USCA11 Case: 21-14098 Date Filed: 12/06/2021 Page: 1 of 94 [PUBLISH] In the United States Court of Appeals For the Eleventh Circuit ____________________ No. 21-14098-JJ ___________________ STATE OF FLORIDA, Plaintiff-Appellant, versus DEPARTMENT OF HEALTH AND HUMAN SERVICES, SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, UNITED STATES OF AMERICA, U.S. CENTERS FOR MEDICARE AND MEDICAID SERVICES, ADMINISTRATOR OF THE CENTERS FOR MEDICARE AND MEDICAID, Defendants-Appellees. USCA11 Case: 21-14098 Date Filed: 12/06/2021 Page: 2 of 94 2 Opinion of the Court 21-14098 ____________________ Appeal from the United States District Court for the Northern District of Florida D.C. Docket No. 3:21-cv-02722-MCR-HTC ____________________ Before ROSENBAUM, JILL PRYOR, and LAGOA, Circuit Judges. ROSENBAUM and JILL PRYOR, Circuit Judges: On November 5, 2021, the Secretary of Health and Human Services issued an interim rule that requires facilities that provide health care to Medicare and Medicaid beneficiaries to ensure that their staff, unless exempt for medical or religious reasons, are fully vaccinated against COVID-19. See Omnibus COVID-19 Health Care Staff Vaccination, 86 Fed. Reg. 61,555 (Nov. 5, 2021) (the “in- terim rule”). Under the interim rule, covered staff must receive their first dose of a two-dose vaccine or a single-dose vaccine by December 6, 2021, or request an exemption by that date. Non-ex- empt covered staff must receive their second dose of a two-dose vaccine by January 4, 2021. Florida brought this lawsuit challenging the interim rule. In the district court, Florida requested a preliminary injunction to bar the interim rule’s enforcement, which the district court denied. Florida has appealed the district court’s order denying its motion for a preliminary injunction. This case was presented to us on Flor- ida’s Time-Sensitive Motion for Injunction Pending Appeal. After USCA11 Case: 21-14098 Date Filed: 12/06/2021 Page: 3 of 94 21-14098 Opinion of the Court 3 careful review, we denied the motion yesterday. Because of the time constraints involved, though we denied the motion yesterday, the attached opinion explains the reasons for our ruling as of the time that we denied the motion yesterday. FACTUAL BACKGROUND A. In Response to the Ongoing COVID-19 Public Health Crisis, the Secretary Issued the Interim Rule Mandating Vaccines for Healthcare Workers at Medicare and Medi- caid Facilities. The United States is currently facing a public health emer- gency as the result of a novel corona virus, which causes the disease COVID-19. See 86 Fed. Reg. at 65,519. In the United States, more than 44 million individuals have been infected with COVID-19 and over 720,000 have died. See id. COVID-19 is the “deadliest disease in American history.” Id. The Secretary recently took steps in administering the Med- icare and Medicaid programs to protect Americans from the risks associated with COVID-19. Tens of millions of Americans receive health care through these federally funded programs. See Azar v. Allina Health Servs., 139 S. Ct. 1804, 1808 (2019). Medicare, which is funded entirely by the federal government, covers individuals who are over age 65 or who have specified disabilities. See id. Med- icaid, which is funded …
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