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Some Iowa employers say they're stuck between federal mandates and a new state vaccine waiver law

kevin kincaid, CEO of knoxville hospital
Katarina Sostaric
Knoxville Hospital and Clinics CEO Kevin Kincaid says he needs more information from state and federal officials to comply with vaccine rules.

Knoxville Hospital and Clinics CEO Kevin Kincaid said he starts each day by trying to keep up with the latest developments around vaccine requirements. But he still doesn’t know what to tell his staff members who haven’t gotten the COVID-19 vaccine.

“If they’re in a situation where they’re thinking about, ‘I need to leave a career that I had a personal calling for from when I was a child,’ Dec. 5 is coming right up,” Kincaid said. “And I would really like to be able to give them some clarity for the decisions that they’ll need to make.”

Workers across the country are facing a Jan. 4 deadline to be fully vaccinated against COVID-19 or, in some cases, get tested weekly. But a new law in Iowa expands their ability to refuse the vaccine and keep their job or get unemployment benefits. With just a few weeks to go before unvaccinated Iowans might have to get their first shot, some employers in the state say they’re caught between state and federal rules.

The new Iowa law directs employers to waive vaccine requirements for any workers who say they believe the vaccine would hurt their health or wellbeing or that of someone they live with, or if they say it would conflict with their religion. And they don’t need to provide any proof.

Kincaid said he has a handful of employees who intend to submit these statements, but he doesn’t know if that will satisfy the federal mandate for health care workers to be vaccinated.

“So that’s where the uncertainty comes in, is at the end of the day, will that protect their jobs?” Kincaid asked. “Or will that not?”

Republican state leaders said the new law is already protecting the jobs of Iowans who don’t want to get vaccinated, and that it pushes back on what they see as federal overreach.

A lot of employers aren’t so sure. The Iowa Association of Business and Industry has said the vaccine waiver law is just an additional mandate that could make it especially difficult for Iowa companies to comply with the federal rules.

“Employers are in this rock and a hard place between the federal government and the state government kind of showdown,” said Denise Hill, an attorney and Drake University professor who wrote a book about workplace vaccine mandates. “And so it’s really a bad place to be for everyone.”

She said the courts will ultimately determine how the federal and state rules interact with each other.

The Biden administration has issued three mandates. Companies with at least 100 employees have to require vaccination or weekly testing. Federal contractors and health care facilities have to require vaccination without a testing option.

“To my knowledge, there’s nothing that tells an employer that they cannot take exemptions, [that] they cannot follow the Iowa law,” said Rep. Henry Stone, R-Forest City, who managed the bill’s passage in the Iowa House of Representatives. “It shouldn’t put them between a rock and a hard place.”

Stone said he has been hearing from business leaders who say the Iowa law is working.

But Hill said the Iowa law has much broader language than the typical employer-based vaccine mandate exemptions aimed at accommodating disabilities and sincerely-held religious beliefs.

“It really takes away the discretion from the employer,” Hill said. “It says that they shall waive this. It doesn’t say that they shall enter into an interactive accommodation discussion to see if they can waive them. And so that’s really problematic. It does, I believe, conflict with what the federal requirements are.”

Hill said if the federal government doesn’t accept Iowa’s waivers, employers could face fines or lose their ability to do business with the government. If companies fire unvaccinated employees to follow the federal rules, they could be on the hook for paying for those workers’ unemployment benefits under the new Iowa law.

Iowa Gov. Kim Reynolds has joined three multi-state lawsuits challenging each of the federal vaccine mandates. The requirement for companies with at least 100 employeesis being blocked by a court, but it’s not clear what will happen with that or the other two mandates.

“Don’t assume the stay is going to stay in place,” Hill said. “You need to get your ducks in a row to come into compliance.”

She said advisors and legal teams will have to help employers on a case-by-case basis.

Hill said Iowa took a unique approach with this new law, and other states may be watching to see how it works out for Iowa.

“Does it do what’s intended both in terms of allowing people to work around vaccine mandates of employers as well as kind of respond to what they think is an overreach by the federal government? And that, of course, will remain to be seen,” Hill said.

If the Iowa law does end up allowing a lot of people to avoid vaccine mandates, it could hurt efforts to end the coronavirus pandemic.

“If we don’t have people actually get vaccinated, we’re going to continue to have these pockets of people who aren’t protected,” said Dr. Christy Petersen, the director of the Center for Emerging Infectious Diseases at the University of Iowa. “Even if they have gotten sick…the evidence is that they don’t stay protected for very long. And we will just continue to go through cycles of illness and death within these groups.”

Petersen said workplace vaccine mandates have been effective. More than 95 percent of people complied at companies like Tyson Foods and United Airlines.

Information from past vaccine campaigns shows that making it easier to get out of a mandate drives down vaccination rates, according to Petersen. She said exemptions for childhood vaccines have required getting a signature or showing some kind of proof.

“It turns out that that one extra step does make it so that people are less likely to try to use the exemption,” Petersen said. “So any small hurdle does lead to more people getting vaccinated and providing greater protection across the state.”

She said lawmakers should be pushing for more people to get vaccinated because the science is showing that’s what will help protect Iowans.

Knoxville Hospital CEO Kevin Kincaid said in the end, he has to follow the federal vaccine mandate. He said it’s the only option for continuing to serve patients who are veterans or are insured through Medicare and Medicaid, and these federal programs make up more than half the rural hospital’s revenue.

The workforce shortage makes this even more complicated. Kincaid said the hospital desperately needs to keep its staff.

“This could be the most confusing time as it relates to communicating with the workforce that I’ve ever, ever experienced,” Kincaid said. “Not comfortable, I guess, is a good way to put it.”

Kincaid said he is hoping for more clarity from the state and federal government soon.

Katarina Sostaric is IPR's State Government Reporter