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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Cue the lawsuits: Biden's vaccine mandates are here

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Happy Thursday morning, everybody. Send us your news, tips and best bets on whether Dems vote on the economic package this week.

Below: Kids vaccines kick off and Democrats eye speeding up their legislative agenda after the party's gubernatorial loss in Virginia. But first: 

The administration has released widespread vaccination requirements

President Biden’s divisive vaccine rules have arrived.

This morning, the administration released its hotly anticipated coronavirus vaccination policies for a wide swath of Americans working for large companies and health facilities. Officials project roughly two-thirds of all U.S. workers will need to be fully vaccinated by Jan. 4, though some could opt into weekly testing instead. 

The aggressive action comes as the administration has struggled for months over how to jump-start the country’s lagging vaccination campaign. But even before they were unveiled, the prospect of vaccine mandates faced weeks of unrelenting attacks from opponents, including Republican state attorneys general who vowed to sue.


Here are the details:

1. The Biden administration is implementing a true vaccine mandate for 17 million health-care workers.

The emergency regulation requires vaccines for staff of the roughly 76,000 health facilities participating in Medicare and Medicaid, such as nursing homes, hospitals and home health agencies. Unlike other mandates, staff won’t be allowed to test regularly in lieu of getting the shot, though it does include religious and medical exemptions.

  • “We have a higher bar for health care workers given their critical role in ensuring the health and safety of their patients,” a senior administration official said.

But what happens if facilities don’t play ball? The official stressed the agency wants to work with facilities first – but then detailed a series of actions the Centers for Medicare and Medicaid Services could take if providers aren’t taking steps to come into compliance, from civil monetary penalties to denying payments to terminating them from the Medicare and Medicaid programs as a last resort.

Across the country, nursing homes are averaging roughly 71 percent of staff vaccinated. Meanwhile, more than 40 percent of hospitals around the country are already mandating the shot, per the administration — and such requirements have been shown to boost immunization rates for some facilities. 

  • In New York, many hospitals saw vaccination rates increase to over 95 percent ahead of the mandate’s deadline, up from roughly 70 to 80 percent before the rule was announced, The Post’s Eli Rosenberg reports.
  • In California, major facilities saw their rates rise to roughly 90 percent after a similar mandate went into effect.

2. Companies with 100 or more employees must now mandate coronavirus vaccine shots or weekly testing. 

The Occupational Safety and Health Administration is relying on little-used emergency powers to issue the new rules expected to cover 84 million workers. 

Under the regulations:

  • The unvaccinated will be required to wear masks.
  • Employers must provide paid time off for their staff to get a shot.
  • Companies can make their employees foot the bill for their own tests.

Administration officials spent at least eight weeks writing rules they believe can stand up to legal scrutiny, as similar mandates have largely withstood challenges across the country. 

  • On a call with reporters, officials stressed their belief that the coronavirus is a “health hazard that poses a great danger to workers,” and the vaccination policy fit squarely within the agency’s legal purview.
  • They also made clear the federal regulation preempts state and local laws, such as those seeking to ban or limit employer’s authority to require shots, masks or tests

Still, the move is sure to lead to an all-out war with Republican state officials, who have been unified in their opposition to the mandates. 

  • “Opposition has been marshaling in advance of the Occupational Safety and Health Administration rule’s release at the political level,” Eli writes.Republican attorneys general in at least 24 states have vowed to fight the rule in court, and one, Arizona Attorney General Mark Brnovich (R), has already filed a lawsuit against the federal government over it. Some state governments, including Missouri’s, are pledging to explore legislation that could exempt their state from the requirement.”

MSNBC's The Beat with Ari Melber

On the Hill

Dems rev up plan to pass Biden’s social spending bill

On Capitol Hill, Democrats’ loss in the gubernatorial race infused a new sense of political urgency into the party’s efforts to muscle Biden’s $3 trillion legislative agenda through Congress. Leaders released a new version of legislative text for the sweeping social spending bill — which includes key health care provisions — and set a plan in motion to vote on it before the end of the week, The Post’s Tony Romm, Mike DeBonis and Marianna Sotomayor 

Reality check: We’ve been here before. Democrats have laid out timetables, then and delayed them, in the past due to intraparty fighting. 

Addressing reporters Wednesday, Biden argued that the party’s vision isn’t its problem — it’s the execution, our colleagues Sean Sullivan, Michael Scherer and David Weigel report. 

  • “People are upset and uncertain about a lot of things, from covid to school, to jobs to a whole range of things,” he said “If I’m able to pass and sign into law my Build Back Better initiative, I’m in a position where you’re going to see a lot of those things ameliorated quickly and swiftly.”

But parts of the Democratic agenda have been significantly scaled back. Take the drug pricing deal released Tuesday. Democrats and some advocates are touting it as historic. Others are raising questions about the compromise that significantly waters down House Speaker Nancy Pelosi’s and Sen. Bernie Sanders’ push to reform the drug industry, The Post’s Dan Diamond, Amy Goldstein and your host report. 

  • While leading congressional Democrats are claiming they have broken pharma’s ‘iron grip’ on Congress, our analysis leads us to believe pharma’s CEOs are likely popping champagne and smoking cigars,” financial services firm Raymond James wrote in an investor’s note to clients on Tuesday night.


Appointment rush for the children’s vaccine begins

Some 5-to-11-year-olds received the nation's first children's coronavirus vaccine on Nov. 3, 2021, after the CDC authorized immunizing millions of kids. (Video: Justin Scuiletti/The Washington Post)

Young children in the United States are lining up for vaccines nearly a year after their parents and grandparents became eligible, The Post’s Fenit Nirappil and Lindsey Bever report. The rush comes after the CDC signed off late Tuesday on smaller doses of the Pfizer-BioNTech coronavirus vaccine for children ages 5 to 11.

Doctors and nurses soon started administering the first shots, while parents scrambled to book appointments in hopes to get their children at least partially vaccinated before Thanksgiving. White House officials have cautioned that vaccinations won’t begin in earnest until next week, after initial shipments of 15 million doses arrive, health care personnel undergo training and doctors plan clinics.

  • “Over the next 24 hours alone, there will be millions more doses in the air and on trucks heading to cities and towns across the country,” Jeff Zients, White House coronavirus response coordinator said Wednesday.
President Biden on Nov.3 said the United States had “reached a turning point” against the coronavirus pandemic. (Video: The Washington Post, Photo: Demetrius Freeman/The Washington Post)

Many patients contracted covid-19 in the hospital after going in for something else

More than 10,000 patients were diagnosed with covid-19 while in the hospital for something else, according to a Kaiser Health News investigative report out this morning. The statistic is, in part, an indictment of hospitals that failed to control infections. 

  • Nearly 21 percent of patients who contracted covid-19 from April to September 2020 in a hospital died, compared with nearly 8 percent of other Medicare patients in the hospital at the same time, KHN's Christina Jewett reports.

Medicare reports suggest that, on average, around 1.7 percent of hospitalized covid-19 patients were diagnosed in the hospital. 

  • But some hospitals were outliers. The KHN report finds that in 38 hospitals, 5 percent or more of the covid cases were documented as hospital-acquired. The reasons stemmed from a failure to appreciate the airborne nature of the coronavirus to failing to inform workers when they were exposed.

Here's what else you need to know: 

  • The Air Force has granted 1,634 medical exemptions for coronavirus vaccines but has yet to approve any on religious grounds, The Post’s Alex Horton reports. Around 97 percent of active-duty Air Force and Space Force members have received at least one vaccine dose.
  • Centers for Disease Control and Prevention director Rochelle Walensky said the agency is not currently planning to change its definition of “fully vaccinated,” as many Americans rush to booster shots. That definition is one dose of the Johnson & Johnson vaccine and two doses of either Pfizer or Moderna, Walensky said at yesterday’s White House covid briefing.
  • In Colorado’s Larimer County, hospitals are near a breaking point amid a surge in covid-19 admissions, The Post’s María Paúl reports. Even as coronavirus cases and deaths have fallen nationwide, many parts of the country continue to grapple with overwhelming cases.
  • Rich countries have given out more vaccine doses as booster shots in the past three months than poor countries have given out in the past year, The Financial Times’s Donato Paolo Mancini and John Burn-Murdoch report.

Agency alert

First in The Health 202: Lawmakers urge the FDA to advance work on long-haul covid

In a letter to acting FDA commissioner Janet Woodcock, a bipartisan group of senators is requesting information on collaboration between the agency and the National Institutes of Health to study the long-term impacts of covid-19. The letter notes that Congress provided funding to the FDA to evaluate vaccines, therapeutics and diagnostics for covid-19, and says the funding “is critical not only for acutely ill patients, but also for those suffering from long-haul COVID-19.”

  • The letter comes from Sens. Jacky Rosen (D-Nev.), Marco Rubio (R-Fla.), Catherine Cortez Masto (D-Nev.), Bob Casey (D-Pa.), Dianne Feinstein (D-Calif.), Susan Collins (R-Maine) and Chris Murphy (D-Conn.).

Sugar rush

Thanks for reading! See y'all tomorrow.