In July 2017, three major hospital chains put forward two proposals to decouple hospitals from mandated vaccines. It was the first stage in a plan to simply refuse to comply with state immunization laws, and it wouldn’t be the last.
California-based Dignity Health, Ascension Health, and LifeBridge Health were reacting to a ruling by the Trump administration that said the government has the right to override state immunization laws—and make states subject to fines—for vaccines against HPV, meningitis, measles, mumps, and whooping cough.
While the lawsuits involved child vaccine exemptions are generally rare, the massive scale of this challenge is daunting. States have required parents with religious or personal objections to get exemptions from childhood vaccines, but the Trump administration scrapped the federal religious exemption in favor of a “philosophical” exemption, and these rules would create thousands of new exemptions. In 2017, around 8 million exemptions were granted.
The U.S. Centers for Disease Control and Prevention says that between 1.2 million and 1.8 million Americans each year get these exemptions, and they vary from state to state. In Pennsylvania, nearly 8 percent of kindergartners get exemptions; in Virginia, it’s about 5 percent. In Pennsylvania, the number of faith-based exemptions, though, has surged from around 25,000 in 2015 to nearly 40,000 last year. The number in Virginia has climbed from 11,000 in 2015 to nearly 15,000 in 2017.
This was supposed to be good news for the groups suing the federal government. In exchange for dropping the suit, they expected the federal government to make changes to state vaccine requirements. Instead, the Trump administration said that getting waivers is a state matter, not a federal one.
“State licensure is not mandated by federal law and patients will not be harmed by licensure of nurse practitioners and physicians assistants, who are under federal jurisdiction,” a statement from the Department of Health and Human Services said.
When LifeBridge Health sent the Trump administration the first letter of complaint, it said that the Trump administration “will see which state election laws it can ignore and sees which hospitals will comply.”
In August, the federal government gave life-sciences organization VMA, the Combined Health Care Association, and other organizations a month to file a second letter, but LifeBridge responded to the next appeal. It will be time for that second letter now, on May 10, to once again lay out the effects that the Trump administration’s actions have had on health care providers.