HEALTH CARE BRIEFING: Democrats Scramble As Manchin Rejects Plan

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President Joe Biden faces the unexpected task of quickly rewriting his policy agenda in a crucial election year after a key Senate Democrat abruptly rejected his signature $1.75 trillion economic plan.

Sen. Joe Manchin (D-W.Va.) stunned the White House and fellow Democrats yesterday by announcing his opposition to a tax-and-spending package tailored to win his support after months of courtship by Biden and other administration officials. The move effectively torpedoes Biden’s campaign promises to address climate change, health-care costs and child-care needs.

Biden and top congressional Democrats must now regroup at once on those priorities, with little more than 10 months before midterm races that will decide control of Congress. The timing could hardly be worse for an administration facing another resurgence of the pandemic and national unease over the new omicron variant of the coronavirus.

Rep. Suzan DelBene (D-Wash.), who leads the moderate New Democrat Coalition, said that “prioritizing doing a few things well for longer” from the package Manchin killed would “open a potential path forward for this legislation.” Biden’s chief of staff, Ron Klain, tweeted her statement. Read more from Josh Wingrove and Jennifer Jacobs.

For now, advocates for nursing home residents will likely need to push for long-sought mandatory staffing levels outside the bill. The House version of the Build Back Better legislation included provisions for a round-the-clock registered nurse in all facilities and a step toward new mandatory minimum staffing requirements for all nursing homes. But Senate Democrats removed the mandatory staffing provisions in a draft version released Dec. 11. Tony Pugh and Alex Ruoff have more.

Biden to Issue ‘Stark Warning’ Amid Covid Surge

Biden is set to warn the nation of the perils of remaining unvaccinated against the coronavirus in a planned speech tomorrow as the omicron variant takes hold in the U.S. and the nation experiences a surge in cases.

“We are prepared for the rising case levels, and @POTUS will detail how we will respond to this challenge,” White House Press Secretary Jen Psaki said on Twitter. “He will remind Americans that they can protect themselves from severe illness from Covid-19 by getting vaccinated and getting their booster shot when they are eligible.”

Biden’s planned speech comes amid mounting Covid-19 hospitalizations and deaths in the U.S., with outbreaks that have forced the cancellation of Broadway shows and football games. Nations worldwide are weighing new border controls and restrictions on indoor gatherings. The president will announce new steps the administration is taking to help communities in need of help, while also issuing a stark warning of what the winter will look like for the unvaccinated, according to a White House official.

Top health experts have warned of a wave of new infections coinciding with the arrival of the omicron variant, holiday travel and colder weather. In the U.S., 800,939 people have died of Covid-19, according to the Centers for Disease Control and Prevention. And the 7-day average of new U.S. cases was 122,297 as of Friday, according to CDC data, up 1.5% from the previous week. Read more from Jennifer A. Dlouhy and Jennifer Jacobs.

Biden’s warning comes as the U.S. government said it’s over-counted the number of Americans who are at least partly vaccinated against the coronavirus, state officials warn, meaning millions more people are unprotected as the pandemic’s winter surge gathers steam. Last weekend, the CDC revised a bellwether metric—the share of people 65 and older with at least one shot. It reduced the proportion from 99.9% to 95%, without changing its raw shot totals. Josh Wingrove has more.
An effective shutdown of the U.S. likely won’t be necessary as Covid-19 surges again, though hospitals will be tested by the expected rush of cases from the omicron variant, according to Biden’s top medical adviser. “I don’t foresee the kind of lockdowns that we’ve seen before but I certainly see the potential for stress on our hospital system,” Anthony Fauci, who leads the National Institute of Allergy and Infectious Diseases, said on ABC. Alan Goldstein has more.
On Friday, Biden’s White House issued some of its most sobering warnings to the unvaccinated yet, saying they face death and will raise pressure on the nation’s health system as the omicron variant spreads. “For the unvaccinated, you’re looking at a winter of severe illness and death—for yourselves, your families and the hospitals you may soon overwhelm,” Jeff Zients, Biden’s Covid-19 response coordinator, said Friday. Read more from Josh Wingrove.

More on the Pandemic

Biden Shot-or-Test Rule to Take Effect After Stay Lifted: The Biden administration’s emergency Covid-19 shot-or-test rule for large employers can go into effect now that a federal appeals court in Cincinnati lifted another tribunal’s order that had blocked the measure. A divided three-judge panel of the U.S. Court of Appeals for the Sixth Circuit granted the administration’s request on Friday to dissolve the Fifth Circuit’s Nov. 6 pause on the regulation. The harm caused by keeping the emergency temporary standard frozen outweighs any damage that would stem from letting it go into effect, the court said.

The Sixth Circuit’s ruling drew an immediate appeal to the U.S. Supreme Court filed by a conservative advocacy organization and a group of businesses. The high court’s conservative majority could decide whether this key Biden initiative to boost workplace vaccination rates takes effect before it expires in May. Biden’s administration has already asked the justices to revive a separate federal shot mandate for health-care workers that lower courts have blocked. Thus far, the nation’s top court has kept several state and local vaccine mandates in place. Read more from Robert Iafolla.

Employers will have until Jan. 10 to comply with the vaccine-or-test rule, the Labor Department said. The Occupational Safety and Health Administration will give companies more time—until Feb. 9—before issuing citations for violating the regulation’s testing requirement, according to the Labor Department’s statement that followed the appeals court ruling reviving the measure. Read more from Robert Iafolla.

CDC Says Unvaccinated Kids Can Test to Stay in School: Unvaccinated kids who come in contact with someone with Covid-19 shouldn’t be required to stay home from school if they test negative and meet other criteria, federal public health officials said. Called “test-to-stay,” the new Centers for Disease Control and Prevention guidance for schools calls for at least two tests within seven days after exposure. If children meet those and other criteria, they can stay in class even if they haven’t been immunized. But the strategy will rely on substantial testing capacity amid already high demand. Josh Wingrove and Jeannie Baumann have more.

Adding to hurdles for children, Pfizer and BioNTech plan to study a three-dose regimen of their Covid-19 vaccine in young children 6 months to 4 years old, a move that may extend the wait for anxious parents as fast-spreading variants complicate clinical trials. When tested in children ages 2 to 4, the two-shot regimen failed to meet a laboratory standard for an immune response set in an older age group, according to a statement. Read more from Riley Griffin.

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What Else to Know Today

ACA Consumers See $2 Billion in Refunds Amid Deferred Care: Nearly 10 million Obamacare enrollees received $2 billion in refunds for 2020, the Department of Health and Human Services reported Friday. The Affordable Care Act requires health plans to offer rebates to consumers if the insurers don’t spend at least 80% of premiums collected on claims or activities that improve the quality of care, a formula called the medical loss ratio. The Centers for Medicare & Medicaid Services data for 2020 showed that 4.8 million consumers in the individual market received $1.3 billion in rebates. Sara Hansard has more.

Texas Wants Abortion to Get State Supreme Court Look: Texas administrative officials asked the Fifth Circuit to let the Texas Supreme Court decide if they can be sued to stop enforcement of a law that prohibits abortion after about six weeks’ gestation—before many people even know they’re pregnant. Abortion in Texas ground to a halt because of the law known as S.B. 8, which the U.S. Supreme Court allowed to remain in effect earlier this month. It’s currently the strictest anti-abortion law in the nation, though several states are considering copycat bills. Read more from Mary Anne Pazanowski.

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To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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