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The Health 202

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

The covid vaccine mandate for military members might be the next one to fall

The Health 202

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

Welcome to Tuesday’s Health 202, where we have Georgia on our mind this morning. Got tips? Send them over to

Today’s edition: Nearly every state in the country is seeing high levels of flu-like illness. Medical malpractice expenses are mounting after being delayed by the pandemic. But first … 

Lawmakers are scuffling over the Pentagon’s vaccine mandate in year-end negotiations

Conservatives have had marked success in challenging or delaying President Biden’s coronavirus vaccine mandates. Now, they’re pushing to halt such a requirement for the military — and they may notch a win. 

The question of the day is whether Congress will end a coronavirus vaccine mandate imposed on military service members as part of a roughly $800 billion bill to reauthorize the Pentagon, known as the National Defense Authorization Act (or NDAA)

Top leaders huddled yesterday as they hash out an array of certain provisions of the legislation, though there are still unresolved issues. One person with knowledge of the NDAA, who spoke on the condition of anonymity to describe the fluid legislation, said the bill as currently written directs the defense secretary to end the covid-19 vaccine mandate for activity duty and reserve component service members. 

But that doesn’t appear final. The vaccine mandate is one of the items still under discussion, two congressional aides, who like others spoke on the condition of anonymity to be candid, said last night. 

The usual caveats with Congress apply here: There’s no deal until there’s legislative text, and such language hasn’t been released. Other policies up in the air include marijuana banking legislation and a bill from Sen. Joe Manchin (D-W.Va.) that would overhaul the nation’s permitting process for energy projects. 

Heather Caygle, Punchbowl News:

The details

Late last week, over a dozen Senate Republicans warned they would drag out consideration of the defense policy bill if they didn’t secure a vote on ending the military’s vaccine mandate. 

Since then, the issue has exploded onto the political stage. House Minority Leader Kevin McCarthy (R-Calif.) — who is looking to shore up enough votes to be speaker — claimed Sunday that he had worked out an arrangement directly with Biden to jettison the mandate, our colleague Tony Romm reported.

White House officials later disputed that characterization, saying instead that McCarthy had raised the issue with Biden, who had said he’d consider it. The adiministration pushed back against the idea of repealing the mandate, and said Biden opposes doing so. 

  • Defense Secretary Lloyd Austin’s “been very clear that he opposes the repeal of the vaccine mandate and the president actually concurs with the secretary of defense,” National Security Council spokesman John Kirby said yesterdayadding that it remains “very much a health and readiness issue for the force.”

The arguments: The GOP asserts the policies have hurt recruitment and have forced several thousand to leave the military. Meanwhile, the Biden administration contends that the vaccine requirement was put in place to keep service members “safe and healthy,” and that the Pentagon has long mandated certain vaccines. If the policy is indeed ended, one question is what will happen to those who were discharged for refusing to get the vaccine.

Manu Raju, CNN:

Mandate checkup

The Biden administration announced a slew of vaccine mandates last year, projecting roughly two-thirds of all U.S. workers would need to be immunized or opt into weekly testing instead. The aggressive action came as the White House had struggled for months on how to jump-start the country’s vaccination campaign. 

Earlier this year, the Supreme Court greenlit a vaccine requirement for health-care workers in facilities that receive Medicare and Medicaid funds. But several other major mandates have been axed or indefinitely delayed amid steadfast Republican opposition. 

For instance: The nation’s highest court blocked the administration’s vaccinate-or-test policy for large employers, which would have applied to roughly 84 million people. In the wake of the decision, the Occupational Safety and Health Administration pulled the rule. 

A nationwide injunction was recently lifted on the vaccine mandate for federal contractors, but the Office of Management and Budget told agencies not to enforce the requirement yet. The mandate for federal workers also largely isn’t being enforced.

  • “The legal landscape is very complicated and contested and not resolved,” said Jen Kates, a senior vice president at the Kaiser Family Foundation. She added: “It really comes down to views about the role of government in people's life [and] health decisions.”

Virus watch

Flu hospitalizations soar as triple viral threat hangs over the holidays

Nearly every state in the nation is battling high levels of flu-like illness, public health authorities warned yesterday as multiple respiratory viruses threaten to overwhelm health-care systems this winter, our colleague Fenit Nirappil reports. 

That ferocious return of influenza is coinciding with rising coronavirus hospitalizations and a surge in respiratory syncytial virus, although RSV is showing signs of leveling off in some parts of the country. 

Officials from the Centers for Disease Control and Prevention said yesterday that the early and severe start to flu season grew significantly worse during Thanksgiving week. Hospitals admitted nearly 20,000 influenza patients, almost double the number from the previous week. 

  • In all, the CDC has recorded at least 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths, including 14 children, from flu since October. 
  • That’s close to the 9 million cases and 5,000 deaths that was estimated for the entire 2021-22 flu season

What they’re saying: CDC Director Rochelle Walensky urged Americans to get their updated coronavirus boosters and flu shots, as vaccination rates for both continue to lag. She said early data suggests this year’s flu shot formula appears well matched against strains currently circulating around the country, and that the shots can help to drive down hospitalizations even when they don’t stop infections.

More from the CDC:

State scan

Social Security offices critical to disability benefits hit breaking point

State offices tasked with deciding who should receive federal disability benefits on behalf of the Social Security Administration are struggling to process a massive backlog of claims, which mounted to new heights during the coronavirus pandemic, our colleague Lisa Rein reports. 

Why it matters: The pileup of cases has left more than a million Americans with fewer resources, worsening medical conditions and no access to the health insurance that comes with disability benefits as they wait in limbo to hear whether they’ll receive assistance — the first step in a system of drawn-out judgments and appeals that can take years before a resolution.

  • Data obtained by The Post paints a grim picture of the holdups claimants are confronting across the country, the worst of which is in Delaware, where the average wait to process an initial application was 261 days

Behind the delays lie years of financial neglect and mismanagement in a system in which flaws were amplified by the public health crisis. Perennial hiring and pay struggles, staff shortages, obsolete technology, and fault lines between the states and federal officials have all played into this dynamic, Lisa writes. 

Social Security officials said they are working to break the logjam by collaborating with states to approve money for vacant jobs; improving hiring strategies, retention and training; and paying overtime. The agency also is sending reinforcements to struggling states to help process claims. 

More from Lisa:

Chart check

Wait times for disability benefit applications have been on the rise

In the courts

Medical malpractice lawsuits, delayed by the pandemic, mount against hospitals

Health systems are grappling with higher-than-usual medical malpractice expenses from prior claims now that courts and jury trials return to normal operations, Stat reports. 

The payouts are a lifeline for patients and families harmed by medical errors, though they’ve added financial strain on hospitals contending with ballooning labor and supply costs. 

The details: Typically, health systems plan ahead for any legal costs they might incur and build that into their insurance reserves, but some hospitals are seeing malpractice costs rise to levels they hadn’t expected.

For instance: Major not-for-profit health systems like Baylor Scott & White HealthCommonSpirit Health and Mass General Brigham all reported larger self-insurance reserves or professional and general liability funds, which include malpractice, in their latest financial statements.

And while many delayed cases were filed before the pandemic, experts say there’s reason to believe more will result from the staff shortages and reassignments that took place during the pandemic, Stat’s Tara Bannow writes. 

In other health news

  • The Secret Service said yesterday that hackers linked to the Chinese government stole at least $20 million in U.S. coronavirus relief benefits, in the first instance of pandemic-fraud tied to foreign, state-sponsored cybercriminals that the federal government has acknowledged publicly, NBC News reports. 
  • The United States won’t agree to waive intellectual-property protections for coronavirus testing and treatments this year, damaging prospects for a World Trade Organization agreement aimed at making the lifesaving medicines more widely accessible in low-income nations, Bloomberg reports. 
  • Pfizer and its German partner BioNTech asked the Food and Drug Administration yesterday to authorize their updated coronavirus vaccine to be used as a third shot in the three-dose primary series for children under the age of 5. 

Health reads

The crisis of student mental health is much vaster than we realize (By Donna St. George and Valerie Strauss | The Washington Post)

An Anti-Abortion Activist’s Quest to End the Rape Exception (By Eren Orbey | The New Yorker)

His Overdose Death in a Halfway House Bathroom Illustrates a System Lacking Accountability (By Moe Clark | ProPublica and The Denver Post)

Sugar rush

Thanks for reading! See y'all tomorrow.