Document ID: ./input/supremecourt_opinions/opinions/21pdf/21a240_d18e.pdf
Page Number: 14

4 

BIDEN v. MISSOURI 

THOMAS, J., dissenting 

regulations  applicable  to  “all-inclusive  care”  programs  for 
the  elderly,  see  §§1395eee(f )(4),  1396u–4(f )(4),  and  a  re-
quirement that long-term nursing facilities “establish and
maintain an infection control program designed to provide
a  safe,  sanitary,  and  comfortable environment  . . .  to  help
prevent  the  development  and  transmission  of  disease,” 
§1395i–3(d)(3).

The Government has not made a strong showing that this
hodgepodge  of  provisions  authorizes  a  nationwide  vaccine
mandate.  We presume that Congress does not hide “funda-
mental details of a regulatory scheme in vague or ancillary 
provisions.”  Whitman  v.  American  Trucking  Assns.,  Inc., 
531 U. S. 457, 468 (2001).  Yet here, the Government pro-
poses  to  find  virtually  unlimited  vaccination  power,  over
millions of healthcare workers, in definitional provisions, a 
saving  clause, and a provision  regarding long-term  care 
facilities’ sanitation procedures.  The Government has not 
explained  why  Congress  would  have  used  these  ancillary 
provisions  to  house  what  can  only  be  characterized  as  a
“fundamental  detail”  of  the  statutory  scheme.  Had  Con-
gress wanted to grant CMS power to impose a vaccine man-
date across all facility types, it would have done what it has
done elsewhere—specifically authorize one.  See 22 U. S. C. 
§2504(e) (authorizing mandate for “such immunization . . . 
as necessary and appropriate” for Peace Corps volunteers). 
Nonetheless, even if I were to accept that Congress could
have  hidden  vaccine-mandate  power  in  statutory  defini-
tions, the language in these “health and safety” provisions 
does not suggest that Congress did so.  Take, for example,
42  U. S. C.  §1395x(e),  which  defines  “hospital”  for  certain 
purposes.  Three subsections define hospitals as providers 
of  specific  patient  services,  see  §§1395x(e)(1),  (4),  (5),  and 
five  describe  administrative  requirements  that  a  facility 
must  meet  to  qualify  as  a  covered  hospital,  see 
§§1395x(e)(2)–(3),  (6)–(8).    The  final  subsection  then  pro-