The Supreme Court blocked the Biden administration from enforcing its emergency rule mandating that workers at large businesses get vaccinated or undergo regular testing for COVID-19, a major setback for the president’s national vaccination effort.

However, the court decided to allow the administration to proceed with a vaccine mandate for health care workers at federally funded facilities.

The justices’ decision to intervene and halt one of the vaccine regulations has major public health implications amid a surge in coronavirus cases due to the omicron variant. The White House hoped the rule, issued through the Occupational Safety and Health Administration, would protect workers against COVID-19 transmission and encourage holdouts to get vaccinated.

The OSHA regulation requires that employers with at least 100 workers implement programs in which those workers show proof of vaccination or provide a negative COVID-19 test each week. The administration estimates it would cover 84 million workers, mostly in the private sector.

Enforcement of the testing provision was slated to begin on Feb. 9.

Business groups and state GOP officials filed lawsuits aimed at blocking the rule, arguing that it went beyond OSHA’s legal power and would hurt the economy by prompting workers to quit their jobs. Lower courts disagreed on whether the rule was within OSHA’s authority.

The Supreme Court held a special session to hear oral arguments on the matter on Jan. 7, expediting the case as enforcement of the rule was about to begin. While the court’s three liberal justices seemed loath to undermine a public health regulation as COVID-19 cases were soaring, most of the conservative justices voiced skepticism of the rule, suggesting it should necessitate an act of Congress.

Associate Justice Samuel Alito poses during a group photo of the justices at the Supreme Court in Washington on April 23, 2021. (Photo: POOL New via Reuters)

Justice Samuel Alito wondered whether OSHA was trying to legally “squeeze an elephant through a mouse hole” by issuing the rule. Chief Justice John Roberts asked “why Congress doesn’t have a say in this.”

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The Biden administration has argued that OSHA has the authority to issue the vaccine-or-test rule under its emergency powers, and that a crisis like the COVID-19 pandemic necessitates such a sweeping regulation.

Unlike her conservative colleagues, Justice Elena Kagan was reluctant to substitute the court’s judgment for that of the occupational health experts at OSHA.

“Why in the world would courts decide this question?” Kagan asked during oral arguments.

In a separate ruling, the justices allowed a different vaccine rule issued by the Biden administration to go into effect. That regulation, issued through the Centers for Medicare and Medicaid Services, would require that health care facilities that receive Medicare or Medicaid funding make sure all their employees are vaccinated against COVID-19.

The court heard oral arguments for the health care rule on the same day as the OSHA rule. The health care rule would cover an estimated 17 million workers at hospitals, long-term care facilities and dialysis centers. Unlike the OSHA rule, it does not provide an option to test regularly in lieu of vaccination.

This article originally appeared on HuffPost and has been updated.

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