The Occupational Safety and Health Administration (OSHA) issued an emergency regulation back in June requiring hospitals and other health care settings to enforce COVID-19 safety practices. Now, OSHA is warning three states—Arizona, South Carolina, and Utah—that if they don’t adopt those rules, the federal government will take over workplace safety enforcement.

“OSHA has worked in good faith to help these three state plans to come into compliance,” Jim Frederick, OSHA’s acting director, said on a call with reporters on Tuesday. “But their continued refusal is a failure to maintain their state plan commitment to thousands of workers in their states.”

The emergency temporary standard for health care facilities requires them to develop a plan for COVID-19 safety including personal protective equipment, health screening, social distancing, ventilation, cleaning, and more. It’s mostly very familiar stuff more than a year and a half into the pandemic. But Arizona, South Carolina, and Utah have failed to fulfill the requirements of the rule, according to OSHA.

States are allowed to do their own workplace safety enforcement as long as they meet minimum requirements. If they fail to do that, the federal government steps in.

“The bottom line is private-sector employers in state plans do not want federal OSHA coming in,” former OSHA official Debbie Berkowitz told Dave Jamieson. “In almost every state where they have a state plan, although they have the same regulations, enforcement is so much weaker.”

All three states were basically “Who, us?” about the OSHA warning that they weren’t meeting the emergency temporary standard. Arizona Gov. Doug Ducey said in a statement that Arizona officials believed the state to be in compliance, but would look into the matter. A South Carolina official said the state’s policies had “proven effective as South Carolina has consistently had one of the lowest injury and illness rates in the nation.” And Utah Gov. Spencer Cox said that his state’s plan was as good as the federal one, but also that the federal one would create too great a burden for the health care industry. 

The emergency temporary standard for health care is, in itself, important. But it’s also an early warning sign about how states will respond when OSHA releases a rule requiring all large workplaces to mandate either vaccination or weekly COVID-19 testing for all employees. If a state isn’t willing to enforce basic standards in health care settings, that’s kind of a red flag for how it will approach the broader rule.