effect, finding that CMS had sufficient statutory authority under its healthcare quality mandate. The OSHA ruling effectively ended the large-employer federal mandate, while the CMS rule continued to apply in the healthcare sector. These decisions had broad implications for HR professionals, particularly in healthcare, and underscored the importance of monitoring state-level vaccine requirement laws, which vary significantly and continue to evolve.

Even after the Supreme Court blocked OSHA's large-employer Emergency Temporary Standard, private employers generally retain the legal authority under federal law to implement their own voluntary vaccine policies or mandates, subject to applicable state law restrictions. The Equal Employment Opportunity Commission (EEOC) has confirmed that employer vaccine requirements are permissible under federal anti-discrimination laws, provided that employers provide reasonable accommodations to employees who request exemptions based on sincerely held religious beliefs under Title VII or qualifying disabilities under the ADA. The interactive accommodation process must be followed for each request, and employers must document their analysis of whether the accommodation causes undue hardship. However, a growing number of states have enacted laws restricting employer vaccine mandates — prohibiting requirements as a condition of employment, mandating broad exemptions, or limiting adverse actions against unvaccinated employees. HR professionals must conduct a state-by-state legal review before implementing any vaccine requirement, as the patchwork of state laws creates significant compliance complexity for multi-state employers.

When employees request exemptions from a workplace vaccine requirement based on religious beliefs or medical conditions, HR must follow a structured, documented process to evaluate each request individually. For religious accommodation requests under Title VII, the employee must demonstrate a sincerely held religious belief that conflicts with the vaccination requirement. Employers generally cannot challenge the validity of the religion, but may ask clarifying questions about the sincerity of the belief if circumstances genuinely warrant it. For medical exemptions under the ADA, the employee must have a qualifying disability or medical condition that makes vaccination contraindicated, and must provide documentation from a licensed healthcare provider. In both cases, the employer must engage in the interactive process to determine whether a reasonable accommodation is available — such as remote work, masking, regular testing, or modified assignments — without causing undue hardship. After Groff v. DeJoy (2023), the undue hardship standard for religious accommodations was significantly elevated. Denying an accommodation without thorough documentation of the analysis significantly increases litigation risk. Consistent application of the accommodation process across all employees is essential to avoid claims of disparate treatment or discrimination.

The COVID-19 pandemic fundamentally reshaped employer approaches to workplace health and safety, and the policy lessons from that period continue to inform best practices for ongoing preparedness. A robust post-pandemic workplace health and safety policy should address several key areas. First, the framework for responding to future public health emergencies — including decision-making authority, communication protocols, and criteria for implementing enhanced safety measures — should be documented in advance rather than created reactively. Second, policies on infectious disease management, including when symptomatic employees should stay home, testing protocols, and return-to-work criteria, should be based on CDC and public health guidance and reviewed periodically as guidance evolves. Third, vaccination and immunization policies should be clearly defined, including whether the organization will require, encourage, or remain neutral on vaccines for specific roles or settings, and how accommodation requests will be handled. Fourth, remote work and flexible scheduling provisions that proved effective during the pandemic should be formalized as permanent policy options. HR should engage legal counsel when developing these policies to ensure compliance with OSHA, ADA, Title VII, and applicable state laws.

The Supreme Court's decision to allow the CMS vaccine mandate for healthcare facilities receiving Medicare and Medicaid funding created a distinct compliance obligation for HR professionals in the healthcare sector that did not apply to most other industries. Healthcare employers covered by the CMS rule were required to ensure that all staff — including employees, contractors, and volunteers who work in the facility — were vaccinated against COVID-19, with limited exceptions for medical and religious accommodations. HR teams in healthcare had to develop comprehensive systems for tracking vaccination status, managing exemption requests and accommodations, and documenting compliance for CMS survey purposes. The consequences of non-compliance included potential loss of Medicare and Medicaid funding — a severe financial sanction for most healthcare facilities. While the specific COVID-19 vaccine mandate has been wound down, the experience established important precedents and infrastructure for healthcare HR compliance. Healthcare HR professionals must continue to monitor CMS conditions of participation, which regularly address staff health and safety requirements, and maintain robust processes for managing staff vaccination policies, immunization records, and accommodation requests.