Home in washington, d. C. I would like to thank United Health group for making these conversations possible. I would like to welcome our audiences. You can follow along on twitter using the axios events. Over the next 30 minutes we will unpack the best way to unpack Health Insurance access and Health Insurance coverage in the united states, and what that path forward looks like following the president ial election and in the midst of a pandemic that is getting worse every day. Our first guest today is senator tina smith of minnesota. Thank you for joining us. Sen. Smith thank you, sam. It is terrific to be with everyone today. Insurance has been with us for a long time but how has the pandemic shaped how you view this problem of health care coverage. Do you see that differently now . Sen. Smith here we are in the midst of a Global Pandemic. Thatt is the pandemic asserted in my home to state of minnesota and the upper midwest that is surging in my home state of minnesota in the upper midwest. We had yesterday 56 deaths from covid19, the highest count ever. As we see infections go up, we see hospitalizations go up. And we see deaths going up everywhere. This reveals some of the systemic inequities we have in our Health Care System, some of the weaknesses in our Health Care System, that we have to address. This is a long story for minnesota and people all over the country, the struggle to figure out how to get health care you can afford no matter who you are or where you live. And have access to that health care, no matter who you are or where you live. Covid we know is not the great equalizer. It is revealing these fundamental inequities. Especially as we see in my state and all over the country, the disparities that are revealed by frontline workers, black and brown and indigenous people, older people, rural people, who struggle to get access to health care. So this should be a moment for us to address this. First, we have to be focused on getting this pandemic under control. And i have a lot of ideas on how to do that. And then look how we are building toward a Better Future for have killer and for americans and then look at how we are building toward a Better Future for health care and for americans. One somewhat Positive Side effect of this terrible expense has been an increase in telemedicine, which i know has been very important to you. Side effect of this terrible experience, has been an increase in telemedicine. Ort can be done in congress the new administration to make this step . Sam this is an important point. Sen. Smith in the midst of crisis we often make big leaps forward in innovation. We need to make sure that does not go away as we work away through this crisis. That is very much the case in telehealth. People, inability of not being able to see their doctor, we have seen a massive expansion in telehealth. Four is a go health and Mental Health, where we have a dramatic shortage of providers and shortage of access to care all over the country. One thing i am excited about, how we can make sure these innovations in telehealth, and expanding it does not go away when the pandemic is over. This is something providers and patients have really appreciated and have described to me as a lifeline. Access toot about the Mental Health and in the midst of this pandemic, we know the need for Mental Health has exploded, whether you are a Frontline Health care worker, or whether you are a Senior Living with a lot of social isolation. The upsurge in depression, anxiety, and also suicidal ideation, are going up dramatically. These are things that telehealth can help heard not as a complete substitution for in person care, but as a way of making care more accessible. I want to come back to your point on Mental Health. But really quickly on telehealth, do you think the challenge here is reimbursement . We have seen medicare and medicaid bump things up to try to make change happen. Is it patient attitudes, internalizing, this is the way to see my doctor . Is it something that needs to happen among providers, what . Are the moving pieces . Sen. Smith while a crucial pieces reimbursement. Provided waivers for reimbursement for telehealth, video telehealth and phone telehealth, make sure access to care stood, you need to make sure those higher reimbursement rates are part with a personal visit do not go away. That will make a huge difference for providers who need to be able to have a reimbursement that is sustainable. It is also, i think, partly a shift in out into toward patients. And this is going to vary a lot depend on who patients are. Is one example of this. A story i heard about up person in rural minnesota. Who needed Mental Health care. This person was very unwilling officee to the doctors because it felt so exposed. And there still is so much stigma around Mental Health. However, the ability to get care in the privacy of their own home made it more accessible because they were protected from some of that feeling of being exposed. That is a barrier to people getting Mental Health care, so i think it can work both for patients as well as providers as long as we have reversed mints that work. And so to pick up on your point about Mental Health. We have seen these reports you alluded to, that Mental Health and Behavioral Health issues have really increased during the pandemic, whether depression, substance abuse, anxiety, the whole list you articulated. Clearly, or at least the strong implication is, a lot of that has come from some of the locked on measures and social isolation that is necessary to spare people from a deadly virus. I wonder, is there a way to square that . Telehealth is maybe part of it. What else is necessary to ensure people can stay healthy in both ways . Sen. Smith yes. Well, we have to be aware of all of the risks and costs of the pandemic. Even the costs that are not, i guess you could describe them is secondary. I think Mental Health is in that category. Being somebody who is always looking on the bright side, i believe we are also seeing a greater recognition and willingness to talk about Mental Health as something that is part of our whole health and not something that is separate and apart. We need to take this as a moment to continue to push through the discrimination and stigma that exists around Mental Health. It gets to something i think is very important about steps we need to take to suppress the virus. We have clearly moved past the point where the only two we have in our toolbox is to ask everybody to stay home and not go out. That is just not feasible, particularly the impact of people who are Frontline Health care workers or other frontline workers and this gets to why it is so important we have a and contactting tracing and humane isolation strategy. So people can be more likely to go about their business in ways that are safe. This has to be testing that is not just diagnostic testing, but also surveillance testing, which will be a path toward getting our economy functioning while we are waiting for a vaccine to be broadly available. I have a bipartisan bill to accomplish this with senator bill cassidy from louisiana that is built around the idea of establishing state purchasing compacts to dramatically ramp up access to rapid testing, naughtily for diagnostics but for surveillance. Sam speak, control of the senate is still up for grabs. We are going to be a deeply divided washington no matter what. Health care traditionally is not a wellspring of bipartisan good feeling. So what is it realistic for people to expect in the next year . Sen. Smith i come from the school of thought that says Bipartisan Legislation bipartisan laws come are the , most sustainable laws. We need to find ways of coming together around these issues. Remember, earlier this year we successfully came together with some significant responses to this Global Pandemic with the cares act and other broadly Bipartisan Legislation we passed. The onus will be on all of us, democrats and republicans, and with president biden, to address the needs that americans have. And put aside our partisanship. I will tell you, in the conversations i have had with minnesotans, they do not see health care as a political issue. They see it as an economic issue. They see it is a hugely personal issue about the safety and health and wellbeing of their families, their kids, their parents. And i think that has to guide us as we look for Bipartisan Solutions as bill cassidy and i have around testing and tracing. And, for example, supporting rural health another place where democrats canand come together. Sam that seems like a good place to leave it, senator thank , you for taking the time in joining us today. Sen. Smith thank you, really appreciated. Sam up next, we have a view from the top, axios cofounder and ceo, jim, and the ceo of United Health group. Thank you very much. Sam, is now my pleasure to bring you a conversation with the ceo of optimum health part of United Health group. Heather, thank you for joining us. Great to be here, thank you, jim. Jim can you give people watching of an idea of what United Health group is . Heather sure. United health group serves people across the globe, working to make sure people have healthier lives and make the Health System work better for everybody. We are in many aspects of health care. Our Health Insurance side of the business is called the benefits side, United Health care, many people know about, and are often services encompass our data and technology segments, rx and pharmacy specialties businesses, together with our optimum health services, where we bring Delivery Services through our optim care practices for Delivery Services and enabling providers and health businesses, which are military and veteran support, health goal programs and other complex Care Management programs. We offer those three united we offer those through United Health care and other clients and customers. And we have a global part of our business that serves the countries around the globe. It is a large enterprise with a focus and dedication to health care. Jim so you have some of the best data lenses into what is happening in the Health Care System. Talk about the effect of the Health Care System amid the pandemic . It is the defining topic of our generation. What has it done to the Health Care System . Heather it is a great question. I appreciate that you asked about the health group and United Health groups purpose and function. A little bit of background, know that one of the things United Health group has focused on and it has been amplified by the pandemic, is really an approach to a nextgeneration Health System and, you know, that means a couple of things. It means universal coverage. It means affordability for everyone. It means improved health care outcomes, and it means a better experience for consumers and practitioners, and we have been advocating for them for over 20 years, but also making sure we are part of the solution, working very hard, to advance those, those, those components of a nextgeneration Health System, and i guess what i would say is, what we learned from the pandemic, was that the things that already did not work in the system, you know, were even more broken, but then we learned that as we come together with private and public partnerships, we can advance very quickly, so about maybe a couple of examples. You know, we noticed that you know, we saw surprise billing. Surprise billing was an issue before the pandemic. But it became an additional anxiety for consumers when, during the pandemic, people may have experienced a surprise bill. We know there is a solution to that, Publicprivate Partnership working together crating a creating a median that if we are great will resolve a lot of surprise billing for people and anxiety and reduce cost to consumers and employers by 40 billion. Those are the kinds of things that continue to be exacerbated by the pandemic. On the other side, telehealth. We needed telehealth before the pandemic. In the pandemic, we saw a greater need for telehealth. How did it show up . We were able through federal regulatory and state regulatory support, Publicprivate Partnerships, to bridge the gap in telehealth. We were able to provide more virtually, and as a result of, you know, removing originating state requirements, state boundaries, and i can say even in our own business, take our optim care business we have 50,000 physicians, where already we have provided a million telehealth visits, as a result of being able to, just expand teleservices. So, i think we have seen things we needed to address, as a result of the pandemic, we have been, United Health group, working with partners, working with policymakers, to really advance and move that faster. Jim one more, a couple heather last example, maybe i would give. We could see a Workforce Shortage so advancing a 21st century workforce that is more virtual, that addresses population health, and that cant really go that extra, im um, extra step, to address the Health Inequities weeks health and we with covid as experience as well. Jim once the coronavirus is gone and things are back to normal, how much of my medical care, especially routine physicals, should be done by telemedicine . Saving people trips to the doctor, is that tiny percentage, half . How much . Heather it is a great question and another thing i might point out where learning to this pandemic is that we are learning. We are learning what can be done virtually and then what is really still required to be done in person. And as we continue to adapt to better solutions, you know, we foundering the pandemic, lets take the [indiscernible] for example. Almost half our Services Today as a result of the pandemic, about half of the complaints claims, have been virtual. Obviously that was a result of shutdowns across the country, but in many cases what we found is we are able to give, to provide even more access to people that either as a result of stigma, barriers, or just lack of access, to, appropriate Behavioral Health and specialized behavioral services, really could not access it. So, i guess i would say, we are going to continue to learn, how much can be virtual versus inpatient, as technology and data continue to evolve, as we continue to partner across, across the spectrum of public and private partnerships. We will be able to do even more. The biggest opportunity i think we noticed through this pandemic is the opportunity for people to continue to get their preventive services. Health screenings are so important. And the ability to do that. Some of that will have to continue to be in person but we are committed to being part of the solution to make that easier to access and bringing up closer to home for people. Jim the final question and maybe most important for people who do not have Health Insurance. How do you, like i have health orurance, so if i get sick need to get tested, i am fine. For people who do not have coverage yet, how do you think about that . What is the easiest way to get to where we do have 100 of the population covered in a way that does not slow down innovation in the Health Care System . Heather it is a great question and i think it is on top of mind for everybody as we look for as we look for opportunities to , expand coverage. But i think one thing that is important to start with, is that although the goal as100 , although the goal is 100 lets not forget 90 have , coverage today. And the 90 have stable coverage. Options based on success. It is really the result of proven Publicprivate Partnerships. Again, for example the medicaid. The medicaid program, the medicare and Medicare Advantage program and employersponsored programs. So working from what we already know works. Start with medicaid, already covering 70 million individuals. United health care is one of the largest participants in that program across the country. Think about expanding that in the 12 states that can continue to expand medicaid, and ensuring the individuals who are eligible are presumptively enrolled in it. Always have a choice, but if they are eligible, they can join medicaid. They would always have a choice to opt out but if they , are eligible, they can join medicaid. That would expand coverage. Another example, Medicare Advantage. We found individual consumers save dollars on Medicare Advantage. So, continuing to fund and support a stable medicare advandage program. And modernizing exchanges. United health group is committed to being part of the solution, expanding them and modernizing them, giving the opportunity for individuals who would be eligible for subsidies if they can be presumptively unrolled. Josh and rolled. Rolled presumptively enrolled. Always an option to opt out, but to be able to be presumptively enrolled. That come alone, adds 18 million individuals to coverage right there. And then allowing states to expand, and buying sometimes flex will options like short duration plans, are necessary for certain individuals. I think that is how we expand coverage. Then making sure it is more affordable for people. Being thoughtful about Exchange Programs and making sure Exchange Coverage allows younger, healthy individuals, to pay rates that are commensurate with their Actual Health experience and their health care status. And ensuring, if we work from that space, i think that is an opportunity to continue to expand what is already a strong coverage platform, and really get every individual covered. Jim heather, thank you for a fascinating conversation and thank you to optim health for making this conversation about Broader Health care possible. Sam thank you. Back to you, sam. Thank you. Back to you, sam. Sam thanks, jim. Our final guest today is avik roy, a Senior Adviser on the Bipartisan Health policy center. Thevery much a fixture of Health Policy debate here in washington. Thank you for joining us. Avik sam, how are you . Sam great. To dive in, when we are talking about coverage and access, a point ive heard you make is universal coverage does not necessarily have to mean government coverage. When you look at the u. S. , i feel these distinctions can get blurred for a lot of people. Millions of people get coverage from their employer which they perceive as private but they do not realize it is heavily subsidized by the government. Millions of people get insurance from medicare which they perceive as public but do not realize a lot of it is actually private. So i wonder if you could, from a big picture level, walkthrough where, in your view, the private sector and Public Center belong in the pursuit of universal coverage . Avik yes, that is a great point and a really important point to make, sam, especially as we think about other countries as models for how to reform the u. S. Health care system. A lot of people on both sides of the debate do not appreciate that universal coverage is not the same thing as single payer, government run health care. A lot of countries in europe or at least a number of them, have achieved universal coverage with private insurers. That is an important distinction. It does not mean theres an absence of government involvement in all those countries in europe where they have say, a universal private insurance system. Theres an effort to provide Financial Assistance in the form of subsidies and other things to low income folks who otherwise would not be able to afford coverage. There are regulations, and other elements of the system, rules of the road, you might say, that bracket how the Insurance Coverage is defined. Broadly speaking, the way i look butbroadly speaking, the way i josh but, but broadly speaking, the way i look at it, but i have tried to persuade freemarket tears of, is that if freemarket tears free is that if you want a market oriented system in health care, what does that mean . Ultimately that means you should have a broad range of choices as to the kinds of insurance we buy, and from whom you buy it. The flaw of a single payer system as it is one system, one insurer, and you have no choice at that insurer that benefit or system is working for you, you have nowhere else to go. Whereas in a system like Medicare Advantage, yes, it is a government sponsored system and our government subsidies for people cannot afford their coverage, but, you have dozens of choices for the kind of plan you by. That is why the Health Reform approach we talked about at free up is called Medicare Advantage for all. It highlights the point that when Bernie Sanders says that a care for all, he is talking about abolishing the insurance 40 of seniors use, which is private insurance. Sam where do you think the republican is now on health care . It is an issue that worked well for conservatives toward the beginning of the Affordable Care act era. When that was the organizing principle. It seems that pendulum has swung back in democrats direction. Why do you think that has happened . Is do you think there anything in the near term can that reverse that . Avik the bottom line to your question, if the question is where are republicans . There is no right answer to that question. There is no wrong answer to that question. Republicans are all over the place. There is no consensus among republicans as to what they think about health care. There are some leaning into the kinds of ideas i have talked about. There is a bill introduced by senator from indiana and a congressman from arkansas, called fair care act based on work we have done that tries to achieve universal coverage through private insurance. So there are people on that end of the spectrum. And there are those who say lets repeal obama care and go back to the old, preobamacare system, which is not sustainable. And then there are people in the middle who certainly do not like being hammered on their lack of solution for the uninsured or affordability of Health Insurance. They are looking for answers at and have not figured out what they believe in yet. That is what think tanks are for. And that is part of why we built the foundation for research on equal opportunity in health care, to solve those problems. Sam uh, very nice. This next question is from our audience, from a reader who asked, how can we reframe the discussion to address actual total cost, not prices or negotiated discounts . I guess, to try to put a finer point on that, one of the few things that people from both parties and really ever be everybody outside the industry sort of agrees on, is that some kind of Price Transparency in health care would be great for patients. But at the same time, as you know, trying to achieve that, and find actual numbers you can give people that will be useful to them individually, is, is very difficult. Is Price Transparency in health care possible . And is it worth doing in your view . Avik first lets make clear the price of health care in america is extremely high. It is unsustainable. It is unaffordable. And it is not the kind of system you would want, in terms of prices, if you had a true market system or a single payer system. Whatever side of the ideological or philosophical struct of you are on, the prices we have are the worst of both worlds. We have health care for almost a system that subsidizes everyone but no accountability for prices patients are charged, by often monopoly providers of those services. So that is a huge problem. Reformers on both sides have different ideas on how to address it. Price transparency is part of the solution. But it is not the whole solution. Let me get into why. It is worth noting, sam, and you have talked about this in your work and some of your colleagues have. The Trump Administration has done quite a bit on Price Transparency. The rules going into effect starting in january, 2022, that require all hospitals and insurers to disclose the rates they have negotiated with each other for health care that is a revolution. I guarantee there are people in Silicon Valley today and in the existing health care industry, that recognize how disruptive that is. And how having that wealth of data is going to transform the way health care is bought and sold among a lot of people in america. That is really important reform that is still winding its way to the courts. If it survives Court Challenges from hospitals and others, it is going to be really important. There is something important to understand about price transparently see transparency, that a lot of people do not understand. People think if hospitals post the price of a knee surgery or heart surgery on their window, we will all have better ability to shop. That is not true for a couple of reasons. One, 80 , of a typical employerbased plan, 80 of your Health Care Dollars are not paid for by you, the patient. They are paid for by your employer or the insurance, your employer contracts with on your behalf. So if your deductible is 2000 and that Knee Replacement is 15,000 in one place and 10,000 and the other, you do not care because once you get to your deductible, the difference to you is not that great. Where you need transparency is so in the price of the Health Insurance you by. Buy. At you and we do not have that. If you get insurance from your employer, it is taken out of your paycheck pretax and you do not have any idea how much is taken out of your wages to pay for that insurance. If you get it from the government even more so for medicare or medicaid. It is ironically only the people in the aca that have some real sense of how much they are paying for their insurance. So a big part of our approach to Health Reform is to increase the number of people shopping for their own coverage who get the reward for shopping for value. If they can reward insurers doing a good job of negotiating for prices on their behalf, insurers will have stiffer spines to negotiate stronger or more carefully the doctors and hospitals and pharmaceutical companies. They do not have that incentive today. Sam i do not need to tell you this. But you have a lot of incoming from a lot of different sides, trying to get more people shopping on their own , both logical and resistance from employers. Avik this is from some employers. The chamber of commerce and fortune 500 Companies Love the status quo. Because they think it is a barrier. Like if you are an engineer at , apple and you know that apple is going to pay for this expense employerbased plan and you have a thought of leaving to start your own company and will have to buy your own Health Insurance, you might be intimidated by that. So you stay at apple even though you could extract more value for yourself working on your own. Of course, big business loves soof course, big business loves this system. , but if you talk to smaller businesses, midsize businesses, startups, they hate the current system. I hear from employers all the time, who said i am tired of , having to be the Health Benefits manager for my workers. I want to give them cash and let them buy their own Health Insurance. It is the tax code makes it hard. Heres another thing that Trump Administration has done that is has not gotten a lot of attention. They created and a regulation that allows employers now to fund Health Reimbursement arrangements like hsas where you can use that 3000 or 5000 or 10,000 to buy your own insurance. So that is a step in the right direction. Our plans build on that and would require all startups to use that approach if they want to draw it would do a lot to of down the tax exclusion. It would do a lot to of all of us in that direction, where workers control the dollars rather than an hr bureaucrat at your employer. Sam all right. I think that is our time. Thank you for joining us, great to talk with you. Avik sam, same to you. Sam thank you all for joining us this afternoon for another virtual conversation i hope has made everyone smarter, faster, and thank you to our sponsor, United Health group, for making this event possible. For news that matters on health care and everything else, check out axios. I would like to put in a plug for vital our Daily Health Care , newsletter and you can sign up for that or air newsletter at sign up on axios. Com. Before you go i want to share exciting news for what is next for axios. In the coming months, we will expand into local markets to get you smarter and faster about where you live, assuming you do not live in washington. For more information on local news and others, check out axios. Com local. Thank you for joining and we will see you at axios. Com. Check out our website for complete coverage on coronavirus, featured interactive gallery, future clips, house and senate speeches, congressional airings, briefings and more. It is all at cspan. Org coronavirus. After the launch of space exit dragon was delayed due to weather, nasa officials held everything to review that mission. A four person crew is headed to the International Space station for six months eared toff is scheduled for today, at 7 27 p. M. Kyle hello, everybody, and welcome from the Kennedy Space center in florida. I would like to welcome everyone