President Joe Biden soon will require millions of workers to get vaccinated against COVID-19 or be tested weekly. But before Biden's announcement earlier this month, 18 states and the District of Columbia already had told public sector workers to get their jabs or risk losing their jobs, and 21 states plus the District of Columbia had such mandates for health care workers.
Many of those state mandates will take effect in the coming weeks, offering a glimpse of the effects Biden's plan could have on the workforce once the final federal rule is in place.
Like the federal plan, most of those state requirements will allow for weekly testing as an alternative to vaccination.
The U.S. Food and Drug Administration spent months weighing full approval of the vaccines. During that time, officials in several states negotiated with unions and considered whether a mandate would chase a large number of employees out of the state workforce.
"Overall, the states that have mandated vaccines have said, 'We really need to do this, and we don't think we'll have a huge loss in our workforce,'" said Hemi Tewarson, executive director of the National Academy for State Health Policy, a nonpartisan forum of state policymakers.
"We need to start understanding where (workers) are going to dig in and decide they'd rather lose employment than get vaccinated," she said. "What sort of expertise are you losing, and does it shut down a ferry system or a public program? I do think there are concerns about what's going to happen to some parts of the workforce."
Even states with strict vaccine mandates have offered medical exemptions, and most allow for religious exemptions as well. But experts say many states' guidelines for granting such exemptions are often unclear, and even in cases where they are allowed, employees may still lose their jobs if they can't be accommodated safely.
Biden's plan, which applies to businesses with more than 100 workers, would mostly bring the entire country in line with the agencies and industries already covered by state mandates. But in the handful of states without a testing alternative to vaccination, workers who are still hesitant about COVID-19 vaccines face a stark choice.
In Colorado, Nevada, Oregon and Washington, some or all state employees fall under vaccine rules that do not include a testing alternative. Health care workers and teachers face similar requirements in several other states, health systems and school districts.
Meanwhile, lawmakers in Montana passed a law earlier this year banning public agencies and private employers from mandating vaccination. They claim the new law nullifies the federal mandate.