The Court Decision

In a 5-4 decision issued on January 13, 2022, the Supreme Court suspended the orders that had blocked the mandate, allowing CMS to enforce the vaccine mandate while further litigation continued. In an unsigned decision issued collectively by the Court, the Court held that the Secretary acted within authority when requiring vaccination as a condition of Medicare and Medicaid participation. They reasoned that healthcare facilities have always been required to meet certain conditions ensuring safe and effective care, and that the Secretary's role extends far beyond that of a mere bookkeeper (Biden v. Missouri, 2022). The Court emphasized that COVID-19 is a highly contagious, dangerous, and deadly disease, especially for Medicare and Medicaid patients. The Court found that the vaccination mandate would substantially reduce the possibility of disease transmission from healthcare workers to vulnerable patients (California Lawyers Association, 2022). The majority noted that vaccination requirements are common in healthcare settings and that the dangerous nature of the pandemic justified exercising this regulatory authority.

Justice Thomas authored the dissent, joined by Justices Alito, Gorsuch, and Barrett. They argued that the government failed to prove that Congress had approved a nationwide vaccine mandate affecting millions of healthcare workers. The dissent stated that the cited statutes did not warrant such a sweeping mandate, particularly given its implications for federalism and state sovereignty.

Relationship to Other Cases

Biden v. Missouri is best understood alongside National Federation of Independent Business v. Department of Labor, Occupational Safety and Health Administration (NFIB v. OSHA), which the Supreme Court decided on the same day. In NFIB v. OSHA, in a 6-3 decision, the court blocked OSHA's rule requiring large private employers with 100 or more workers to require either vaccination or weekly testing. The court concluded that OSHA did not have clear congressional authorization to issue such a broad regulation beyond workplace specific hazards (NFIB v. OSHA, 2022). The court upheld the CMS healthcare worker mandate because Congress had more explicitly authorized the Secretary of HHS to impose health and safety conditions on Medicare and Medicaid facilities (Biden v. Missouri, 2022).

This contrast represents the Supreme Court's application of the major questions doctrine, a principle in administrative law essential for upholding constitutional separation of powers and ensuring proper checks and balances within the government (Veres, 2022). The doctrine states that executive branch agencies cannot decide major national policies, especially those with vast economic or political consequences, unless Congress has clearly and specifically authorized them to do so (Somin, 2022). This principle is vital because it reserves policymaking to the legislative branch which maintains accountability to the public. It prevents executive branch agencies from claiming sweeping power over the American public, especially during times of crisis (May & Magloughlin, 2022).

The differing outcomes in Biden v. Missouri and NFIB v. OSHA reinforced the necessity of oversight and congressional clarity even in the face of a national threat. The CMS mandate in Biden v. Missouri was upheld because Congress had clearly granted the Secretary of HHS the authority to impose health and safety conditions on facilities receiving federal funds, allowing this specific, authorized power to stand. The OSHA mandate in NFIB v. OSHA was blocked because it was based on a general grant of authority for workplace safety, which the Court deemed too ambiguous to justify such a massive national policy mandate. The Court's message is clear. The need for rapid government action during an emergency does not void the constitutional requirement for oversight (Somin, 2022). This restrictive enforcement of generalized power preserves the limits of government, ensuring that the necessary power to respond to crises remains in Congress.

Significance for Homeland Security

Biden v. Missouri has profound implications for homeland security, particularly concerning the government's authority to respond to national security threats while upholding constitutional principles and civil liberties. The Supreme Court's contrasting decisions in Biden v. Missouri and NFIB v. OSHA highlight the critical balance between effective emergency response and the need for established limits on government power. These rulings demonstrate that federal action during crises must be based in clear statutory authority, ensuring that emergency measures do not become a tool for unchecked federal expansion. This principle becomes even more significant when considering broader national threats such as pandemics, cyberattacks, bioterrorism, or large-scale infrastructure threats where the government may feel pressure to intervene rapidly in both public and private areas of interest. This balance is critical in contexts where swift federal action is necessary but must still respect state governance and the private interests of American businesses, industries, and individuals.

The case underscores ongoing tensions between federal emergency powers and state sovereignty that are central to homeland security. The differing outcomes exemplify the importance of congressional clarity when delegating emergency powers, ensuring that future administrations cannot claim broad authority without proper authorization and review. Legal scholars have expressed concern about the potential for abuse, noting that multiple administrations have relied on previous emergency declarations to pursue sweeping federal actions that affect private enterprise, labor markets, and individual rights without direct congressional approval. Biden v. Missouri reinforces the principle that executive agencies must remain accountable to regulatory boundaries set by Congress to prevent the erosion of separation of powers and protect private American interests from unwarranted government interference during homeland security crises. The decision serves as a reminder that powerful national security measures must remain consistent with constitutional principles to preserve America's democratic foundation and the trust of its constituents.

References

Adashi, E. Y., & Cohen, I. G. (2022). The CMS vaccine mandate at the Supreme Court: A Hippocratic imperative. The American Journal of Medicine, 135(9), 1035-1036. https://doi.org/10.1016/j.amjmed.2022.03.041

Biden v. Missouri, 595 U.S. ___ (2022). https://www.supremecourt.gov/opinions/21pdf/21a240_d18e.pdf

California Lawyers Association. (2022, January 25). Biden v. Missouri, 595 U.S. ___, 2022 WL 120950 (U.S. Jan. 13, 2022) (Nos. 21A240 and 21A241). https://calawyers.org/business-law/biden-v-missouri-595-u-s-___-2022-wl-120950-u-s-jan-13-2022-nos-21a240-and-21a241/

May, R. J., & Magloughlin, A. K. (2022). NFIB v. OSHA: A unified separation of powers doctrine and Chevron's no show. South Carolina Law Review, 74(2), 265-306. https://scholarcommons.sc.edu/cgi/viewcontent.cgi?article=4453&context=sclr

National Federation of Independent Business v. Department of Labor, Occupational Safety and Health Administration, 595 U.S. ___ (2022). https://www.supremecourt.gov/opinions/21pdf/21a244_hgci.pdf

Somin, I. (2022). A major question of power: The vaccine mandate cases and the limits of executive authority. Cato Supreme Court Review, 2021-2022, 69-121. https://www.cato.org/sites/cato.org/files/2022-09/Supreme-Court-Review-2022-Chapter-3.pdf

Supreme Court of the United States. (2022). Biden v. Missouri, 595 U.S. 87. United States Reports, 595(Part 1), 87-108. https://www.supremecourt.gov/opinions/21pdf/595us1r7_4315.pdf

Somin, I. (2022). A major question of power: The vaccine mandate cases and the limits of executive authority. Cato Supreme Court Review, 2021-2022, 69–121. https://www.law.gmu.edu/pubs/papers/ls2225

Veres, J. (2022). The ultimate congressional workaround: Why businesses should advocate the return of a robust and originalist nondelegation doctrine after NFIB v. OSHA and Biden v. Missouri. Business, Entrepreneurship & Tax Law Review, 6(2), 346–369. https://scholarship.law.missouri.edu/betr/vol6/iss2/5/