Document ID: ./input/supremecourt_opinions/opinions/21pdf/21a240_d18e.pdf
Page Number: 17

Cite as:  595 U. S. ____ (2022) 

7 

THOMAS, J., dissenting 

(quoting §482.42), as well as a few regulations that require
“infection  and  prevention  control  programs”  at  some  (but
apparently not all) facility types.  See ante, at 3 (citing, inter 
alia, §482.42).  But many of these infection-control regula-
tions,  like  the  infection-control  program  set  out  at  42
U. S. C.  §1395i–3(d)(3),  are  far  afield  from  immunization.
See, e.g., 42 CFR §§485.725(b)–(e) (specifying requirements
for “aseptic techniques,” “housekeeping services,” “[l]inens,” 
and “[p]est control”).  And insofar as they do touch on im-
munization, they require only that facilities offer their res-
idents the opportunity to obtain a vaccine, along with “the 
opportunity to refuse” it.  §483.80(d)(1).  These regulations
are not precedents for CMS’ newfound authority mandating 
that all employees be vaccinated. 

Finally, our precedents confirm that the Government has
failed to make a strong showing on the merits.  “We expect
Congress  to  speak  clearly  when  authorizing  an  agency  to
exercise powers of vast economic and political significance.” 
Alabama Assn. of Realtors v. Department of Health and Hu-
man Servs., 594 U. S. ___, ___ (2021) (per curiam) (slip op., 
at  6)  (internal  quotation  marks  omitted).    And  we  expect
Congress to use “exceedingly clear language if it wishes to 
significantly  alter  the  balance  between  state  and  federal
power.”  Ibid. (internal quotation marks omitted).  The om-
nibus rule is undoubtedly significant—it requires millions 
of healthcare workers to choose between losing their liveli-
hoods  and  acquiescing  to  a  vaccine  they  have  rejected  for 
months.  Vaccine  mandates  also  fall  squarely  within  a
State’s police power, see Zucht v. King, 260 U. S. 174, 176 
(1922), and, until now, only rarely have been a tool of the 
Federal  Government.  If  Congress  had  wanted  to  grant
CMS  authority  to  impose  a  nationwide  vaccine  mandate,
and consequently alter the state-federal balance, it would 
have said so clearly.  It did not.