| Good morning, and TGIF. Big news for this (and all cat-lovers): The Bidens finally have a cat in the White House. Today, a government watchdog report says the federal health department is at "high risk" of bungling a future crisis and Biden's vaccine mandate for medical workers has kicked in. But first: | Extra Obamacare subsidies boosted enrollment – but they're temporary |  Affordable Care Act sign-ups hit record levels this year. (Alex Brandon/AP) | | | Sign-ups for health coverage in the Obamacare insurance marketplaces hit record levels this year. The federal health department held a press call touting the historic numbers. President Biden said "this did not happen by accident." The elephant in the room: Millions of Americans could soon reevaluate keeping that coverage. Last year, Democrats' coronavirus relief package made subsidies more generous for low-income Obamacare shoppers and granted them to middle-income Americans for the first time. That financial help is set to run out at the end of this year, meaning consumers could see their premiums increase in 2023 if Congress doesn't continue the policy. | | Biden's roughly $2 trillion social spending bill included continuing the enhanced aid through 2025, but the status of the package is still in peril after Sen. Joe Manchin (D-W.Va.) said he couldn't vote for it. Experts say — and the federal health department acknowledges — that the Biden administration could lose some of the coverage gains if the new subsidies lapse. At least 14.5 million Americans signed up for health coverage through the Obamacare exchanges this year, outpacing the previous record by nearly 2 million, our colleague Amy Goldstein noted yesterday. | - "If the subsidies are allowed to expire, what we'd likely see is premium payments for millions of enrollees doubling and that could lead to coverage losses going into next year," said Cynthia Cox, a vice president at the Kaiser Family Foundation.
- A Department of Health and Human Services spokesperson said the subsidies are likely one factor to extend coverage — and that's why the administration supports continuing the financial aid through Biden's economic package.
| | Our read: The record-breaking Obamacare enrollment is good news for Biden, who campaigned on making health care more accessible and affordable. And even Manchin appears on board with keeping the enhanced subsidies. But if the measure doesn't pass, Americans would learn of rising costs to their health coverage right before the midterms. | | The rate of uninsured Americans also fell to below pre-pandemic levels — a data point health experts say is key. That's because it means the increase in Obamacare enrollment isn't merely shifts in coverage, like people moving from getting coverage through their employer to a plan on the health law's marketplaces. Roughly 10.7 percent of Americans under age 65 were uninsured as of September 30, per a new HHS report. That's not the lowest the uninsured rate has been, according to the Centers for Disease Control and Prevention's National Health Interview Survey. The Health 202 compared third-quarter data over the last decade for that same age group. As Americans bought Obamacare plans for the first time, the uninsured rate dipped to 13.2 percent in 2014 from 16.5 percent in 2013. | - The rate hit a low of 10.1 percent in 2016 before climbing during the Trump administration. Some experts contend policies, like substantially decreasing funding for groups that help people sign up, contributed to the rise in the uninsured.
| | Now the rate has fallen to 10.7 percent for the third quarter of 2021— and the Biden administration attributes some of the decline to a special Obamacare enrollment period it created for the pandemic last year and outreach it poured behind the effort. But the numbers also tell a more complicated story, since they began falling before the new subsidies kicked in. | - Other factors include the economy rebounding, a few more states expanding Medicaid and the requirement that states not kick people off their Medicaid plans during the public health emergency, according to experts as well as the HHS report.
| | |  | Readers help us | | | Private insurers are now required to cover coronavirus tests. We want to hear from you how it's going. | | Has the process been easy or cumbersome? Have you had to pay up front for the tests or did you get them free without paying first? How long is it taking to get reimbursed? Tell us all at rachel.roubein@washpost.com. | | |  | Coronavirus | | Yesterday was the deadline for health-care workers to get vaccinated |  (Photo by CLEMENT MAHOUDEAU/AFP via Getty Images) | | | In much of the country, about 10 medical workers had to get at least their first dose of a coronavirus vaccine, as the Biden administration's mandate starts to take effect. The Supreme Court recently backed the requirement for health-care workers while striking down Biden's broader vaccination-or-testing rule for large employers. "Enforcement of the federal vaccine mandate begins in 25 states and the District of Columbia and will extend to the rest of the country in the coming weeks," Hannah Knowles and Amy Cheng write. "The Centers for Medicare & Medicaid Services (CMS) staggered its deadlines after Republican-led states challenged the rules, leading to a patchwork of court rulings before the Supreme Court weighed in." 🚨 On high alert: A government watchdog says HHS is at "high risk" of botching a future crisis. Government Accountability Office investigators found "persistent deficiencies" in how HHS has led the coronavirus response and past public health emergencies dating back to 2007. And the federal health department repeatedly ignored recommendations to improve its pandemic response, our colleague Dan Diamond reports. | - "The department's response to the COVID-19 pandemic has highlighted long-standing concerns we have raised about its ability to execute its role leading federal public health and medical preparedness for, and response to, such public health emergencies," the GAO wrote in a report released yesterday, .
- For instance: GAO said it warned HHS about shortages of covid-19 tests back in September 2020. Then in January 2021, the agency recommended the department create a comprehensive national testing strategy — but one has not yet been provided to investigators.
- The view from HHS: Officials said they're still reviewing the report, but are working to improve long-standing issues the Biden administration inherited.
| | Roughly three-quarters of Americans say they are "tired" of the current state of the pandemic and 73 percent say they are "frustrated" by it. That's according to a new survey from the Kaiser Family Foundation, which shows Americans across the ideological spectrum are ready for the pandemic to wane. | - Just 4 in 10 feel optimistic about the state of the pandemic, with Democrats slightly more optimistic than Republicans.
- More than 3 in 4 of those surveyed say most people in the country will likely get the coronavirus.
- Just over half of Democrats say the pandemic is the country's biggest problem, compared to 28 percent of Independents and 19 percent of Republicans.
- The poll also confirms the country's testing frustrations. About 6 in 10 of those who tried to buy an at-home covid test say they were difficult to find amid the omicron surge.
| Major health care lobbies warn of a blood shortage | | The groups say the length and severity of the shortage could "significantly jeopardize" health care providers' ability to meet their patients' needs. The pandemic has meant fewer blood drives at the usual spots, like businesses, houses of worship and universities. The need for blood has risen, while high rates of the coronavirus have diminished donations, the American Hospital Association, American Medical Association and American Nurses Association wrote in a statement yesterday. The groups are urging more Americans to donate blood — a call that comes as the American Red Cross warned of the worst blood shortage in over a decade earlier this month. | | |  | Close up | |  Anthony S. Fauci, chief medical adviser to the president. Stephen Voss/Stephen Voss | | | Anthony Fauci is up against more than a virus: The Post's Dan Zak and Roxanne Roberts profile Fauci, the nation's top infectious disease specialist. They begin with him opening his front door. | - Fauci says: "'I know who you are. Do you think these guys would let you get this close to me, if we didn't know who you are?' Across the street is a security agent in Nikes, a badge on his belt. He's not the only one watching," Dan and Roxanne write.
| | Fauci has been a doctor and public servant for over 50 years, serving under seven presidents. He knows infectious diseases, and he knows Washington. But the pair of Post reporters chronicle this moment in time — one that's new for Fauci and new for the country. | - "Fauci is unnerved by 'the almost incomprehensible culture of lies' that has spread among the populace, infected major organs of the government, manifested as ghastly threats against him and his family. His office staff, normally focused on communicating science to the public, has been conscripted into skirmishes over conspiracy theories and misinformation," Dan and Roxanne write. Read the rest of the profile here.
| | |  | In other health news | | - Google-owned YouTube permanently banned prominent conservative media figure Dan Bongino after he repeatedly broke its rules on posting coronavirus misinformation, The Post's Gerrit De Vynck reports.
- The Trump administration created a secret list prioritizing allies, like Israel and Taiwan, for global vaccine distribution over low- and moderate-income countries, Politico's Erin Banco writes.
- Pharmaceutical Research and Manufacturers of America is launching a new seven-figure national digital, print, radio and tv ad campaign against some of Democrats' drug pricing measures included in their sweeping social spending bill.
| | |  | Quote of the week | | | Anthony Fauci, the president's chief medical adviser | "It's messy because, as you know, in covid times, nobody comes over. So nobody cares," Fauci says of his home. | | | | | | | | |  | Sugar rush | | | Thanks for reading! See y'all Monday. | |
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