Keith Mack
Missouri's public health laws have been a topic of discussion and debate in recent years, with court rulings and legislative actions shaping the state's ability to enforce them. The state has laws in place to address public health concerns, including those related to contagious diseases and paid sick leave. However, there have been legal challenges to the authority of public health officials and the validity of certain regulations. A notable example is the 2021 ruling by a Missouri judge, who blocked state and local health agencies from issuing pandemic-related public health orders, citing concerns about the potential for abuse of power. Additionally, Missouri's legislature has considered bills that could impact public health, such as Proposition A, which includes provisions for paid sick time and an increase in the minimum wage. The state's Health Care Freedom Act also plays a role in shaping public health enforcement by prohibiting the implementation of a health insurance exchange and restricting certain insurer practices.
| Characteristics | Values |
|---|---|
| Can the state enforce public health laws? | Yes, but not during a pandemic. |
| Can the state implement a health insurance exchange? | No. |
| Can insurers accept remuneration? | No. |
| Can the state enforce contract provisions that prevent the disclosure of payment amounts for healthcare? | No. |
| Can the state enforce the use of paper money to buy execution drugs? | No. |
| Can the state enforce COVID-19 restrictions and mandates? | No. |
| Can the state enforce the minimum wage law? | Yes, but it is currently being challenged in court. |
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What You'll Learn
Missouri's public health orders for contagious diseases
According to Missouri Laws 67.265, orders issued during an emergency that directly or indirectly close or restrict access to business organizations, schools, churches, or other places of public or private gathering shall not remain in effect for longer than thirty calendar days in a 180-day period. These orders can only be extended beyond thirty days with a simple majority vote of the political subdivision's governing body. Additionally, the governing bodies issuing these orders have the authority to terminate them at any time with a simple majority vote.
In November 2021, a Missouri judge ruled that local health departments cannot issue orders, close businesses, or quarantine students. Cole County Circuit Judge Daniel Green stated that the Director of the Department of Health and Senior Services (DHSS) or a local health agency director cannot implement discretionary "control measures," including the "creation and enforcement of orders." This ruling was in response to a lawsuit filed by several parties, including Shannon Robinson and the Missouri Restaurant Association, who argued against the closure of schools and businesses based solely on the opinion of an unelected official.
To prevent the spread of contagious diseases, Missouri's local health authorities and department directors are responsible for notifying potentially exposed individuals and the public when a case or outbreak poses a serious health risk. This notification should include necessary information for recipients to respond appropriately to potential exposure. Additionally, local health authorities may establish control measures such as isolation, quarantine, disinfection, immunization, and closure of establishments.
Missouri's public health efforts have faced challenges due to federal funding cuts and staff reductions. The Missouri Department of Health and Senior Services lost significant funding for public health departments and pandemic preparedness. These cuts have impacted community health workers, communicable disease response divisions, and state and county laboratories, hindering their ability to protect public health.
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Missouri's Health Care Freedom Act
In Missouri, public health orders are issued in response to an actual or perceived threat to public health, with the aim of preventing the spread of contagious diseases. These orders can close or place restrictions on access to businesses, schools, and other places of assembly. However, in November 2021, a judge ruled that local health departments could not enforce such orders, close businesses, or quarantine students. The ruling stated that the Missouri Code of State Regulations violated the state constitution, and that public health officials had used the regulations to "exercise unbridled and unfettered personal authority to, in effect, legislate".
The ruling by Cole County Circuit Judge Daniel Green stated that the Director of the Department of Health and Senior Services (DHSS) could not implement discretionary "control measures", including the "'creation and enforcement of orders' affecting individuals, schools, businesses, and other entities. Judge Green also ordered the DHSS to instruct local health officials to refrain from issuing verbal or written orders regarding circumstances where children could be excluded from school.
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Missouri's public health orders during the pandemic
Missouri's response to the COVID-19 pandemic has been largely decentralized, with Governor Mike Parson taking a hands-off approach to public health guidance. While he issued a social distancing order and limited gatherings and business capacities, he stopped short of mandating masks, leaving it to individual communities to adopt their own policies. This order expired in June 2020.
During the pandemic, local health departments in Missouri had the authority to issue restrictive public health orders. However, this changed in June 2021 when Governor Parson signed House Bill 271, restricting local public health orders and banning vaccine passports. This bill was a response to local masking ordinances and business restrictions during the COVID-19 pandemic. Under this new law, health orders issued during a state of emergency are limited to 30 days within a 180-day period, and orders issued outside of an emergency are limited to 21 days within a 180-day period. Local governments, such as city councils, have the power to extend or end these health orders with a majority vote.
In November 2021, a Missouri judge, Cole County Circuit Judge Daniel Green, blocked pandemic public health orders from state and local agencies. Judge Green ruled that the Director of the Department of Health and Senior Services (DHSS) or director of a local health agency cannot implement discretionary "control measures," including the "creation and enforcement of orders" affecting individuals, schools, organizations, businesses, and other entities. He stated that closing schools and places of public assembly based solely on the opinion of an official was not valid. Judge Green's ruling stated that local health departments cannot issue orders, close businesses, or quarantine students, as it violated the state constitution.
This ruling was in response to a lawsuit filed by Shannon Robinson, B&R STL, and Church of the Word, who argued that DHSS policies should not be able to "abolish representative government in the creation of public health laws" and that unelected officials should not have the power to close schools or assemblies based on their personal opinions. The ruling ordered the DHSS to instruct local health officials to refrain from issuing orders regarding circumstances where children can be excluded from school and nullified all discretionary orders that closed businesses based on the opinion of an agency official.
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Missouri's public health bureaucracy
In addition to the legal challenges, Missouri's public health bureaucracy has been navigating other complexities. The Missouri General Assembly has been considering bills that would impact paid sick time benefits provided under Proposition A, including a potential full repeal of the earned paid sick time part of the statute. Proposition A, passed by Missouri voters in 2024, includes provisions for a minimum wage increase and the requirement for employers to provide earned paid sick time starting in 2025. The Supreme Court of Missouri heard legal challenges to Proposition A, and its decision could invalidate or alter parts of the law.
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Missouri's Proposition A
In November, Missouri voters elected to support Proposition A, a ballot measure that will increase Missouri's minimum wage to $15 an hour by 2026. The proposition also requires private employers to provide "earned paid sick leave to eligible employees." This means that employees can take sick leave if they or a family member have a physical or mental illness, require medical care, or if their workplace or their child's school has been closed due to a public health emergency.
Proposition A creates a private right of action for violations of its "earned paid sick time" benefits. Willful failure to comply is a class C misdemeanour, and each day of violation constitutes a separate offence. The proposition also prohibits retaliation or discrimination against employees who use their earned sick time.
However, some Missouri lawmakers are considering repealing the paid sick leave provisions of Proposition A. They argue that the proposition imposes additional liability on businesses and that legislators should be able to make things better for Missouri's small businesses.
In addition, a Missouri judge blocked pandemic public health orders from state and local agencies, ruling that local health departments could not issue orders, close businesses, or quarantine students. The ruling stated that parts of Missouri's Code of State Regulations pertaining to the Department of Health and Senior Services (DHSS) violated the state constitution.
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Frequently asked questions
Yes, the state can enforce public health laws in Missouri. However, in November 2021, a judge blocked pandemic public health orders from state and local agencies, ruling that local health departments could not issue orders, close businesses, or quarantine students.
The judge ruled that parts of Missouri's Code of State Regulations pertaining to the Department of Health and Senior Services (DHSS) violated the state constitution. The ruling stated that the DHSS policies should not be able to "abolish representative government in the creation of public health laws" and that only elected officials could order the closure of schools and assemblies.
The ruling ordered the Missouri Secretary of State to remove the invalidated DHSS state regulations from the state register. It also directed the DHSS to instruct local health officials to refrain from issuing verbal or written orders regarding circumstances where children can be excluded from school. All discretionary orders or rules that closed businesses based on the opinion or discretion of an agency official were nullified.
Missouri has several public health laws, including the Missouri Health Care Freedom Act, which prohibits the state from implementing a health insurance exchange and insurers from accepting remuneration. Other laws address inspections of lodging establishments, requirements for mammography facilities, and modifications to the Hospital Liens Law.
