HR-1381-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Erin Houchin (R-IN)
What it does
The bill would prohibit any funds authorized or appropriated by federal law, including trust fund money and funds under Medicare (title XVIII), Medicaid (title XIX), and CHIP (title XXI), from being made available to a facility that refuses to provide treatment to an individual based on that person's COVID-19 vaccination status. It applies "notwithstanding any other provision of law." The text does not define "facility" or "treatment," set an enforcement process, or state an effective date.
Who benefits
Unvaccinated patients, and patients with no record of COVID-19 vaccination, who might otherwise be refused care or transplants by a facility. Patients who object to vaccination for medical, personal, or religious reasons. Clinicians and advocates who want a uniform federal rule on vaccination-status screening in care decisions.
Who is hurt
Hospitals, transplant centers, nursing homes, and other facilities that use vaccination status in care decisions and could lose Medicare, Medicaid, CHIP, or other federal funding. Immunocompromised patients and others who might face added infection risk if facilities cannot consider vaccination status. Facilities and regulators that would have to work out undefined terms like "facility" and "treatment" and handle compliance and enforcement, with no process specified in the text.
Supporters argue
Supporters argue that medical care should not be withheld based on vaccination status, pointing to reported cases where patients were denied or delayed for organ transplants and other treatments for being unvaccinated. They contend that facilities receiving taxpayer money through Medicare and Medicaid should serve all patients on equal terms, and that tying federal funds to that condition is a well-established way for Congress to set conditions on its spending.
Opponents argue
Opponents argue that clinicians need to weigh infection risk, including vaccination status, when treating immunocompromised patients and when allocating scarce resources like organs, and that a funding bar overrides medical judgment. They contend the bill's undefined terms and sweeping "notwithstanding any other provision of law" language could put facilities' entire federal funding at risk, threatening care for the Medicare and Medicaid patients who depend on them.
Constitutional context
Congress may attach conditions to federal funds under the Spending Clause (Art. I, §8, cl. 1), and South Dakota v. Dole (1987) allows conditions that are unambiguous and related to the federal interest. NFIB v. Sebelius (2012) limits conditions that are so coercive that the recipients have no real choice, a question that could arise given how much of a facility's revenue comes from Medicare and Medicaid.
Checks and balances
Congress would set a funding condition that the executive branch (likely HHS and CMS) would have to interpret and enforce, with no enforcement process stated; courts would review any challenges to the condition or its application.