| Welcome to Thursday's Health 202 📰 Did you order a free rapid test? Let us know how it went, and importantly, when you get it. Reach out at rachel.roubein@washpost.com. Today: President Biden's lengthy press conference gave a window into his thinking on Build Back Better and the coronavirus. Maryland's governor takes issue with the White House's rapid test plan. But first: | Breaking up Build Back Better puts health measures in limbo |  President Biden spoke yesterday for nearly two hours during a wide-ranging press conference as his presidency hits the one-year mark. (Photo by MANDEL NGAN/AFP via Getty Images) | | | President Biden said the quiet part out loud. His sweeping social spending bill is going to change again amid resistance from his own party (read: West Virginia Sen. Joe Manchin). | - "I think we can break the package up, get as much as we can now, and come back and fight for the rest later," Biden said during his nearly two-hour news conference yesterday.
| | Our read: His comments weren't immediately clear, but some Democrats said they're interpreting them as paring back the package to focus on fewer items, rather than voting on a slew of individual bills. (The White House didn't respond to a request for clarification from The Post.) | - "My interpretation is that he's saying, 'let′s … see what can pass and then let's do other things perhaps piecemeal,′ " Rep. Ro Khanna (D-Calif.) told our Climate 202 pal Maxine Joselow. "But let′s have one key bill."
- Especially because to pass a spate of smaller bills in the Senate, "someone is going to have to go find 10 Republicans," as one House Democratic aide put it.
- Biden said he believes he can get the support of the party for provisions on climate change and early education, as well as mechanisms to finance the new spending. He didn't specifically call out health care in that list, but he did bring up the bill's pharmaceutical price limits at one point, saying "the American people overwhelmingly agree with me on prescription drugs."
| | The Post's Tony Romm |  | | | | | Not much has changed on the health-care front since Manchin announced he couldn't vote for the Build Back Better Act late last year, in part because voting rights legislation has taken center stage the past few weeks, according to multiple Hill aides and lobbyists. The sweeping bill includes Medicaid expansion for holdout states, enhanced Obamacare tax credits, new hearing benefits in Medicare, government limits on the prices of some prescription drugs and more funding for in-home care. | - "I think the conversations on the future of the reconciliation package will probably come to the top of the list in the next couple weeks," the House Democratic aide said.
- Meanwhile, the bipartisan "Byrd bath" meetings over the health-care provisions haven't happened yet, according to a Senate Democratic aide. That's where both parties argue over what policies can be included in the budget maneuver Democrats are using to pass the package without any GOP votes.
| | The Post's Jeff Stein |  | | | | | If past is prologue Let's walk through what we know to find the potential middle ground here. Back in December, Manchin sent the White House a concrete counteroffer to its spending bill, which included extending new financial aid for Obamacare shoppers, our colleagues Jeff Stein and Tyler Pager reported last year. He's also previously expressed support for letting Medicare negotiate the price of prescription drugs, a policy critical for paying for the broader economic package. | - What Manchin opposes: Medicare expansions. The House-passed bill included adding a hearing benefit to Medicare, but Manchin has previously said he wants to first address the program's long-term solvency.
| | The package — at least right now — also includes other signature policies Democrats want to pass before the midterms, like extending Medicaid to 2.2 million poor adults and bolstering in-home care for seniors and the disabled. And Democrats are already worried about delivering on their health-care promises ahead of this year's elections. | - "There are few policies that drive down costs for families as effectively as the health care provisions in Build Back Better, and we are confident they will remain," Anne Shoup, a spokeswoman for Protect Our Care, a Democrat-aligned group, said in a statement.
| | |  | White House prescriptions | | | Here's what else we learned from Biden's news conference: | | Biden is leaning into a midterms strategy of explain, explain, explain. Democrats are cognizant that many voters don't know what's in the social spending bill, as well as legislation the party passed last year. | - "I'm going to be out on the road a lot … with my colleagues who are up for re-election and others, making the case of what we did do and what we want to do," Biden said.
| | He maintained the federal government's pandemic response was succeeding. "I think we've done remarkably well," Biden said. As The Post's Dan Diamond notes, the president occasionally nodded to setbacks, while praising efforts to ramp up covid-19 tests, vaccines and other supplies. Yet, his record on the pandemic is mixed. Keeping schools open is important to the White House. Biden acknowledged that schools could be a potent issue in the midterm, yet stressed that more than 95 percent are still open amid the omicron wave. …And about that surprise medical bill comment. What Biden said: "We just made surprise medical bills illegal in this country." | - The reality: Providers can no longer send hefty bills to patients for inadvertently getting out-of-network care. The ban took effect Jan. 1 — but it was passed in December 2020 as part of a year-end spending package that former President Donald Trump signed into law. Biden's health department was charged with crafting rules around the new policy.
| | |  | Coronavirus | | Hogan says Biden's plan for rapid tests is undercutting Maryland's supply |  Maryland Gov. Larry Hogan speaks at a news conference on Jan. 11 in Annapolis. (Brian Witte/AP) | | | Maryland Gov. Larry Hogan, a Republican, said the state had ordered millions of rapid tests and was expecting a "huge shipment" this week, only to hear from vendors that they were diverting supplies to support the federal government's effort to send 500 million rapid tests to Americans, The Post's Joe Heim reports. The White House denied that assertion, saying that federal contracts prohibit interference with state supply. The federal program to distribute the tests "is specifically not allowed, by contract, to take away tests from state governments or U.S. commercial operations," Tom Inglesby, senior adviser to the White House covid-19 response team, said in a call with reporters. New analysis: A CDC study in two states compares protection from prior infection and vaccination — and concludes getting vaccinated is the safest way to prevent covid-19, The Associated Press reports. Amid the delta surge, the study found those who were vaccinated and survived a prior infection had the most protection. But in the fall, before boosters were widespread, those unvaccinated with a past infection had a lower case rate than those vaccinated alone. The study has key caveats. The study ended before boosters were widespread. Some of the breakthrough infections in people who were vaccinated may have occurred because the effectiveness of the vaccine fades over time in some people. The analysis was completed before the emergence of omicron, and thus, the findings can't be applied to the new variant, the CDC said in a statement. | Here's what else you need to know: | - Senators are pushing for masks made in America. Sens. Tammy Baldwin (D-Wis.) and Sherrod Brown (D-Ohio) led a letter with nearly 20 Democrats calling on Biden to ensure that masks used to replenish the strategic national stockpile are made in America, claiming companies are struggling to compete with overseas manufacturers.
- Updated guidelines from the National Institutes of Health discourage the use of two of three authorized monoclonal antibody treatments because they are unlikely to work against the omicron variant, The Post's Laurie McGinley reports. The new guidelines reflect CDC estimates that the variant is responsible for 99.5 percent of cases.
- Supreme Court justices tried to dispel rumors of conflict over masking Justice Sonia Sotomayor and Chief Justice John G. Roberts Jr. said that they did not ask Justice Neil M. Gorsuch to wear a mask while on the bench, The Post's Robert Barnes reports. The statement seemed aimed at refuting a report from NPR that claimed Sotomayor participated remotely in oral arguments because of Gorsuch's refusal to wear a mask. (NPR has said it stands by the reporting).
| | |  | State scan | | | In Florida: The Department of Health placed a top official on administrative leave after he criticized the agency's vaccination rate and encouraged employees to get vaccinated against the coronavirus, The Post's Timothy Bella reports. | - The Florida Dept. of Health provided few details on what led to the decision but said it was investigating whether the official violated any laws. Florida Gov. Ron DeSantis, a Republican, signed a law this fall prohibiting state government agencies from implementing vaccine mandates.
| | In Missouri: Republican Attorney General Eric Schmitt renewed threats to sue school districts that require masks, The Post's Brittany Shammas reports. In Arkansas: Inmates at a detention center are suing after they say a doctor treated them with ivermectin without their knowledge after they tested positive for the coronavirus, The Post's Andrea Salcedo reports. Health agencies have warned against using the deworming drug to treat covid-19. Across the country: New mayors stepped into crisis mode on day one, Politico's Lisa Kashinsky reports. The pandemic has overtaken their agendas. Instead of enjoying a honeymoon period, they are responding to protests about vaccine mandates and battling to keep schools open. | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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