FORT LAUDERDALE, Fla.— As Gov. Ron DeSantis fights COVID-19 vaccination passports and mandates — most recently by threatening the Special Olympics with a $27.5 million fine — there’s one mandate he can’t stop.
The Centers for Medicare & Medicaid Services is enforcing a federal vaccine requirement for health care staff that offers only medical or religious exemptions. The rule, which the U.S. Supreme Court validated in January, contradicts a state law that requires employers to offer broad exemptions that are not allowed by CMS.
Though the Florida Agency for Health Care Administration has vowed not to monitor or report whether Florida health care facilities are following the requirement, that isn’t stopping the federal government from checking. CMS required 100% of eligible Florida health care workers to be fully vaccinated or receive an exemption by Feb. 28.
CMS has reduced Florida’s federal allocation of survey and certification funding by $1.2 million and will pay contractors to check if health care facilities are following the law, which would typically be the state’s responsibility, a CMS spokesperson said. The agency plans to cut funds to non-compliant states in future years until they start overseeing the vaccine requirement, a Feb. 9 memorandum said.
Brock Juarez, communications director for the Florida Agency for Health Care Administration, in a Thursday email said the CMS moves do not change the agency’s policy.
“1.2 million dollars is a small price to pay to protect the freedom of health care workers,” he wrote.
Juarez added that he doubted CMS would actually go through with its threatened penalty for non-compliant hospitals: termination from the program, which would mean hospitals would no longer be able to accept Medicaid or Medicare.
A record 5,242,984 people are currently enrolled in Medicaid statewide, according to the Florida Agency for Health Care’s April tally.
“The concept that the Biden Administration would tie Medicare and Medicaid funding to a vaccination mandate – funding that pays for medical care for children, the elderly, disabled, and low income individuals is half-baked public policy,” Juarez wrote. “I would be surprised if that was the route they choose to take.”
Christina Pushaw, spokesperson for DeSantis, in an email said state laws the governor signed in November restricting vaccination mandates still stand.
Businesses with 99 employees or fewer that issue vaccination mandates without exemptions will be fined $10,000 per employee violation, and larger businesses will be fined $50,000 per employee violation, a Nov. 18 news release from DeSantis’ office said.
“Florida law provides protections from employer vaccine mandates. Nobody, including healthcare workers, should lose his or her livelihood due to covid vaccination status. This is a personal medical decision, and in Florida, we respect that,” Pushaw wrote.
The state law differs from federal law by requiring exemptions that CMS forbids, such as an exemption for prior COVID-19 infection.
“Available evidence indicates that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections,” a CMS FAQ document reads.
Pushaw called this position “unscientific.”
The state law also requires people without qualifying religious or medical exemptions to be given the option to test weekly instead of getting vaccinated, which CMS does not allow, citing evidence that vaccination is a more effective infection control measure.
CMS contends that states cannot prohibit hospitals from following the rule due to the U.S. Constitution’s Supremacy Clause, which establishes that federal law takes precedence over state law when they conflict.
The hospital regulator has cited 69 hospitals nationwide for not complying with the mandate and is working to bring them in line, the agency told Politico on May 30, though policy experts told the publication they worry whether the agency has sufficient resources for the task.
The idea of a health care vaccine mandate has had broad support from the medical community since before it was enacted.
In July 2021, over 50 medical groups including the American Medical Association, American Nurses Association, American Academy of Pediatrics, Association of American Medical Colleges, and National Association for Home Care and Hospice all called for health care employers to require employees to be vaccinated against COVID-19, according to a news release from the Association of American Medical Colleges.
“The AAMC, whose members continue to provide patient care on the frontlines of this ongoing pandemic, did not come to this decision lightly,” said AAMC President and CEO Dr. David J. Skorton in July. “Based on the large and convincing body of evidence and real-world experience of the safety and efficacy of the COVID-19 vaccines, requiring vaccinations among those serving at health care institutions is the right decision to promote the health of our patients, their families, and communities.”
Critics such as DeSantis and Florida Surgeon General Joseph Ladapo have argued that vaccination mandates will increase the current shortage of health care workers in Florida and violate people’s bodily autonomy.
“Your rights or your freedoms should not be circumscribed by your decision to take or not take a COVID vaccine,” DeSantis said at a June 3 news conference to discuss the end of the Special Olympics’ vaccine requirement.
The vaccination mandate so far does not appear to have exacerbated staffing shortages, at least in nursing homes, where vaccination rates increased by 25 percentage points nationally from 63% to 88% from the mandate’s announcement in Aug. 2021 to its deadline at the end of February, a May analysis by Kaiser Family Foundation researchers found.
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