Which is harder, a rock or a hard place? Situated squarely between the two of them, University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson decided to take his chances with the hard place.

The hard place is a new Arkansas law passed earlier this year that requires state-run health-care facilities to seek legislative approval to institute COVID-19 vaccine mandates.

But even in the Diamond State, the federal government is a harder rock. It is requiring all health-care facilities receiving Medicare or Medicaid reimbursements to mandate their employees to take the vaccine.

It’s a well-established legal principle that federal law trumps state law. And as much as UAMS needs to stay on the Legislature’s good side, it needs the $600 million it receives annually from Medicare and Medicaid even more. That’s almost 60 percent of UAMS’s total funding to operate its hospital system and medical schools.

That being the case, Patterson announced Monday that employees must be fully vaccinated by Jan. 4, as per the federal Centers for Medicare and Medicaid Services’ requirement. They must get their first dose by Dec. 5. Those seeking a religious or medical exemption must submit the paperwork by Nov. 23. About 80 percent of the staff already is fully vaccinated, UAMS spokesperson Leslie Taylor told the Arkansas Democrat-Gazette.

To be sure, Patterson is a believer in the vaccines. On Nov. 10, he tweeted that the hospital during the pandemic had admitted 2,937 patients with COVID-19 complications, 187 of whom had died. Meanwhile, the hospital had admitted no patients and had no deaths due to vaccine complications.

But we’ve had the vaccines for almost a year, and Patterson has been encouraging their use for a long time. The mandate came this week with the federal rule looming and the conflicting state law still sitting there.

Arkansas is part of a 10-state coalition suing the federal government challenging the mandate, and other states have instituted other suits. But Taylor said the hospital can’t know what will happen with the courts and, with those deadlines, doesn’t have time to wait and see.

The federal mandate on health-care providers comes at an uncertain time in the pandemic. The numbers have fallen to the point that many Arkansans have pretty much resumed normal life. But we’ve been down this road before. The numbers spike, Arkansans become more cautious, vaccinations increase, the infections fall for varied reasons and life becomes more normal. Then the numbers rise again.

The cycle eventually will end. Is this the time? We don’t know. We do know that winter is coming, and cases have been rising in cold-weather states. Minnesota’s rate is almost three times the national average.

UAMS’s mandate might be easier to enact in one of those places. But Arkansas is split in half over the vaccines. The state has just over 3 million people, and 1,421,492 are listed by the Department of Health as being fully immunized. Counting only Arkansans ages 12 and up, which were all that were eligible until recently, we’re right at 50 percent fully immunized, with another 10.7 percent partially so. Uptake has been slow among the 5-11 age group since it became eligible Oct. 29.

On the other hand, we’re probably missing some people. According to the Department of Health, only 14 percent of the population of Miller County – Texarkana – has been fully immunized. Surely some of those folks are going across the state line and not getting counted. The same must be happening in Crittenden County near Memphis.

About 84,270 more Arkansans will have to be fully vaccinated for the state officially to hit 50 percent. If and when that happens will depend largely on two factors. One is whether infections spike and more people choose to be vaccinated. The other is the number of Arkansans covered by a mandate that doesn’t really give them that choice, if they want to maintain their current employment.

At the moment, UAMS will be adding to that second group, even as it tries to navigate its way through hard places and rocks.

Steve Brawner is a syndicated columnist published in 16 outlets in Arkansas. Email him at brawnersteve@mac.com. Follow him on Twitter at @stevebrawner.

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