Biden's COVID-19 mandate to vaccinate all health care workers may come with unintended consequences

The Biden administration is requiring all health care workers get vaccinated against COVID-19 in a sweeping plan revealed Thursday that aims to increase vaccinations across the country amid surging coronavirus cases.

The Centers for Medicare & Medicaid Services said workers in health care settings that receive Medicare and Medicaid funding must get their shot.

“There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”

Health care associations applaud the new policy and underscore the importance of getting vaccinated, but they're worried it could exacerbate workforce shortages amid a surge of COVID-19 cases and hospitalizations.

This unintended consequence could hit rural hospitals especially hard, said Alan Morgan, chief executive officer of the National Rural Health Association.

"Right off the bat, vaccines are safe and effective and it’s imperative that all rural health care workforce providers and staff need to be vaccinated,” he said. “But we also know that there are higher rates of hospital workers that are unvaccinated and have no intention of getting vaccinated in the rural context … this is a significant concern.”

A handful of hospitals across the country were already in the process of requiring COVID-19 shots before Thursday's announcement. Houston Methodist – one of the first hospital systems to implement a vaccination policy – lost 153 workers who were either terminated or resigned after the mandate, a spokesperson for Houston Methodist Hospital system told The Associated Press.

Larger hospitals may be able to handle the loss, but Morgan said losing more than 150 employees would be a huge blow to a rural hospital.

“In a large health system or urban provider, you have that workforce ability to adjust,” he said. “You don’t’ have that flexibility in a rural context.”

Other health care leaders are more hopeful after seeing the progress made in nursing homes. On Aug. 18, Biden told nursing homes they had to vaccinate their staff if they wanted to continue receiving federal funding.

The nursing home mandate never materialized; instead it was replaced by the new policy announced Thursday. But just the announcement itself encouraged staff to get vaccinated, said Mark Parkinson, President & CEO of the American Health Care Association and National Center for Assisted Living

"When the administration made the announcement three weeks ago, one positive thing it did was increase vaccination rate in nursing homes from 61% to 64%," he said. "The requirement did not see a large number of staff leaving facilities."

A June report by the AHCA/NCAL found more than half of nursing home and assisted living providers lost key members of their staff last year during the pandemic due to workers quitting.

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But Parkinson says by requiring all health care settings to comply with vaccination mandates, unvaccinated nursing home staff won't have anywhere to go without facing frequent COVID testing.

"The administration eliminated the risk of staff threatening to leave to work at hospitals and go to home health," he said. "Anytime you have a mandate there will be some fallout but the policy of the administration is really smart, so hopefully, the fallout will be minimal."

Biden also reduced the risk of workers leaving the health care sector by requiring all companies with 100 workers or more to mandate vaccinations or conduct weekly testing. It's unclear if CMS will offer this testing alternative when it issues a final rule in October.

Health care systems are working hard to boost vaccine confidence among staff, but they say the federal government needs to support hospitals if workers decide to leave because of the new policy.

"We have to get staff vaccinated, but we recognize that we’re going to have a challenge with workforce," Morgan said. "We need to be recognizing this challenge, knowing we have to get our staff vaccinated, but getting ready to backfill vacancies as they arrive."

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: COVID: Biden, CMS requires all health care workers to get vaccinated