So, this behavior has changed again. I added a one time alarm last night before bedtime and there was no alarm this morning. Tried again just now to add a new alarm, allowed app to mousy the change and still not present on the watch. Does the app (iOS) no longer push alarm changes following the v12 update?
UPDATE: I did some more tinkering. Two-way sync with alarms is working for the first time on my watch in years. If I create an alarm on watch, it gets pushed to app on next sync. If I create an alarm in app, it still pushes it to the watch.