Transcripts For CSPAN Health Care Policy 20171019

We will also hear from tim kaine of virginia and bill cassidy from louisiana. Please welcome our host mike allen. Good morning, early birds, on a fantastic day for healthcare policy. A great day to look at next steps for the Nations Health care system. Thank you all for coming out so early. Thank you for joining us. Thank you, cspan, for welcoming the audience here to axios. We want to thank delta dental and jason don for sponsoring the event. Thank you all for coming, and for you following online, please use the axios 360 and we will get the conversation going online. Axios events are like all of the manifestations of axios. We bring information you can trust, information to help you make better decisions using smart so that you can get smarter faster. We see that also with these events. We are honored to have three senators at the center of this conversation were going to be here with us one on one. We hope that together we will have a tour of the landscape and also make some news and make you smarter. We can count on how many of those we do. Im going to welcome to the stage an axios healthcare reporter that has been in the capital at the center of this, all through these amazing years of healthcare, i welcome my colleague, Caitlin Owens. Good morning. Thank you for coming, thank you for your great coverage. Appreciate it. Behind the curtain at 11 30 last night, what happened . Ms. Owens so have been writing about the Alexander Murray deal and i just shuttle pilot to go to bed and i checked my email. And lo and behold there is how much of a surprise yesterday, was the announcement and what was the news . You know, alexander and murray have been working for this since repeal and replace died. So lets take a pause and explain if i had checked out, if i had been hiking yesterday and i came back today, tell me what happened yesterday and why it matters. Ms. Owens this is the first bipartisan Major Health Care bill, at least being related to the digital market, since obamacare past. The two parties have been going about this for eight years now. And now we have a bipartisan deal. That is a big deal. It is just it goes this point. A Committee Chairman ranking member, it has not passed anywhere. Its not enough it will have a bill but just that alone is really significant because it has a huge impact on millions of peoples lives. And this often gets lost in conversation. If im someone taking advantage of the affordable healthcare plan, how is my life changed in the last year . Ms. Owens if you are on the exchange right now, you have a lot of uncertainty about what is going to come next. You dont know what is going to happen to your premiums going forward, you do not know if your plan will get canceled. You do not know what your options will be. What it means is if you are on this exchange you dont know if youll be able to afford your health care, especially if you have an emergency. So i think this tries to stabilize and give people certainty that they will have coverage and what they need is something catastrophic happens and even something routine. And so i think the goal here is to keep those premiums stable or lower them to make them more affordable. But also to make sure that insurers stay in the market and states had opportunities to entice ensures and stabilize markets. Axios has Great Health Care coverage, our managing editor, sam baker who does the newsletter, your coverage from the capital how to keep the human dimension in mind as youre covering these big policy fights ms. Owens i think it is hard. It is such a political fight. You forget that, i mean this is not just a back and forth about who is right and who was wrong about health care. There are millions of people who really i mean right now, obamacare has been in place for what, three or four years . I mean, people are enrolled. This is peoples coverage. The thing about health care, it is such a personal thing. It is your family, your medical care. So while we are out here in washington fighting about, do we repeal and replace or not we are going all the way to singlepayer, i mean it gets hard to forget that there is a lot of people waiting for these decisions to be made. And kind of far along for the ride. So, Caitlin Owens, a key part of journalism is being there. Every time i pop into the capital for lunch or something, you are there, in the subway, in the elevators waiting for the senators, spending so much time literally enough building. It was a great source video on axios, one of our projects or videos called source. It takes you there, the reality of politics and reality of health care. It is a great source video of you by the elevator where you spend so much time. What was it like to be in that building yesterday . It was a day of high drama for people in this room and others around the city who feel so passionately about these battles . Ms. Owens you know, i think the crazy thing about the healthcare fight is how quickly everything moves. Which is everything everywhere. Which is ms. Owens yes, exactly, so yesterday, we did not have much notice that a deal had been made. Was it enough that the policy lunches . Ms. Owens during lunch it was like ok, they have a deal there briefing and then and then alexander came out and but then there are some questions about what does the president think, what republicans, where is the bill, what is the impact we does this work . So many questions to answer. So you will be joining us with each of the three senators. Caitlin will join us with questions to make sure i dont mess something up. Lets walk through the three guests today and tell me why they matter in the scheme of things. Our first guest will be senator first guest will be senator tim kaine, a democrat in virginia who is a member of the Senate Education labor and pensions committee. Tell me his role. Ms. Owens first of all i think everyone knows im very excited about the three senators we have today. I think that they might have known that today we had a big event so they struck a deal yesterday for us. But you know so senator kaine, he is a democrat on our panel today. He is, i think i mean he has been out there from the getgo. He was at all for Health Committee hearings. People go in and out and they dont want to listen to the whole thing because it is boring at times. He has really been pushing for this bipartisan deal. I think he really has made a good faith effort to meet republicans in the middle. And his interesting thoughts about where the Health Care System goes from here besides really the partisan ideas. Second will hear from senator cassidy, republican, of louisiana. He was also a member of Senate Health, education, labor and pensions committee. He has been a headline name all year in health care. Those quickly why he matters. Ms. Owens he is also on Senate Health, education, labor and pensions committee. He supports the deal that was struck yesterday. He is the author of the plan republicans say they want to go back to early next year, Cassidy Graham. And i think the mind turns into a grant. I think he will have some ideas about where we are going after this deal if it passes. And how it did not pass last summer. And then we have one more incentive . What is number one thing that you would like to learn from chairman Lamar Alexander today. Ms. Owens i think Everyone Wants to know if this is going to pass. It was going to become law . Do we have a future where it is conceivable that health care is something that create such a partisan warfare . And what do you think is the number one thing that democrats would want to know from senator alexander if they got him on truth serum . Does he still want to repeal and replace, is what they want to know. Where do we go from here where do we go from here . And we will try to answer that today. Caitlin owens, thank you for your coverage. Thank you for telling it why it matters. Thank you very much. For those of you for joining us, i am mike allen, cofounder of axios. We would like to welcome cspan and axios online at axios 360. We like to think delta dental and now we would like to welcome senator tim kaine. Thank you for joining us. Senator kaine good morning. It feels like clubbing at eight in the morning. They have been here all night. Senator, going back to the days, youve been my mayor, my senator and my governor. Senator kaine i knew you when you are a club reported value in international figure. Mr. Allen the bios on a pretty standard but yours actually has a pretty nifty backing. How can you possibly know that youre one of 30 people ever to exist that was a mayor, senator and a governor . Senator kaine i was introduced that way once at an event. And i say clearly that is wrong. There has to be more than 30 people that have been that. So i went back to the Senate Historian said i was introduced this way, is this accurate . There have been so many governors ive been senators but they said yes it is accurate. Then i remembered why. Being a mayor will tell you. Mr. Allen big news yesterday on healthcare, the introduction of a compromise plan by senator alexander will be hearing from leader and patty murray of washington. This is a republican, democrat, what do you support . Absolutely, and just a little back story. We need to show the American Public that we can do something bipartisan on health care. And i have been making the argument that even something modest that is bipartisan in this very controversial area will be a good sign. Mr. Allen your acknowledging that this is a bridge. Senator kaine yes. It is a bridge. I think it stabilizes the toughest part of the insurance market. If we can get it passed. Put that if in front of it. It has not tested. The way this came together and you will hear this from Lamar Alexander, after the skinny repeal failed in late july, we started talking about now the door opens for bipartisan solutions. Senator alexander and i did a dinner about five days after that failed vote. We got 14 democrats together to talk about the essential concept which is, how do you guarantee the costsharing payments to avoid this uncertainty that the president has created . And how to give states the flexibility that the aca intended for states after the waiver process but many states have felt has not allow them to have the innovation and flexibility that was originally intended . And then obviously that was a discussion that were not just in the community but beyond. Lamar have ambar fantastic track record of being good negotiators. It has been slow and steady and we were almost there two weeks ago and the president poured cold water on it because he did not want to see whether Graham Cassidy could get a vote. But it was a delaying tactic, not stopping the discussions and it was good to see that they reach that final accord yesterday. You have working on the scenes with senator alexander. What do you see them do behind the scenes to maybe, in spite of some parts of his party, to pull this off . Senator kaine i could go on and on about that. Let me Say Something that you did really well in then something that patty did really well. What lamar did was isolate and narrow the problem. Health care is a lot of challenges. There are a lot of ways to improve it. But lamar has been very focused on the individual market. Youre trying to buy Health Insurance not through an employer, it continues to be tough. So he focused on this particular problem, and focusing i think was the thing that i would say what patty does, she has two republican houses and a republican white house. To be able to negotiate and get a deal that protects for core democratic principles for the essential Health Benefits, protect their people with preexisting conditions. But to know that i have got to work with to republican, a republican chair but it has to go through did to republican houses. She has done it again here. Mr. Allen senator, in the spirit of a health care event, lets put on your lab coat. Lets get clinical. What are the chances that this compromise will pass . Or what are the chances that this will come to a vote . Senator kaine i think it will. My prediction is that it will pass as part of some kind of a mustpass a piece of legislation. Mr. Allen such as senator kaine it could be the year in the appropriations or something else. Im not sure that will go through sand along all the way through but i think it will be connected to something. That is my sense now. Mr. Allen senator, you made the news of your honesty. You introduced medicare x. It sounds futuristic. Senator kaine this is by all accounts, even the president said this yesterday, he praised lamars work and said this will be good for a couple of years, we sought to have discussions about improving the Health System. You will hear from senator cassidy is not only senator but he will talk about what he thinks a big idea is. And i have one, too, but it was important to stabilize for the near term and that have a more deliberate discussion, not under pressure about the next big idea. We basically say that will hear from our constituents, its what we hear from the republican colleagues. People should have more choices and there is a real problem. In 2018 there will be 1500 counties in the United States where they will only be one or no Insurance Companies offering policies on the exchange. Mr. Allen say that again. Senator kaine in 2018, and 2017 there are about 1200 but in the next year prediction is that there will be 1500 counties in the United States that there will be one or no Insurance Companies offering policies on the individual market. They write Group Policies but not to individuals. This has hit Rural America the hardest because the world america tends to have a higher percentage of people on the individual markets. So an Insurance Company will often, these countries tend to be rural and there are fewer patients because they tend to be a little bit sicker, and it hits Rural America hardest. Michael bennet and i hear our constituents want more choices and more affordable. We have medicare x which is the idea to take advantage of medicares provider network, reimbursements schedule, and low administrative costs. Take advantage of that. Direct the hhs secretary to write an insurance policy that would cover the essential Health Benefits under obamacare. And offer that policy on the exchange. So the x is for extra, x is for expanded, and we will have it on the exchange. We would roll this out in 2020. In all of the jurisdictions that have one or no insurance policies good and by 2023 will be available everywhere come by 2024 it will be available on the Small Business exchange. Mr. Allen what would republican what republican cosponsors do you have now. What we dont have any right now. It is a problem for now but here is the way i look at this. Lamar and i talked about this. Now is the time for us to talk about the big ideas. If we can get Alexander Murray asked. Lets have a deliberate discussion about the big ideas. Bill cassidy has two different goals. He is the Graham Cassidy but he also has collins cassidy. Im sure there are things that he would want to put on the table. Bernie sanders is on the committee he has a single pay your bill. That problem is wanting to gymnast through without votes. Use the Committee Process because as you know, this committee, lamar was a governor and knows medicaid. He was the university of tennessee president. Patty is a fantastic negotiator. You have doctors on the committee, another governor, maggie hassan. You have people on the committee that are doctors, run medicaid programs, insurance commissioners. Now is the time for big ideas to come to the table and be discussed in a deliberate, careful way with transparency. Mr. Allen is a long road what it you think the time is right. Senator kaine i do. The more and more that people constituents are saying, i live out here in rural colorado, rural anywhere in theres just no options for me. I dont think that we are going to long tolerate big parts of the population not being able to buy insurance on the individual market. Mr. Allen talking about big ideas. You are the Vice President ial nominee last year, youre from one of the most important states, commonwealth of virginia, in president ial elections, to think big about your party, are democrats moving too fast to hug single payer . Senator kaine i dont think so. Bernies singlepayer bill has 15 democratic sponsors. Mr. Allen it has almost become a litmus test for people that want to run a 2020. Is that a mistake . Senator kaine i dont think ill call it a litmus test. You will have to decide what they think works best. Rather than comment on why some people say that singlepayer is the idea, i just think that we have come up with one. Singlepayer and Cassidy Graham both turn the system topsyturvy. Block grant is a different system. What we do with medicare x is we take advantage, we just stick you right where you are. No new taxes, mandates stay the same. Subsidies to low income people stays the same. We just add one element, there will be an additional offering on your exchange. So we take advantage of the system as it is. We do not blow it up. We had one element to it. But what is the right way for the health care future of this country . Is it to work with what you have and add an element or two or turn it topsyturvy . That is the kind of thing that is worthy of a good decision. Mr. Allen Caitlin Owens, i am going to come to you in a few seconds. But, senator mccain, do you believe that the nation needs a singlepayer Health System . Senator kaine do you believe that the nation needs a singlepayer Health System . Senator kaine i do like more choices rather than fewer. So if someone wants to buy individual market, people by all the time. If they want to, fantastic. No skin off of my nose. I just want people to have more options and have them be more affordable. Mr. Allen Caitlin Owens . Ms. Owens hello, senator. Youve been talking about, youre trying to take a middleoftheroad approach. You have been very proactive about this bipartisan stabilization deal. You have gone a lot more towards development some of your colleagues. As you guys are talking, as the party of a whole is talking about singlepayer and whether or not to do it, are you afraid that this is going to become kind of the left version of repeal and replace where you know, to be frank, it is an idea that parties rallying around, is a but everyone knows there are not votes for it at this time. Does it become this mythical thing that you guys are campaigning on and chasing and talking up with your base that you cannot pull off . Senator kaine we are in a room of health care people. I dont think theres anything more with putting big ideas on the table. There are big ideas on the table, i would say the block grant idea is a big idea, very different. I think that mine is big even though it takes advantage of the network. But there is also some ideas on the table that are much more like built out of a bipartisan backgrounder. For example, tom carper and i had talked about a National Reinsurance program. Everyone knows that there was a reinsurance in the first three years that expired. That is for highcost claims. Premiums down for everybody and established this mechanism. That it would be productive, and Insurance Companies would get certainty. We want to bring reinsurance that because we used it for three years with republican support. There are big ideas on the table but i am not sure a lot of democrats will sign on it. And im not sure a lot of ours will sign on. There are the Alexander Murray bill gives a little bit of a push. We can conceive of doing Something Like that. You will see ideas that will spread the zone, and maybe also some ideas that will enable us to do alexandermurray chapter 2. And that is a bipartisan thing that we do. I do think congress owes the American Public some important thing where we say, look, we can work together, and work it on something that has been controversial but that is really important in your daily life. And that is why we need to focus on getting the deal passed, send the message, and then sometimes successfully get this done. Mr. Allen Caitlin Owens, are you good . Owens senator kaine her face says nice try on the offer but ms. Owens the singlepayer set you guys up for you now disappointing your base. Senator kaine you know, that is a political question. Im trying to do something for people. I disappoint people every day and i make people happy every day. That is just my occupational hazards of the occupation i got into. My thought is, ive always felt as mayor or governor, good politics. Advocate your best idea. But be open to listening to the good ideas of others. I ensure that if we get medicare x passed, it will not be as we wrote it. We will have to make changes according to others. No one should be afraid of making their case in the process. Mr. Allen in the last couple of seconds we are going to touch on, youre just back from puerto rico. Tell us when you are there and with the bottom line is . Senator kaine the magnitude of the disasters hard to convey. But when i was there, i was there two saturdays ago with a 10member delegation. I suddenly realized that i am back to being a governor. Have had a massive hurricane in virginia. It knocked out power in 1 4 of your state. In the rest of the state the hospitals are running and their hotels are open and schools are functioning and people can move a little bit while youre trying to fix this one part of the state. Puerto rico 78 municipalities, the heart can cut across from southeast to northwest of the island. Every locality lost housing, power, road access, access to water, access to food, access to health care, schools are not open yet. Every jurisdiction. They cannot move people here were there and the response has not yet been you know, a response as you are every bit of an american as somebody in texas or florida. In virginia there is a hurricane, i would go traveling around as governor. I would see the indiana utility in virginia trying to get the grid back up. There is Mutual Aid Agreements where we help each other out. I did not see them puerto rico. This or allen how would you grade the Administration Response . I would put it as a d response. Whyt know where the the Mutual Aid Agreements were not put in. Some people say we didnt ask. But we said we did ask but you are not sure you will get paid. I mean, the governor told us that four weeks later, which will be six weeks after the hurricane, he hoped to have power at 25 . Where else in america, would people tolerate this, if power is back on a 25 percent of the state that is okay . We would not tolerate this anywhere else in the United States. And these are american citizens that happen have one of the most notable records of service in our military ever since world war i. We should not tolerate the intolerable, another good tweet there. Your thoughts about the president s statement on iran on friday in the context of north korea. The three problem with the president what he is doing. This might be the first in the president is elected and just make me mad but really sort of scares me. He said it did not just make you mad . It did not just make me mad, it really scares me. And here is why. Three problems. When the head of the joint chiefs and signatory of defense executive status and publicly, iran is complying with the deal. When the iaea says iraq is complying with the deal here when our eye lies are saying iraq is complying with the deal, a step backward for is extremely problematic and it suggests what we do not value diplomacy anymore. Remember this, the iaeas are to us in 2003 iraq did not have a weapons of mass destructions program. Bush Administration Says what do they know . And we went to war. And it turns out that the iaea was right and we were wrong. So goes back to politicians trying to overrule or tarnish these experts. That is number one. Number two, if the president said that he wants congress to rethink the deal, well if it will be renegotiated what will iran renegotiate . Give us back some of the rich uranium, centrifuges . This can put iran back on the path to finding a Nuclear Weapons program. Which would make the world more dangerous. And finally and most important, were in the midst of negotiations with north korea. What are the chance of getting a diplomatic deal with north korea in a Nuclear Program . Less than 20 percent but more than zero percent. If china can leverage it, he could find potentially, and secretary tillerson and james mattis said over and over we are diplomacy first. But if he said he is will back that have a deal that is being complied with, you dropped the chance to zero that we will ever get a deal. The president should not put cold water on diplomacy. You risk the unnecessary risk of war. Kressa gave us a great tour of kressa gave us a great tour of the landscape of healthcare where you are on the front lines. This is such a dynamic area. Can you come back in six months and tells the progress . Yes. Thank you so much for joining us. [applause] thank you very much. Well see a quick work from delta dental and i will be right back. My favorite line is that we are trying to save south dakota one tooth at a time. There are challenges obviously, transportation, getting to places. Some people are phasers not even are faced with not even having water. Not able to brush their teeth. We see a lot of kids that have never been to the dentist. So they do not even have an idea whats going to happen. We have a place in northwest south dakota we can drop a landmass the size of massachusetts and not hit a dentist. So we take this to the people. You dont just buy a truck and start delivering care. You have to have the site and willing to do the work ahead of us, had to make this a successful visit. Youve got to have the staff, you have the heart in the right place. Bringing this here in our community is a huge asset to the people. I have had parents coming just thrilled that their kids were able to get their teeth pulled, cavities filled, able to get a crown. A lot of medicaid patients around here. Theyre just not accepting anymore. So this means an opportunity to get their kids taken care of. Your smile is how you get your first job, it is how you first meet people on the street. It is everything. It is the confidence that they have, it makes such a big difference in their lives. Just watched some of these kids smile and you know the power. It is the smile inside that makes the difference. When they feel like they can smile, that gives them the ability to do anything. Thank you very much. Now we are honored to welcome to the axios stage, senator bill cassidy, republican of louisiana. Member of the Senate Health education labor and Budget Committee and an actual doctor. Doctor senator cassidy. Thank you for joining us. [applause] thank you. Tell us what you practiced in when you did honest work. Gastroenterologist. And on the campaign trail there is a gastroenterology that prepared me very well for politics. [laughter] if youre less than 50 are wondering if you are over 50, you get that joke. [laughter] senator, thank you for joining us on such a newsy day. We had Lamar Alexander, patty murray, we support this compromise. I have not finished reviewing it but it looks pretty good. The way the Obama Administration implemented some things has been ruled unconstitutional. Congress received this and done something. There is an ability that the state can lower the cost of healthcare. It is very positive. The transition is a couple of years. There needs to be something more permanently but it allows something permanent to be implemented with in the interim. Expect the president to support this to. He has said that he would. So i gather. I did not have the comments but i have been told so. At the same time he has endorsed an approach like cassidy or Graham Cassidy for the longterm. What would you say is the outlook for this . Will it become law . I think so. You on the front lines of this with your own plan. Did you rush it too much . So lets set the stage a little bit. Tell us your plan and what happened. That is not a yes or no answer. Our plan was, if you will, it began with Cassidy Collins. Which is the vision that states that in mind and program. States could implement a program. Senator tim kaine talked about block grants are topsyturvy. Well know, a state can receive that plant and do exactly what theyve been doing. Nothing would have to change for the state. But if you are a stately tennessee where the individual market is totally imploded, of course i mean, it is already topsyturvy. We need to do something different. So cassidycollins effectively was a block grant to states. Worked on that and attempted to socialize that with the other party. For about eight months. And no one was interested. So when the republican leaderships bill failed, i had about three to four weeks to put together an alternative. Now, if you say didnt happen too quickly . Well, in one sense if you consider cassidycollins then i would say no. But if you say that grahamcassidy which was different, but still had at its core, giving states the option to do what works for them then i would say no. But on the other hand, to get the policy changed, we working 18 hours a day, seven days a week. Do not have a chance to push back on the left which was misrepresenting the bill. And in that case, it clearly was done too quickly. And senator tim kaine criticism is a fair criticism. It did not go through the Committee Process. I totally accept that, i did not control that. It was dictated by the short term. In retrospect, what did you learn about what it takes to socialize and get people comfortable with such a massive change . Again, im going to dispute the idea that it is a massive change. Acceptance so far that some states in which these status quo is failing we do things differently. But california, if they love what they are doing and they can do exactly what they are doing. So what did you learn about what works and what doesnt work . What i learned is that some people are going to push back any way in which, if you have like they scored the bill over 11 in 20 years. When we wrote it for 10 years. So of course, they had all these people becoming uninsured. But it was your 11. We ran it through the chip program when it had to be reauthorized just like chip is regularly reauthorized with what i have been a fall off. But if you scored over 20 years and it does look like over 20 years, we only have it for 10, it does look like there is 1 trillion and fewer resources for states. Standard and poors picked that up. So you have to realize there are people that will push back however, misleading and then that will be echoed by others. Okay so we can argue about different scores. But just to talk about reality. Probably for republicans it is that all have the protections for preexisting conditions are ran throughout. They have all kinds of places and republicans have to figure out where theyre going to draw a line. And if more states have more control, there are some sick people who will be worse off. I disagree with that. It reveals the prejudice of washington, d. C. Which is that you cannot trust the governor. It really is interesting. There is a thought that people have to be protected against a venal, corrupt governor scheming to take away their Health Insurance even though the governor typically is up for reelection or has been recently reelected. Now i say that because the bill, we specifically says that if a state wishes to do something different, habit waiver, they must show that whatever they do. Let me see if i can remember this exactly. Is adequate and affordable for those with preexisting conditions. This agreement that we just agreed to, again, i am told but not have read this myself. That the waivers now just have to show themselves to be of comparable affordability. You can argue there is vocal theres wiggle room there. Now, that is basically the kind of language we have. And let me if there is somebody here on the individual market, and earning 401 percent of federal Poverty Level for a family of three about 82,000 a year, you cannot afford the policies now. In my state, you can pay anywhere including deductible and premium 30,000 to b 45,000 a year. That is affordable for a family with a preexisting . Of course not and by the way they Fact Checking on that. Turns out that glenn did not know it before hand but turns out i am right. No pinocchio. None whatsoever i am on a 30second sound bite have give context to but he checked what i referenced and i think he said that the total to be 46,000. That is affordable . Of course not. Now that is status quo. Under our conditions, we actually give it to the states allowing them to come up with a system which is affordable and we think our way isbetter. Lets put the camera little bit. To repeal and replace, the number of people whose coverage will not be zero. So how does the gop figure out where to draw the line . We can have more coverage under Graham Cassidy then status quo. And by the way everything youre saying i am disputing that that was echoed by the left. If you actually think about what we propose, we would allow states to do so called, automatic enrollment. Example is medicare. If you turn 65 year on medicare. It is about a 99 percent pay cut. We will allow states to do whats called automatic enrollment. If theyre eligible, you get a premium sufficient or get a credit sufficient for your animal premium. In that way all these young are in the pool. Helping lower the overall cost because youre spreading this over the many healthy. We would end up in that scenario then more people would be involved in the status quo. You are committing yourself to a plan introducing and supporting a plan under which the number of people that with this coverage is zero. Who would lose coverage is zero. It would be up to a state. Because again, washington d. C. Does not dictate. But it is in the best interest of the state to have as many people in short as possible. And by the way, i am all about people having coverage. My background as a dr. In the Public Hospital system was trying to bring coverage to those who did not. And right now, we have families im told, 6 Million People are paying the penalty as opposed to purchasing insurance. 70 percent of those households have adjusted gross income of 50,000. I am committed to those working families being able to afford insurance under status quo, they cannot. Senator cassidy, do you plan to revise the plan and revive efforts in 2018 . And if so how . Yes. Obviously, there are things that have to change. We won last year for a different set of years for the 10 year window. Were going to socialize it. Virginia, senator tim kaine was right. There should have been a Better Process. There under ram cassidy so your senate should have been a better yes all along. But it was sort of a function. The failure gave us until the end of september to put it together and we were able to Research Much of the time. Doing other things always a but no committee hearings. But senator kane mentioned there should be a Better Process and i agree with that. But under grahamcassidy, there would be billions with a b more in virginia to care for working families. And they have a history of talented governors who would be able to take those dollars and do something in virginia that would expand coverage for the working uninsured. Similarly, missouri. They would get billions more under Graham Cassidy. People said this was a partisan bill. I just listed two states represented by Democratic Senators but i can also list maine, florida, wisconsin, indiana and others that would do far better under Graham Cassidy then under status quo. And they are represented by democratic senders. Senators. The 2018 is the same congress, the same players. You do not have the votes. What do you do . Some complain about the process. We now have more time for a Better Process. I would like to think that we can socialize this among our democratic colleagues. They are finally showing a willingness to give a little bit on the aca. And so, have given a little bit. And this deal that senators murray and alexander worked out. Maybe now, they say well, this is okay for working families. Families that cannot afford insurance now. Maybe i need to look at this a little more closely. Not through the lens of partisan politics. If this is the case we win. Caitlin owens i will come to you in 30 seconds. But what did jimmy kimmel make, any difference . A couple of things. Jimmy kimmels son, and how can you not feel for this trip and he was born with a congenital heart disease. It is been sometime since ive been in the delivery your wife is a doctor, right . Yes doctor laura. Retired Breast Cancer surgeon. But i can imagine what happens. The child was born, the nurse and dr. Immediately realized the child was blue. They quickly made the diagnosis. And they knew the child would die. Probably before the mother and the father held the baby was on his way. Who cannot relate to the emotional response . And i think that First Episode in which i you know, referred to him said that we should have a test to make sure that his child is addressed and the needs are addressed. Help define the terms of the debate. That was so positive. Now he later came after me and talk to schumer, never called me. I wish that he had. I wish he had. Not to confront but to explain. Under Graham Cassidy so did you talk to jimmy kimmel . No. We will make that happen. Please. [laughter] under grahamcassidy, there will be families in virginia, texas, florida, maine, indiana, missouri, i can go down the states who would now have access. These days and have billions of dollars of resources to help purchase insurance for those and help families purchase insurance in ways that otherwise they would not have. Did the courage of Jimmy Kimmels statements, the support of the capital did it cost you votes . I do not think so. The democrats were not going to vote for it anyway. It could be the end of the world and they would not vote for. When i was trying to push Cassidy Collins they were not Caitlin Owens. You cover a lot here. Theres a lot to go over. Do something i want to touch on with the idea that youre saying you do not know, no one will lose coverage on your plan. Im saying is that you have the ability to put in plans that would avoid that or expand coverage. I cannot dictate what a state does. And then talk about democrats. The good thing about your plan is that it shifted money among states. It was a big shift and states that did not expand medicaid, generally benefited. And a lot of those are red states. Blue state that did expand medicaid, they lost a lot of money. California being a great example. Billions more in resources to support the plan. How do you justify that loss in california . In turn, how the u. S. Democratic senators to support your plan how do you ask Democratic Senators to support your plan . The way i phrased that is the answer. Claire mccaskill gets billions more under the status quo begs the answer. Of course the people in the state do better. Earlier transfer of wealth if you will of blue states to read. To red. Not really. The red states, which have not expanded, do have a significant growth. But the blue states, which already expanded from end up with more money because they get a set amount over time and the red states are growing over time. By the way, the red states including virginia, missouri, maine, florida, all represented by Democratic Senators, so i reject that its partisan. By the way, we also work to mitigate. So under Graham Cassidy, new york was held harmless. And massachusetts was held harmless. A couple of states did have money relative to the current wall that they lost. Let me ask you, should the federal taxpayer be on the hook for no matter what extent it expense the state passes on to the federal taxpayer . If you have a high cost to states which is deliberately put in the system of care that is known to be a higher cost than other states. Should the federal taxpayer subsidized those decisions . If you say yes, theres no hope for controlling healthcare costs because the state legislature can get a special deal to this union or special deal to those hospitals or special deal the federal taxpayer should have the ability to say there should be some cap on how much is going out if you compare this to other states. One more thing i will say, states actually have the ability to reimpose some of the penalties that grahamcassidy did away with, for example the employee mandate and individual mandate. If you reimpose the penalties, that gave the state a heckuva lot of money that they could then use to subsidize their system. The head of covered california was reinstituting the Health Insurance fee i think it was for reinstituting one of the fees that was going to be lost under the executive action. He was going to use that to subsidize the policy. States could have done that which i just said california approved the example, california didnt have to lose resources. They would just have to leverage themselves as opposed from getting it from the government. Its been a great conversation. So youre going to stay at ground zero on the front lines. Would you come back in six months and update progress on this area . Absolutely. Its an lsu time. Go tigers. Something you have in common with James Carville . He is a big lsu fan by the way. [inaudible] [inaudible] lsu football you can sit there and rub shoulders with people that you otherwise disagree with and who cares. We should be able to put politics aside. [applause] thank you very much and now we are going to hear from jason, delta president of relations and then we will be right back. Thanks, mike. Good morning everybody. This is part of the program where someone reads to you, so get ready. In all seriousness, i hope that you enjoyed and were moved by the video that we just watched, because it truly captures who we are at the delta dental and what we care about. I understand we are not here to talk specifically about dental care but its our belief that the current policy conversation needs to include oral health. Polling shows 90 of americans view dental benefits as a welcome part or critical part of the public debate about health care legislation. And according to the Kaiser Family foundation, in 2015 more than a quarter of uninsured adults believe or went without delayed or went without needed to dental care due to the cost. Importantly, research from the institute of medicine, hhs and many other sources show oral health is a critical component of Overall Health. Good oral health is a positive effect on Overall Health and wellbeing, reflects General Health conditions and social and medical impact of oral diseases in children is substantial. To be happy and healthy, americans need access to highquality medical and dental benefits. Everybody needs both. As healthcare reforms discussions move forward, we believe oral health must be a part of the conversation to ensure americans achieve optimal Overall Health. As the largest and most experienced provider in the u. S. , we believe delta dental is the perfect partner in helping americans achieve optimal Overall Health because at delta dental, we live and breathe oral health. It is our own money priority. It is our only priority. We consider this partnership to be an exciting opportunity to elevate this issue and the broad Health Policy conversation. Thats why we are underwriting this event and another that we will hold next year. Thank you all for joining us and now i will hand things back over to mike. Thank you, jason, for the partnership. [applause] thank you for making this and now it is our honor to welcome to the stage senator Lamar Alexander, republican of tennessee, chairman of the Senate Health education and labor committee. Mr. Chairman, thank you so much for coming. [applause] so senator alexander, ive been covering you since i had hair. [laughter] that is a long time. So, theres always the the newsbreak and kaitlyn just whispered to me you just got off the phone with President Trump. What did he say . He called to say number one, he wanted to encourage me about the bipartisan agreement that the senator and i already announced yesterday and number two, he intends to review it carefully to see if he wants to add anything to it. Number three Companies Still for block grants later on but he still wants to focus on tax reform this year. That is i was thinking this morning its a sort of parlor game around washington as if President Trump doesnt know what hes doing and in health care,healthcare, he probably does. In health care, he probably does. In september, against the advice of paul ryan and mitch mcconnell, he sort of cleaned out the last half of september so the senate could consider the cassidy grand duel you just talked about. The cassidygraham bill you just talked about. He completely engineered the bipartisan agreement that the senator and i announced yesterday in this way. He talked to senator schumer and encouraged him and called me twice over the last ten days to talk to me about the bipartisan agreement for the shortterm bridge the people are not hurt. Shortterm bridge so people are not hurt. And he checked in this morning. Why didnt he just say that he is for it . What we are going to do is we have a number of republican and Democratic Senators we are going to introduce the bill thursday or put it on the force of people can see it. Then we will see where it goes from there and my guess is that it will be a part of the discussions between the president , speaker ryan, senator schumer, mitch mcconnell, and i predict that it will pass to reform by the end of the year. My experience is that it usually most ideas fail for the lack of the idea, and this is a very carefully thoughtout compromise that advances some republican principles that havent been advanced in eight years. So, i think it will happen before the end of the year, and i appreciate the fact that he encouraged me to do it and i understand the fact that a president , whether any president would want to review it may try to add something to it and make it part of a larger negotiation before its done. What did he indicate as far as the general feeling about it and did he indicate [inaudible] he hasnt read it yet. Hes been busy and just received it yesterday afternoon. He called me 10 days ago and i was encouraged in the fact that he was willing he understands the Graham Cassady bill or any other to repeal and replace obamacare doesnt take effect until 2020 or 2021, so what do you do in the meantime, and what you dont want to do is create chaos and hurt millions of americans by skyrocketing premiums. And some counties where they cant buy insurance because the Congressional Budget Office says without the costsharing payment of to 16 million americans might live in counties where they cant buy insurance. Well, what is chaos does chaos duplex is a four lane highway to a singlepayer solution. Its a present for bernie sanders. I think the president is pretty shrewd to understand that there is a gap here that needs to be filled and the only way to solidify the bipartisan agreements likeagreement like bipartisan agreement like the one we suggested yesterday. And you eluded to the fact sometimes there are questions about the president s master policy that you said in healthcare you believe he does know what hes doing. Tell us about that. I think i just did. In september, he cleared the way so he could deal with the cassady bill and in this case he recognized there is a gap and he worked with me and patty murray to produce a agreement to close the gap. What do you believe based on what you said on what you believe the goal is that he is trying to achieve. Its the same as mine which is to move more decisions about the kind of policies that are written for americans to buy Health Insurance out of washington doctor the states so out of washington, back to the states so people have more choices and lower prices. That is 80 of the dispute that has created the stalemate over the last eight years and by the way the three or four steps in the alexander marine murray agreementi that move in that direction it is the first that weve had in eight years. Theres also a compromise, said democrats have some things to come about you dont get a conservative win without a result. And we havent had any results. We have a lot of speeches and lost votes. That is not a conservative victory. Chairman alexander, you are sitting down with some coffee this morning or youve been to the gym and relaxed. So you can take this question. Do you expect or want republicans to advise fullblown repeal and replace to change in 2018 . I expect the president to introduce a bill to do that. And if he does and its the same bill that he introduced before. I would vote for it. Do you believe that it will pass . I do not predict the senate very well. [laughter] although i did predict the alexandermurray agreement in one form or another would pass before the end of the year. I hope it will. The major problem in the Affordable Care act is one that i just said which is too many of the decisions about the kind of entrance policies that are insurance policies that are written are written in washington and it doesnt take into account what happens in the states. And in this case as a former governor, i know we want to help people even more than washington do, we can offer more choices and that is what it is about. First, is there any risk in the way this is being done is there a risk Insurance Companies will say this roller coaster is too much and it isnt worth losing control . Exchanges are not worth the trouble . No, i think that the bridge to whatever comes next is something that Insurance Companies can easily plan for. 2018 rates are mostly set. But they would now have 2018 to they had they would have plenty of time to make the 2019 rates. What we would do is find a mechanism to make sure consumers get the benefit of the costsharing payments in 2018, not the Insurance Companies and in 2019, consumers automatically will get the benefits. I would expect if we pass the agreement before the end of the year, it will have an effect in 2018 and it wont go up as much. And then the rates will go down. Are of the great minds of the Republican Party, someone actually knows the country as fast country. Someone who actually knows the country. As you look ahead to a tough Midterm Election next year do you support the repeal and replace or do you not 100 i dont look at life that way. I am a resultoriented person. We announced an agreement yesterday. I went to get something done wireline here. We did that with no child left behind and that is as the wall street journal said the biggest evolution of the state in 25 years to was the result and i dont know if we get elected or not elected based on that, but i would like to see us succeed on changing the Affordable Care act. Theres a variety of ways to do it. We have shortterm agreements to start with, the executive orders are another way. But we do need to take a new look at the Affordable Care act and i would like to see the power moved back to the states. I think that would i dont know what the effects of that would be in the november elections but its what we ought to be doing. Take your point on no child left behind. You are talking to a young senator, someone who wants to be a leader, who wants to come listings. What is the secret to passing something bipartisan and pulling off something even modest . Its no secret if you dont know each other you dont know the areas of agreement and number two, dont try to do something comprehensive, go a step at a time and go where you want to go and number three, you have a lot of patience. Number four, keep your word. If you do that, you get a result. I like working with senator murray. I know shes part of the democratic leadership, so we do not agree on a lot that she could do all those things i just mentioned Caitlin Owens. The first one is about the deal that you reached yesterday. If the Republican Party and the housesenate pass this bill and sign it into law, is this a win for republicans and is it something that trump gets to say that he is forced a deal were and deal or going in the november election they say say the only passed the insurer bailout . A conservative victory requires the result. Its been eight years. We have 50 votes to repeal obamacare and we lost them all. We got snow results. Weve had a thousand speeches and we have no results. There are three or four results better than this compromise. One is the catastrophic plan for the first time for people of all ages for the catastrophe that doesnt turn into a financial catastrophe and more importantly the change in the affordability guard rail gives more states opportunities like the alaska waiver and open oklahoma and New Hampshire waver all of these are different ways of doing things and as i said earlier the single biggest objection is to move objective of republicans is to move decisions out of washington back to the states. It also encourages interstate compact on Health Insurance and streamlines. Thats four results in this compromised agreement that conservatives have achieved in eight years despite all the votes and the speeches. Thats what i would say to the people that ask me about it. Do you think if this passes, the president could say that this is a deal he influenced . If this passes, how much of an impact does trump have and is it something that he can see say he owned and is responsible for . The president engineered the bipartisan agreement by calling me and asking me to work with senator murray to do it. I talked with him three times in the last ten days including 30 minutes ago. So, he has it out there as an option. If he decides in the end to make it part of something that he signs, then of course it will be something he supports when he gets there. I think hes been pretty shrewd , giving himself an option to give three or four conservative wins on the way to try to get the block grants again. As senator alexander and not speaking for the entire caucus , you said this is a bridge to whatever comes next what is your ideal version of what comes next . Bill cassidy does a good job with his bill. He has time to improve it between now and the time he comes up but it is pretty fundamental. It allows the states to make more decisions about a variety of policies as a goal of having more prices and choices step to lower prices and more choices. Withis the difference obamacare. Step one is the executive orders the president issued last week. Step two is making sure people are not hurt and we had a few conservative wins in the meantime in step three is whatever we can agree to in a longterm change. Longterm change wont take effect until 2021, 2022. What are we going to do in the meantime . I think that the agreement is an option and i hope it is one that the congress will adopt. Step three that comes after, is that something you can work on . Theres other issues that can be considered like the employer mandate is about to kick in and a lot of the employers are about to get charged a lot of money to repeal that retroactively that would cost money. There is bipartisan support for changing the 30 to 40 hour workweek standard in the Affordable Care act, so theres smaller things that could be changed in step two or three. When you get things like the block grant proposal or the senate or house bill there is a fundamental difference between republicans and democrats. Democrats like decisions made here and republicans like decisions made in the states and that is likely to be considered a purpose in. To continues likely to be partisan. Did you have anything . Is it sustainable to have this debate every time the president changes or do you eventually have to decide on something both parties can live with . It is best to do something durable. One of the advantages of no child left behind as nobody is trying to repeal it every here because we were told and the consensus. It was the most important open congress and it probably was very contentious and harder to do. Nobody is trying to repeal it because we had a consensus very fast consensus. Nobody is trying to repeal it because we had a consensus. We need to eventually get to that on health care it is just hard to do and i think the smart thing to do is to take step one, recognized the win when you see it and make sure people are not hurt. People would like to see us get results and as i said, i will have to say this a lot i guess is that you dont get a conservative victory unless you get a result and you do not get a result in the Senate Unless you get 60 votes. We might be able to get more we might get the block grant with 50 votes, but we will not get the results because the most important ones require 60 votes. Theres been a fantastic tour of the landscape. As you make progress on your project, would you be willing to come back in six months and update us on how things are going . Sure. As we say goodbye, tell us who the amateurs are. Tim kane and me. He has seven harmonicas, one for each key that he knows. And i have to change every time we perform at the resume and roots festival in tennessee at the state line. A couple months ago we had a pretty good time at the birthplace of country music. So we called ourselves honestly the amateurs which is an accurate description. [laughter] deltaould like to thank dental for making this possible and Kaitlyn Owings and my colleagues for their great coverage and those that are so fantastic thank you cspan and the viewers for joining us and all of you for coming out so early and senator alexander thank you for a fantastic conversation. [applause] thank you for joining us. [applause] topic on the Senate Floor Today is the budget proposal. Talking about the proposal as the senate has been doing day. Ghout the it is a measure setting the stage for rewriting the tax code with only a majority vote, not the 60 votes typically needed to pass legislation in the senate. The president tweeting the republicans are going for the big budget approval today. First step toward massive tax cuts. I think we have the votes, but who knows. They have already had a series of votes. More expected later on this evening. At final passage as well. Follow the debate on cspan, we will review the white house separate 3 00 eastern. Sarah Huckabee Sanders will take reporters questions. It is scheduled for 3 00 eastern. Alexanderyou senator from yesterday talking about legislation. Today, he and senator murray