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The U.S. Supreme Court declined to block a vaccine mandate for health workers in the state of Maine on Tuesday, sending a potential green light to state mandates across the country.

It was the first time the Supreme Court weighed in on a statewide vaccine mandate. It previously rejected challenges of vaccine requirements for New York City teachers and Indiana University staff and students.

Justice Stephen Breyer rejected the emergency appeal but left the door open to try again as the clock ticks on Maine’s mandate. The state will begin enforcing it Oct. 29.

The Maine vaccine requirement that was put in place by Democratic Gov. Janet Mills requires hospital and nursing home workers to get vaccinated or risk losing their jobs.

Opponents tried to block the mandate, but a federal judge rejected the request Oct. 13. The judge said the record indicated regular testing alone wasn’t sufficient to stop the spread of the delta variant.

That decision set off a flurry of emergency appeals to the 1st U.S. Circuit Court of Appeals and then the U.S. Supreme Court.

A three-judge panel of the appeals court in Boston quickly dismissed the emergency appeal but fast-tracked additional arguments. That timetable provides enough time for another ruling before enforcement of the vaccine mandate begins at the end of next week.

Mat Staver, founder and chair of the Liberty Counsel, which challenged the vaccine mandate, said the Supreme Court is ready to consider the case “if we do not get relief” from the appeals court in the coming days.

The Maine attorney general’s office declined to comment.

The Liberty Counsel, which filed the lawsuit in federal court in Maine in August, claimed to be representing more than 2,000 health care workers who don’t want to be forced to be vaccinated.

Dozens of health care workers have opted to quit, and Central Maine Medical Center in Lewiston already curtailed some admissions because of an “acute shortage” of nurses. But most health workers have complied.

State agencies vowed to work with hospitals and nursing homes individually to address issues.

Joe Biden imposed a federal vaccine mandate in September requiring all companies with more than 100 employees to ensure their workers are either vaccinated or take a weekly COVID-19 test. The mandate would affect roughly 100 million Americans, and many groups plan to challenge the policy as soon as it goes into effect.

“We’re going to protect vaccinated workers from unvaccinated co-workers,” Biden said when introducing the mandate. “We’ll reduce the spread of COVID-19 by increasing the share of the workforce that’s vaccinated in business all across America.”

Republican South Dakota Gov. Kristi Noem vowed to sue the federal government the day Biden announced the policy, and the state of Arizona has already filed a lawsuit as well. Days later, 24 state attorneys general signed a public letter vowing to take legal action if Biden’s mandate takes effect.

“Your plan is disastrous and counterproductive,” the group wrote in the letter. “If your Administration does not alter its course, the undersigned state Attorneys General will seek every available legal option to hold you accountable and uphold the rule of law.”

SCOTUS has yet to weigh in on Biden’s federal mandate.

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