| Hey, good morning! Have you gotten a booster shot? Are you finding available appointments? Confused about the guidance? Let us know: rachel.roubein@washpost.com. Below: President Biden says he'll chart a strategy to fight the coronavirus this winter as the world rushes to understand the new omicron variant. Meanwhile, two health care fights over hospital payments are at the Supreme Court. But first: | Congress is running up against multiple deadlines |  Speaker of the House Nancy Pelosi, D-Calif., celebrates in the chamber with her caucus after the House approved President Biden's social spending bill. (AP Photo/J. Scott Applewhite) | | | December typically brings lots of deadlines for Congress. But this year is worse than usual. Lawmakers are scrambling to wrap up a flurry of unfinished business before the end of the year. This includes a number of policy battles, like averting a government shutdown, staving off cuts to providers' pay and passing Democrats' sprawling economic package – all of which have deep implications for health-care spending. | - "It's brinkmanship every step of the way," said Rodney Whitlock, a vice president at McDermott+Consulting and a former Senate Republican aide.
| | A short-term measure funding the federal agencies and other policies is set to expire Friday, giving Congress just a few days to send legislation to President Biden's desk. Lawmakers are eyeing another stopgap spending bill, potentially until late January, and the House could vote as soon as Wednesday, per a senior Democratic aide. The stakes are high. Averting a government shutdown is critical for helping fund the U.S. territories' Medicaid programs. The current stopgap spending measure sustains federal dollars for their safety net programs. | | It's also crucial to keeping government agencies running and providing paychecks to overworked staff in the federal health department. | - The Biden administration has strived to insulate federal coronavirus efforts from any lapse in funding. Anthony Fauci — Biden's chief medical adviser — said earlier this year that the "worst time in the world" to shut down the government is in the middle of a pandemic.
| | Hospitals are pushing hard to fend off cuts to Medicare's provider pay. A hospital coalition launched an ad campaign urging Congress to prevent any cuts to hospital reimbursement. Major hospital lobbies sent a letter yesterday to congressional leaders detailing their asks. And in both, providers contend they're facing financial challenges in the midst of the pandemic. There are two main issues: Medicare sequester moratorium: Congress' freeze on a 2 percent cut to all Medicare payments expires at the end of the year. Pay-as-you-go requirements: Generally referred to as PAYGO, this policy mandates that new legislation not increase the deficit. If it does, then automatic spending reductions kick in — unless Congress stops them. | - By early next year, the White House's budget office comes up with a report to sum up the impact of legislation subject to PAYGO. If it increases the deficit, then the executive branch must make across-the-board spending cuts to certain programs.
- Up to $36 billion in Medicare payments are on the table. That's according to the Congressional Budget Office, which estimated Democrats' coronavirus release bill passed in the spring would trigger the cuts.
| | Will Congress step in? The specter of cuts to Medicare ahead of the midterm elections could be politically untenable for both parties. | - Democrats are exploring avenues to avert the cuts before the end of the year, according to the senior Democratic aide.
| | By Christmas That's the goal Senate Majority Leader Chuck Schumer (D-N.Y.) has given his chamber to pass Democrats' $2 trillion social spending bill. The measure includes health-care policies important to the party, such as on Medicare, Medicaid and prescription drugs. Democrats are continuing to meet with the Senate parliamentarian, who is the arbiter of what policies are allowed under the strict budget process the party is using to pass the bill without any GOP votes. Once that work is complete, Schumer said he plans to bring the legislation to the Senate floor. | - But Republicans could challenge certain provisions in an attempt to get them nixed from the bill. Democrats are practically itching for a fight on popular provisions, like a $35 cap on insulin for those with health coverage through Medicare or private plans.
- This process will take time. There likely won't be decisions this week on the health-care items, according to a Senate Democratic aide. And it's still unclear what provisions the GOP will challenge.
| | |  | Coronavirus | | | Coming Thursday: Biden's plan to fight the coronavirus this winter | | The White House will release a detailed strategy to battle the pandemic this winter, Biden announced yesterday. | - The plan, to be unveiled Thursday, will focus on widespread testing, vaccinations and booster shots. The administration plans to steer away from lockdowns "for now," Biden said.
- "If people are vaccinated and wear their masks, there's no need for the lockdowns," he said.
| | The spread of the new variant coincides with a waning appetite among Americans for the type of pandemic restrictions, including school closures and indoor-gathering bans, that defined the early days of the pandemic. In 15 minutes of remarks yesterday, Biden called the new omicron variant a "cause for concern, not a cause for panic." Warning that the new variant would reach the United States "sooner or later," despite travel restrictions, the president urged Americans to get fully vaccinated and receive booster shots to shore up their protection against the virus. Federal health officials have been pushing a similar message. In the past 24 hours... | - The Centers for Disease Control and Prevention changed its guidance on booster shots to recommend that everyone over the age of 18 receive one. The previous guidance allowed all adults to get the shots, but said those 50 and over should make sure to get the shot.
- Pfizer and its partner BioNTech, meanwhile, are expected to ask the Food and Drug Administration to authorize its booster shot for 16- and 17-year-olds in the coming days. Regulators are expected to sign off quickly, The Post's Laurie McGinley and Tyler Pager report.
- The administration is working with Pfizer, Moderna and Johnson & Johnson to develop contingency plans for vaccines and boosters if the omicron variant evades the shots, Biden said.
- But the administration's vaccination efforts faced a setback Monday when a federal appeals court in Missouri halted a federal vaccine requirement for certain health-care workers in 10 states.
| | Much is still unknown about the new variant. Scientists have long feared a variant that can evade, even partially, the body's early lines of defense against the virus. But there are other elements of the immune system that provide backup protection and are likely to protect against severe disease, The Post's Joel Achenbach reports. | - Another key question: Can omicron outcompete the delta variant? Or will it be similar to other variants — like alpha and beta — that appeared concerning but were ultimately overtaken by the more transmissible delta variant?
| Here's what else you need to know about omicron: | - Biden rebutted criticism that the United States is hoarding doses of coronavirus vaccines at the expense of South Africa and other middle- and low-income countries. He pointed to the fact that South Africa has turned down vaccine doses in recent days. But the reality is much more complicated, our colleagues Yasmeen Abutaleb and Lesley Wroughton report. Unpredictable deliveries, fragile health systems, challenges in keeping Pfizer's vaccine ultracold and vaccine hesitancy have all posed challenges to South Africa's vaccine campaign.
- In naming the omicron variant, the World Health Organization skipped over Nu and Xi in the greek alphabet. The reason: Nu was too easily confused with "new" and Xi is a common surname, shared by Chinese President Xi Jinping, The Wall Street Journal's Isabel Coles reports.
| | |  | In the courts | | Health-care cases before the Supreme Court could affect hospital payments, regulatory authority |  The sun sets at the U.S. Supreme Court building the week that the court is expected to hear arguments in a Mississippi case that challenges Roe v. Wade. (Leah Millis/Reuters) | | | Tomorrow's high-stakes abortion case is dominating the attention of Supreme Court watchers. But two other health-related cases that have garnered far less notice could have big implications for hospital finances and the regulatory power of federal health agencies. On Monday: The justices heard arguments about the application of a complex Medicare rule that provides additional payments to hospitals that see a larger share of poor patients. Hospitals contend that a 2005 federal health department regulation to how supplemental payments are calculated shortchanges safety net hospitals from what they should be paid under a law passed by Congress. | - "The case was a complicated one that seemed to frustrate the justices during the hour-long arguments. Justice Clarence Thomas called the language in the rule indecipherable, Justice Stephen Breyer said he was exhausted by the dispute, and Justice Brett Kavanaugh rattled off at least five problems with the Department of Health and Human Services regulation," Bloomberg Law's Lydia Wheeler reports.
| | Today: Justices will hear oral arguments in American Hospital Association v. Becerra, which centers on a Trump-era dispute over how Medicare should pay for drugs that hospitals dispense in outpatient departments, including some types of chemotherapy and other anti-cancer treatments. | - At issue is a Medicare rule slashing payments hospitals receive under the federal drug discount program.
- The regulation was aimed at bringing reimbursements to hospitals somewhat more in line with the prices they were actually paying for steeply discounted drugs, but hospitals say HHS exceeded its authority, Nicholas Bagley — a professor at the University of Michigan Law School — writes for SCOTUSblog.
| | Both cases could raise the question of how much deference agencies should get in interpreting the statutes they administer. In a 1984 case, Chevron v. Natural Resources Defense Council, the Supreme Court established the precedent that courts should defer to agencies if they make reasonable interpretations of statutes. But some conservative justices have indicated that they might be open to rethinking that precedent — a move that could sharply curtail the power of the executive branch. | No discipline for unvaccinated federal workers until early next year |  Pfizer-BioNTech coronavirus vaccines in Worcester, Pennsylvania. Photographer: Hannah Beier/Bloomberg | | | Federal employees who have not complied with the administration's coronavirus vaccine mandate will not face aggressive discipline (including unpaid suspensions or firing) until at least early next year, according to guidance the White House sent to unions, Eric Yoder and Lisa Rein report. "The American Federation of Government Employees said Monday that administration officials have told the union that agencies for now will continue offering counseling and education to the roughly 3.5 percent of workers who have yet to receive a vaccination or request an exemption," they write. Agencies will "take no further actions beyond a possible letter of reprimand 'for most employees who have not yet complied with the vaccination requirement until the new calendar year begins in January,' according to the White House message to agencies," they add. | | |  | On the Hill | | | Coming today: Roughly 240 organizations will call on Congress to beef up overdose prevention efforts as U.S. drug-related deaths topped 100,000 within a 12-month period for the first time. The groups — led by People's Action, The Drug Policy Alliance, National Harm Reduction Coalition, and VOCAL-NY — are outlining several asks in a letter to congressional leaders today. | - This includes $69.5 million in funding to increase overdose prevention and harm reduction efforts; eliminating a waiver doctors need to prescribe a medication used to treat opioid addiction; improving efforts to detect the potent synthetic drug fentanyl; and allowing Medicaid to cover health services during the last 30 days of incarceration.
| | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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