| Good morning! We hope you enjoyed the holiday season. In the (belated) spirit of giving, drop us a note and tell us what we need to know for 2022: rachel.roubein@washpost.com. Today we're exploring what we know — and don't know — about omicron and diving into Biden's recent actions on everything from Obamacare to drug pricing. But first: | Welcome to 2022 and lots of shifting fault lines in the health-care world |  President Biden's 2022 challenges: A surging pandemic and intraparty fighting over his legislative agenda. REUTERS/Evelyn Hockstein | | | Across the country: Coronavirus cases are surging. Hospitals fear staffing shortages. Americans are scrambling to find tests. Here in Washington: Tensions over passing President Biden's economic package reached a boiling point in the wake of opposition from Sen. Joe Manchin (D-W.Va.). Welcome to 2022. The Biden administration is still grappling with how to best respond to an ever-shifting pandemic. And congressional Democrats are hoping to pass some semblance of their social spending bill while they still control both chambers. The next few months will be critical for both. | | The most transmissible variant yet is proving the coronavirus isn't going away, though booster shots and new anti-covid pills are powerful tools to prevent severe disease. And while omicron is proving significantly less deadly than other variants, around 1,500 Americans are still dying from the disease every day. Biden's chief medical adviser, Anthony Fauci, summed up the moment bluntly on Sunday: "There's no doubt about it, the acceleration of cases that we have seen is really unprecedented, gone well beyond anything we have seen before," he said on ABC's "This Week." | | That poses a massive challenge for the Biden administration. Officials are trying to balance curbing the spread of infection with ensuring essential services stay open, but those efforts are already facing backlash. | - Last week, federal health officials recommended shortening the isolation period for people with asymptomatic coronavirus infections — or if their symptoms are resolving — to five days.
- Some experts quickly panned the guidance for declining to say those infected should get a test before cutting their isolation period in half. Centers for Disease Control and Prevention Director Rochelle Walensky defended the measure, arguing PCR tests can show positive results after a person is no longer infectious, our colleagues Yasmeen Abutaleb, Sean Sullivan and Eli Rosenberg reported.
| | But now, health officials could change course. Fauci said Sunday that the CDC is considering adding a testing component, The Post's Jeff Stein reports. | | Fauci on ABC's "This Week": |  | | | | | But Americans would need to be able to find tests. The holidays exposed the limits of the country's testing capacity, as appointments filled up and Americans scoured retail stores and the web to find rapid at-home tests. The administration says it's laying plans for two efforts aimed at making tests more accessible and affordable amid public frustration over their availability. While both add another tool to America's testing arsenal, neither completely solves the country's testing woes. | - Shortly before Christmas, Biden detailed a new effort to distribute 500 million free at-home tests. The first delivery is planned for this month, and the White House says it'll create a website to help Americans get the tests. It's unclear if more will be ordered after the half-billion are delivered.
- Health officials pledged to issue guidance by Jan. 15 requiring private health insurers reimburse tens of millions of Americans for buying rapid, at-home tests. But consumers will need to know they can seek the coverage from their plan, and the policy doesn't apply to Medicare and Medicaid.
| Meanwhile, on Capitol Hill… | | Democrats will attempt to salvage Biden's legislative agenda. | | For weeks, Senate Majority Leader Chuck Schumer (D-N.Y.) said he aimed to vote on Biden's sweeping social spending bill before Christmas. But the year ended on a disappointing note for Democrats after Manchin said he couldn't vote for the roughly $2 trillion legislation. Those comments were met with a lengthy, and public, rebuke from the White House. The bill includes major Democratic priorities on health care, such as drug pricing reforms, extending Medicaid to 2.2 million people and bolstering Obamacare's financial aid. Delivering on these pledges is critical for Democrats in the midterms. Meanwhile, some Democrats are open about the likely need to pare the legislation down further, per our colleagues Tony Romm, Mike DeBonis and Marianna Sotomayor. Schumer has vowed to put the Build Back Better Act to a vote on the Senate floor "very early in the new year." | | |  | Quote of the year | | | Thanks to everyone who voted for our first quote of the year. The results are in … and the winner is West Virginia Gov. Jim Justice (R) for his clear-eyed assessment of who should get a booster shot. "In my opinion, if you're breathing, you can qualify," Justice said even before federal officials endorsed booster shots for all adults. His comments were captured in this Politico story. | | |  | Coronavirus | | What we know — and don't know — about omicron | | Coronavirus cases are skyrocketing to their highest levels during the pandemic, largely due to the contagious omicron variant. And those record numbers are happening despite the fact that many cases detected via home tests go unreported. Part of the rapid spread is likely due to the fact that omicron can at least partially evade the immune responses of people who are vaccinated or have been infected before. That leaves it with more potential targets, though booster shots offer significant protection. But other factors, including a potentially shorter incubation period, may also play a role in the lightning-fast spread. | | Those infected with the variant are 40 percent less likely to be hospitalized overnight, compared with those infected with delta, according to data from the United Kingdom. Scientists say this is in part because the population has more prior immunity, and they are also investigating features of the variant that may make it less virulent. Meanwhile, experts say that young, healthy people who are boosted are unlikely to develop severe illness. Healthy people with two shots are also likely to fare relatively well, though they may have more intense symptoms, Yasmeen reports. It's not clear how protected older, boosted individuals and those with underlying conditions are, but doctors say the majority of people entering hospitals are unvaccinated. Still, a small share of a large number can leave hospitals reeling. Hospitalizations have risen 31 percent over the past week, and that's at a time when some health-care workers are out of commission because they, too, have tested positive. | | |  | Agency alert | | | ICYMI: The Biden administration released a slew of decisions aiming to put its stamp on Obamacare and rescind Trump-era moves on drug pricing and Medicaid. Here's a quick rundown: New rules of the road for Obamacare: The Biden administration is proposing to ban health insurance issuers from discriminating on the basis of sexual orientation and gender identity — an effort representing a reversal from the Trump era. | - The Centers for Medicare and Medicaid Services' annual rule governing the health insurance marketplaces also aims to require insurers offer standardized plan options and implement new reviews to ensure plans have adequate networks. Read the fact sheet here.
| | Say bye to the most favored nation model: The Biden administration officially repealed a Trump-era drug pricing pilot project to tie the prices of some drugs in Medicare to the lower prices in other developed countries. In its rescission, CMS cited a preliminary injunction against the measure, while also adding that courts found procedural issues with Trump's rule. Read the decision here. | - In a statement, a CMS spokesperson said the agency will "continue to carefully consider" comments it received on the measure as it explores ways of paying for medical treatments.
| | No Medicaid work requirement for Georgia: The Biden administration decided Georgia's partial Medicaid expansion can't include a work requirement or charge people premiums. Read CMS' letter here. | - The Trump administration approved the state's plan to extend Medicaid up to 100% of the federal poverty line. But the measure hadn't yet gone into effect amid negotiations with Biden's CMS over the controversial work rules.
- Georgia Gov. Brian Kemp, a Republican, plans to fight the agency's decision in court, per The Atlanta-Journal Constitution.
| | New year, and a new ban on surprise medical bills: Providers may no longer send patients many eye-popping bills for inadvertently seeking care outside of their insurance network. Congress passed legislation banning the practice in late 2020 after a years-long lobbying onslaught, and the Biden administration fleshed out the details last year. | | The Kaiser Family Foundation |  | | | | | |  | Our top holiday reads | | - Prenatal tests initially focused on Down syndrome, but they've since expanded to include many more conditions. A large share of the positive results from these newer tests are incorrect, The New York Times's Sarah Kliff and Aatish Bhatia report.
- The past two years have seen incredible biomedical advances to combat the coronavirus, including vaccines and powerful antiviral pills. But some experts say the nation's public health system has not kept up, The Post's Frances Stead Sellers writes.
- Biden officials say more doses than expected will be used for booster shots in countries with high vaccination rates. That puts pressure on Novavax to garner regulatory approvals to help reach the World Health Organization's goal of vaccinating 70 percent of the world's population by the middle of next year, Politico's Erin Banco, Adam Cancryn and Sarah Owermohle report.
- Twitter suspended the personal account of Rep. Marjorie Taylor Greene (R-Ga.) over covid misinformation, The Post's Brittany Shammas reports.
|  Rep. Marjorie Taylor Greene (R-Ga.) speaks during a press conference outside of the Department of Justice on July 27, 2021. (Amanda Andrade-Rhoades/The Washington Post) | | | |  | Daybook | | | Here's what we're watching to kick off the new year: Early this week: The Food and Drug Administration is expected to authorize booster shots of the of the Pfizer-BioNTech vaccine for 12-to-15-year-olds, per The Post's Dan Diamond. (The New York Times first reported the news.) Wednesday: The Senate HELP committee will consider the nomination of Robert Califf for FDA commissioner. Friday: The Supreme Court will hold a special hearing to consider challenges to the Biden administration's vaccine or testing mandate for private businesses and its vaccine requirement for health care workers. | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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