Federal Vaccine Mandate Forces Tennessee Hospitals to Choose Between Funding and Employees

John M. Dabbs

Cpl. Danielle O'Connor and Spc. Ryan Tate (right) carry a ulta-cold box container with COVID-19 vaccinationsOklahoma National Guard/Flickr

Most large companies across Tennessee are struggling with how they will implement federal COVID-19 vaccination mandates going into effect January 4th, 2022. The mandate effectively requires employees to loose their job if they aren't vaccinated. Health and hospital systems across the state more threatened, as the majority of their revenue often comes from government based insurance programs.

Threatened funds mandates vaccination

Ballad Health in Northeast Tennessee announced they are requiring all employees to be fully vaccinated by January 4th. Those who do not obtain their first dose of vaccine by December 5th will loose their jobs, if they choose not to get vaccinated.

In a press release, Ballad Health's CEO, Alan Levine, said "I wanna be clear. These people, whether they are vaccinated or not, these people are heroes. They have worked their tails off for almost two years to take care of our region." While the mandate is unpopular, health systems like Ballad are at risk of losing millions in federal dollars from Medicare and Medicaid insurance programs. Ballad Health receives greater than 70% of its patient care insurance from government insurance programs. Leaders at Ballad Health emphasize the crucial funding received from Medicare and Medicaid cannot be jeopardized. Therefor the vaccine mandate is not an option for them.

Recently, Levine testified before Congress against the vaccine mandate. It is also why they have not mandated the vaccine to their employees before the federal government's mandate came down.

The rural climate is one where you do not just impose mandates on people. People in rural America are very independent and do not like to have their actions dictated to them. The current nursing shortage is affecting healthcare in a big way.

Levine told Congress “If you do this and you lose even 3 to 5% of your nurses, that is going to have a major effect. We already have a shortage and people feel it.”

The health system already requires other vaccines for their employees, such as the annual influenza vaccine. The COVID-19 vaccine appears to have a new stigma attached to it for a multitude of reasons, not all of which are understood.

Levine believes taking the vaccine should be a personal choice, but Ballad Health has a fiduciary responsibility to comply with the law. “We are going to continue to educate people. Even though it has now been required by the federal government, we still want to be sure we are educating people on the efficacy and the safety,” said Levine.

Knoxville area

Other leaders at East Tennessee hospitals said they expect to loose some employees as the deadline approaches, but they have no other choice. Leaders at U.T. Medical Center-Knoxville, Children's Hospital, and Covenant Health believe the vaccine is the best means to gain control of the pandemic. The change from the federal government means to comply with the mandate - or lose significant funding.

Governor Lee attempts to help

While Tennessee Governor Bill Lee signed a law limiting COVID restrictions, legal scholars beleive Federal Law will still trump State Law, and spelled out in the U.S. Consitution. State law can be more stringent than federal law, but not lesson federal law.

Hospital leaders know they don't have a choice, as their revenue streams are highly dependent on federal insurance programs. Greater than 65% of Covenant Health's patients are insured via Medicare or Medicaid/Tenncare, 61% at UTMC, and even 60% at East Tennessee Children's Hospital.

Nearly three-fourths are already vaccinated

In order to comply, most health systems will need to convert the remaining 25% (+/- 5%) of their employees who have yet to be vaccinated fully. The staffing shortages in healthcare across the country are trying enough without having to coerce employees into vaccination. None of the healthcare systems in the state want to lose staff due to the federal mandate, though they totally understand. The caring and compassionate employees are what make Tennessee a special place to be.

Just another regulation

East Tennessee Children's Hospital President, Matt Schaefer, says the mandate is just one more regulation of thousands hospitals are already required to follow under CMS (the Centers for Medicare and Medicaid Services) to qualify for payment from Medicare/Medicaid for services rendered to patients.


CMS has issued policies on the mandate, stating employees will have options other than getting vaccinated or fired. They can have religious or medical exemptions.

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An outdoor enthusiast with a passion for travel and adventure. John is a professional consultant and photojournalist.

Bristol, TN

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