Legislative Update 11/1/2021: OSHA, Build Back Better Act, and Vaccine Mandates

US capitol

This is the legislative update for November 1, 2021. View all updates here.

The November 1, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

COVID-19 Vaccines For Children Ages 5 To 11

A Centers for Disease Control and Prevention (CDC) advisory committee is preparing to consider expanding COVID-19 vaccine eligibility to children ages 5 to 11.

At the same time, the American Hospital Association (AHA), American Academy of Pediatrics (AAP), and Children’s Hospital Association (CHA) are planning a webcast panel discussion about the vaccine for November 8 at 2 p.m. EST.

Panelists will discuss strategies to protect children and keep them in school, as well as how hospitals can partner with local schools, school boards, PTAs, and teachers to build vaccine confidence.

Panelists will include:

  • Yvonne Maldonado, MD | Chief of Pediatric Infectious Diseases at Stanford University School of Medicine
  • Lee Savio Beers, MD | AAP President, Professor Of Pediatrics, Medical Director for Community Health and Advocacy at Children’s National Hospital
  • Elise Herman, MD | Pediatrician at Kittitas Valley Healthcare-Ellensburg
  • Andrew Pavia, MD | Chief of Pediatric Infectious Diseases at Intermountain Primary Children’s Hospital

Register for the webinar here.

In The White House

This week, we can expect to see a new federal rule from the Occupational Safety and Health Administration (OSHA) outlining how large employers will meet the requirement that workers be vaccinated or tested regularly for the COVID-19 virus.

According to the White House, the federal government will require companies with at least 100 workers to provide:

  • Paid time off for employees to get vaccinated against COVID-19
  • Paid sick leave to recover from the effects of the shots

Separately, the administration will give federal contractors broad authority on how to treat employees who refuse to be vaccinated.

Under an executive order issued by President Joe Biden in September, contractors have until December 8 to ensure that employees are fully vaccinated.

The Build Back Better Act

Last Thursday, President Biden released his revised framework for the Build Back Better Act (H.R. 5376), paring the omnibus spending package down from $3.5 trillion to $1.75 trillion.

The scaled-back legislation continues to include numerous health care provisions, including:

  • Expanded health care coverage by permanently funding the Children’s Health Insurance Program (CHIP)
  • A focus on prevention and reliable coverage with 12-month continuous coverage for all children and new mothers under Medicaid
  • Expanded eligibility for coverage through the Health Insurance Marketplaces for those under 138% federal poverty level — including individuals not previously eligible for Medicaid because their state failed to expand
  • Funding for medical school scholarships and residencies
    • Increased funding for graduate medical education at teaching health centers and children’s and veterans hospitals
  • Taking steps to improve maternal health by:
    • Expanding access to behavioral health services
    • Addressing drivers of mortality, inequities, and disparities
    • Imposing civil monetary penalties for violating parity laws
  • Taking steps to improve the public health infrastructure, including:
    • Shoring up the supply chain
    • Providing additional funding to federal agencies for emergency response

The legislation does not include hospital infrastructure funding under the Hill-Burton program that was in the earlier version of the bill.

Additionally, the Paid Family Leave initiatives baked into previous reconciliation packages have caused significant delays — even within party lines. Other issues include finalizing how the bill will be paid for and whether prescription drug negotiations will be added.

Needless to say, the 1,684-page bill will likely go through additional changes but could be voted on in the House as early as this week.

State Updates

Budgets And The New Year

Interim studies continue in the Legislature as the 49 state senators prepare for a short 60-day legislative session, beginning the first Wednesday in January 2022.

This coming session is not a budget-setting year, but with $520 million of American Rescue Plan Act (ARPA) funds, the Appropriations Committee will suggest otherwise.

Additionally, the Nebraska Economic Forecasting Advisory Board met Friday and made significant updates to the state’s revenue forecast, including increasing projections for this fiscal year (FY) 21-22 to $5.355 billion — an additional $475 million.

The board increased the FY22-23 forecast by $428 million.

While most of the funds will automatically be dumped into the property tax relief fund, some will roll over to the General Fund, offering more relief opportunities for entities seeking ARPA fund support.

Pushback On Vaccine Mandates

Senators have a hard deadline of Monday, November 1 to find 33 signatures to initiate a special legislative session. This special session would attempt to pass legislation to opt-out of President Biden’s vaccine mandate for employers with 100 employees or more.

Up to 28 signatures have been attained, but they will ultimately fail — as expected — to initiate a special session.

Last week, Iowa’s Governor Kim Reynolds signed similar legislation into law requiring employers to pay unemployment insurance if an employee quits because of a vaccine mandate. We will continue to monitor activity on existing legislative bills such as this that would remove or impact any mandate on the COVID-19 vaccine.

Understanding The Governor’s Executive Order About Vaccine Mandates

Governor Pete Ricketts released another Executive Order (EO) on Friday that bars state agencies from enforcing coronavirus vaccine mandates on state teammates.

Children’s sought to further analyze the language to clarify whether it also aims to prohibit the State from working with entities that impose vaccine mandates:

“No Cabinet executive branch agency shall be a party in any agreement, any contract, any contract amendment, contract renewal, contract addendum, contract modification, grant agreement, lease agreement, memorandum of understanding or agreement that includes any requirement imposing a duty, obligation, or mandate on any person to receive a COVID-19 vaccination.”

We received clarification from the Governor’s Chief of Staff Matt Miltenberger that the EO applies to contracts that would require any State teammates to be vaccinated. It does not prevent the other contracting party from requiring vaccines of their employees.

Child Care Provider Support Grants

Nebraska Department of Health and Human Services (DHHS) officials have set aside $140 million of DHHS American Rescue Plan Act (ARPA) funding to establish grants to support child care providers across the state.

The Child Care Stabilization program was established to ease financial burdens faced by child care providers as a result of the public health emergency and the instability of the child care market as a whole. It has a special focus on supporting providers in underserved and lower-income areas of the state.

The money can be used for a variety of purposes, including:

  • Personnel costs
  • Rent or mortgage payments
  • Buying equipment and supplies
  • Mental health support for children and employees,
  • Co-payment and tuition relief for struggling families
  • Paying for past financial losses incurred between March 13, 2020, and March 11 this year

Grants will be awarded based on a funding formula.

(Sources: CHA, AHA, Congress.gov, Nebraska Legislature, World-Herald, Peetz & Co.)


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