stabilize insurance markets.♪ ♪ [music] ♪ [music] >> weird joining the conversation. use the # axios on social media. please welcome our host, mike allen. [applause] >> good morning early birds on a fantastic day

for healthcare policy. a great day to look at next steps for the nation's healthcare system. thank you all for coming out so early. thank you for joining us. thank you c-span for welcoming the audience here to axios. we want to thank delta dental and jason don for sponsoring the event. thank you all 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 gravity so that you can get smarter faster. we see that also with these events. we are honored to have three is 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 -- i'm going to welcome to the stage a 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! [applause] thank you for coming, thank you for your great coverage. appreciate it. behind the curtain at 11:30 pm last night what happened? >> 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, i've been working

for this since repeal and replace died. >> so let's 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. >> is the first bipartisan major healthcare 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. it's not enough it will have a bill but just that alone is really significant.and it is most significant because it has a huge impact on millions of people's lives. >> and this often gets lost in

conversation. if i'm someone taking advantage of the affordable healthcare plan, how is my life changed in the last year? >> if you are on the exchange right now, you have a lot of uncertainty about what is going to come next. he did not know what is going to happen to your premiums going forward, you do not know if your plan will get canceled. we do not know what your options will be. what it means is if you are on this exchange you don't know if you'll be able to afford your healthcare 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 they have opportunities. >> axios has great healthcare coverage, our managing editor,

sam baker who does the newsletter and your coverage from the capital, how to keep the human dimension in mind as you're covering these big policies? >> 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 healthcare. 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 people's coverage. the thing about healthcare 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 single-payer. 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! subway, at 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 sourced. it takes you there, the reality of politics and reality of healthcare. 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 will feel so passionately about these battles. >> you know, i think the crazy thing about the healthcare fight is how quickly everything moves. >> which is everything everywhere. which is -- >> yes, exactly! so yesterday, we did not have much notice that a deal had been made.

>> was it enough that the policy lunches? >> during lunch it was like okay, they have a deal there briefing 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 don't miss anything. let's walk through the three guests today and tell me why they matter in the scheme of things. the 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.

>> first of all i think everyone knows i'm very excited about the three senators we have today. i think that they might have known that today we had a big event because they struck a deal yesterday for us. but you know so senator can, he is a democrat on our panel today. he is, i think -- i mean he has been out there from the get go. he was at all for health committee hearings.people go in and out and they don't want to listen to the whole thing because it is boring at times. he has really been pushing for the 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 healthcare system goes from here besides really the partisan ideas. >> second will hear from senator bill 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 healthcare. those quickly why he matters.

>> 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 planet republicans say they want to go back to early next year, cassidy graham. and i think the mind turns into a grant.i think you 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? >> i think everyone wants to know if this is going to pass. it was going to become law?

-- >> what would, 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. i guess that's what they not to know. where do we go from here? >> will try to answer that today, caitlin owens thank you for your great coverage. thank you for telling us why it matters. thank you very much. for those of you for joining i am mike and cofounder of aski/os. we welcome our guests online, we would like to thank delta dental for sponsoring this and welcome to the stage center and

cavorting, democrat from virginia. senator, going back to the richmond days, you have been my mayor, my senator and my governor. >> i knew you when you were a cub reporter and now you are an international call to figure. >> bios online are pretty standa standard. a pretty nifty background, how do you know you are one of 30 people ever to exist to where mayor, senator and governor,? >> i was introduced that way. there has to be more than 30 people so i went back to the senate and said i was introduced this way. so many are senators, and i remembered why being mayor will

kill you. that is why there have been so well. >> host: big news on healthcare, the introduction of a compromise plan by senator lamar alexander and senator patty murray from washington. >> absolutely, just a little back story, we need to show the american public we can do something bipartisan on healthcare. even something modest that is bipartisan in this controversial area will be a good sign. >> it is a bridge. >> it stabilizes the individual market for a couple years. it is not passed yet but the way it came together and you heard this from lamar who is a defender of it is after the skinny repeal failed in late

july we started talking about now the door opens for bipartisan solutions. senator and alexander and i did a dinner 5 days after that failed vote, we got 14 democrats and republicans together to talk about the essential concept which is how do you guarantee the cost sharing payments to avoid this uncertainty the president has created and give states the flexibility the aca instead it takes to have through the waiver process but has been too clunky it hasn't allowed them to have the innovation and flexibility originally intended and that was a discussion that grew not just in the committee but beyond. patty and lamar have a fantastic track record of being good negotiators, no child left behind was thought to be impossible and it been slow and steady and we were almost there two weeks ago when the president poured cold water on it because he doesn't want to see whether graham cassidy could get a vote but it was a

delay tactic not stopping the discussions and good to see they reached the final court yesterday. >> you worked behind the scenes with republican chairman alexander. why is he -- what is his gift in this area, what do you see him doing behind-the-scenes in spite of some parts of his party to pull this off? >> i could go on and on, something lamar did really well that patty did really well, what lamar did was isolate and identify and narrow the problem, healthcare, a lot of challenges. from the beginning he has been focused on the individual market. don't tinker with the group market. there are things that could be better. that is generally working. the individual market which if you're trying to buy health insurance not through an employer continues to be tough so he focused on this particular problem and focusing was the thing to do. i would say what patty does is

she has two republican houses and a republican white house, to be able to negotiate and get a deal that protects core democratic principles, the essential health benefits, protection for people with preexisting conditions, but to no, to work with two republican chairman, she is a superb negotiator. paul ryan's budget deal in 2017 writing no child left behind and do it again here. >> the spirit of healthcare event, let's put on your lab coat, be clinical, what are the chances the compromise will pass? will come to a vote? >> i think it will lose my prediction is it will pass as part of a must pass piece of legislation. could be the omnibus appropriations or something else, not sure it will go through standalone but connect to something, that is my sense now.

>> you made news of your own introducing medicare x. sound very futuristic. >> this is by all accounts, the president praised lamar's work saying this will be good for a couple years. you have to have discussions about improving the system, you will hear from senator cassidy who 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 have a more deliberate discussion not under pressure about the next big idea. we said what we hear from our constituents is what we hear from our 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 there will only be one or no insurance companies offering policies. in 2018, this year, 2017, there are 1200 but the prediction

next next year there will be 1500 counties in the united states where there will >> or no insurance companies offering policies on the individual market. they are not offering policies to individuals. this is rural america the hardest, rural america tends to have a higher percentage of people in the individual market so an insurance company will often -- they tend to be rural, fewer patients are older and tend to be sicker so it hits rural america hardest. i hear that and our constituents want more choices. we hear republican colleagues say more choices affordable. we introduced a bill we call medicare x, take advantage of medicare's provider network reimbursement angle and low administrative costs, take advantage of that and direct the hhs secretary to write an insurance policy that will cover the essential health benefits under obamacare and after that policy on the

exchange so it is offered on the exchange and we would roll it out in 2020 in all the jurisdictions that have one or no insurance companies writing policies and the idea would be by 2023 would be available everywhere, 2024 it would be available to small business. >> what public republican buying now? >> we have no republican cosponsors now. >> it is a problem for now but here is the way i look at it. now is the time to talk about the big ideas, if we can get alexander murray passed. we stabilize the market, have a liver discussion about the ideas. bill cassidy has two bills, graham cassidy -- there are elements that he would want to put on the table for the committee, bernie sanders is a member of the committee, doesn't want to put that on the table. nothing wrong with big ideas. what is wrong is trying to jam them through with no committee

process or public hearings, partisan votes under reconciliation. as you know this committee, lamar was governor, he knows medicaid, president of the university of tennessee, patty is a fantastic negotiator come you have doctors on the committee, another governor, people on the committee, medicaid programs, insurance commissioners, now is the time for big ideas to come to the table and discuss a deliberate way with a lot of transparency. >> it is a long road but the times are right. >> more and more people's constituents say i live out here in rural colorado, rural virginia and there is no options for me i don't think we are going to long tolerate big parts of the population not being able to buy insurance. >> talking about big ideas, you were the vice presidential, not

the last year, a couple, the most important states, the commonwealth of virginia, in presidential elections, to think big about your party i democrats moving too fast to hug single-payer? >> i don't think so. bernie's single-payer bill has -- >> almost a litmus test for people who want to run in 2020. >> i don't know that i would call it a litmus test was people need to decide what system works best and read and comment on why other people say single-payer is the idea, we might come up with the one. single-payer and cassidy graham turn the systems, block grant is a different system and single-payer is a different system, we take advantage of where we are, no new taxes, mandates stay the same, subsidies stay the same and we had one element, an additional

offering on your exchange so we take advantage of the system as it is, we don't blow it up, we just add one element to it, what is the right way for the healthcare future of this country, to work with what you have and add an element or two? that is worthy of a good discussion. >> i have a question here but you believe the nation needs single-payer health system? >> i like more choices so if somebody wants to buy on the individual market, people buy policies all the time, if they want to fantastic, no skin off my nose was i want people to have more options and be more affordable. >> caitlin owens. >> you have taken a middle of the road approach, been very proactive about this, you have gone towards the middle then

your colleagues. as you are talking about single-payer and whether or not to do it are you afraid this will be the left version of repeal and replace, it is an idea party is rallying around? but everyone knows there are not votes for it at this time so does it become a mythical thing you are campaigning on and chasing and talking up with your base that you can't pull off? >> we are in a room of healthcare people, nothing is wrong with putting big ideas on the table. there are big ideas on the table. the block grant idea is a very different system. i think mine is big even though it takes advantage of the network but there are also ideas on the table that are much more built out of bipartisan backgrounds. for example we had a bill on

reinsurance, everybody knows there is reinsurance in the first 3 years of the aca, that reinsurance is a backstop for high-cost claims kept premiums down for everybody and established a mechanism, insurance companies get some certainty. we want to bring reinsurance back because we use it for flood insurance and medicare part d and with republican support. there are big ideas on the table i'm not sure a lot of democrats will sign on. there is some more prozac. i think this will help, states like maine, minnesota using reinsurance profitably under their own state. the alexander murray bill gives a push so we could conceive of doing that. you will see ideas that will spread the zone and threaten parties which will see ideas

that will enable us to do alexander murray chapter 2, the next bipartisan thing to do because congress does the american public some important thing where we say we could work together and work together on something that has been controversial but it is important in your daily life and that is why we need to get the deal past, send the message and sometimes get success built on it. >> are you good? did you want to jump in. >> her face says nice try on the answer. >> single-payer ui -- disappointing your base. >> that is a political question. i'm trying to do something for

people. i disappoint people every day and make people happy every day. that is the occupational hazard of the occupation i got into. my thought is i always felt good policy is good politics. advocate your best idea but be open to listening to the good ideas of others. i am sure if we get medicare x past it will not be exactly the way we wrote it. we have to listen to the ideas of others and that would be the case for any idea on the table, subjected to tough questions, make it public in the committee, the committee is composed of people who know this stuff very well and no one should be afraid of taking their case to it. >> in the last couple seconds we touch a couple other news of the day. you are back from puerto rico. tell us, when you were there and what your bottom line is. >> the magnitude of the disaster is hard to convey but when i was there i was there two saturdays ago. a 10 member delegation.

i realized i'm back -- we had a massive hurricane in virginia. a hurricane knocked out power in a quarter of your state and in the rest of the state the hospitals are running and power works and hotels are open and schools are functioning and people can move a little bit while you are trying to fix this one part of your state. puerto rico, 78 municipalities, the hurricane cut from southeastern northwest, every locality lost housing, power, road access, access to water, access to food, access to health care, schools aren't open yet, every jurisdiction. and the response has not yet been a response that says you are every bit an american is somebody in texas or florida. two weeks after the hurricane coming in virginia when there is a hurricane and you go -- when i was governor i go traveling around and 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 don't see that in reagan. >> how you great administration response? >> the response generally, some is administration and some is this why haven't these utility -- i would put it is a d response. i don't know why the utility mutual aid agreements weren't taken in. they were finger-pointing, you didn't ask. we did ask and you said you weren't sure you would get paid so order of magnitude. the governor told us six weeks after the hurricane he hoped to have power at 25%. where else in america would people tolerate powers back on at 25% that is okay. we would not tolerate this anywhere else in the united states and these are american citizens with i of the most notable records of service in our military since world war i. we shouldn't tolerate the intolerable. >> another good tweet for

access 360 and last question, your thoughts about the president's statement on iran in the context of north korea? >> three problems with the president is doing with iran. this might be the first thing that didn't make me mad but sort of scares me. >> you didn't just make me mad. it scares me and here's why. when the head of the joint chiefs and secretary of defense and secretary of state i think publicly iran is complying with the deal. the iaea says iran is comply with the deal. when our allies say iran is complying with the deal. any step backward from that is extremely problematic and suggests we don't value diplomacy anymore. remember this. the iaea said to us in 2003 iraq doesn't have weapons of mass destruction, the bush administration said what do they know and we went to war and the iaea was right and we were wrong. the first problem is it brings

back all this bad memories of politicians trying to overrule or tarnish experts so that is number one. if the president said he wants congress to rethink the deal, if it is renegotiated what is iran going to renegotiate? enrich uranium? this could put iran back on the path to finding a nuclear weapons program which would make the world more dangerous. most important we are in the midst of negotiation with north korea. what are the chances of getting the poetic deal with north korea nuclear program? you could find potentially, rex tillerson saying diplomacy first but if you say the us will back out of the deal that is being complied with you drop to 0 the chance that north korea will ever do a deal and that is extremely frightening.

the president should not pour cold water on diplomacy, if you do that you raise the risk of unnecessary war. >> you have given us a great tour of the landscape on healthcare where you were on the front lines. this is such a dynamic area. would you come back in six month and tell us what progress there has been? >> i would be glad to. >> thank you for joining us, thank you, sir. appreciate you, thank you very much. a quick word and i will be right back. >> my favorite line is we are trying to save south dakota. >> there are challenges, transportation, getting places and some people are faced with not even having water and not able to brush their teeth. >> a lot of never been to the dentist so the have no idea what is going to happen. >> a place in northwest south

dakota where you can drop a landmass the size of massachusetts and not hit a dentist so we take the dental office to the people. >> you don't just buy a truck and start delivering care. you have to have those who are willing to do the work ahead of us getting here to make this a successful visit. you have got to have staff. the heart in the right place. >> bringing this here in our community is a huge asset to the people. i had parents come in just thrilled their kids were able to get teeth pulled and get cavities filled and able to get crowns. a lot of medicaid patients are not accepting any mayor so this means an opportunity to get all the kids fixed, get their teeth taken care of.

>> healthy smiles get you your first job, you meet and greet people when you see them on the street. >> it is everything. >> the confidence they have, the help they have, makes a big difference in their life. >> just watch these kids:-)you know the power. it is the smile's eyes that makes the difference. when they feel like they can smile that gives them the ability to do anything. >> thank you very much, we are honored to welcome to the stage senator cassidy, republican louisiana, member of the labor committee and doctor. doctor cassidy, thank you for joining us. >> good to be here. tell us what you practiced when you did honest work?

>> gastroenterologist, they paid me well for politics. >> if you are over 50 you get the joke. thank you for joining us on a newsy day. yesterday the compromise by senator lamar alexander and patty murray, these up with a couple lies? >> the way the obama administration implemented the payments was ruled unconstitutional by a federal judge, trump said he wasn't going to do that, congress received it and done something. there is flexibility to lower the cost of healthcare, that is very positive, the transition is a couple years, needs to be done more permanently that allows something permanent to be limited within the interim. >> do you expect donald trump to support it? >> he said he would. i didn't hear the comments. at the same time, endorse and

approach like graham cassidy for the long-term. >> what would you say is the outlook? will this become law? >> i think so. >> you were on the front lines of this with your own plan. did you rush it too much? >> to set the stage tell us your plan and tell us what happened. >> that is not a yes or no answer. our plan, if you will, was begun with cassidy collins which all of us envision states could implement a program. tim kaine said block grants were topsy-turvy, the state could receive the block grant and do what they have been doing, nothing would have to change but if you are a state

like tennessee where the individual market imploded of course, it is already topsy-turvy, you need to do something different so cassidy collins envisioned that and effectively was block grant states, we worked on that and attempted to socialize that with the other party for eight months and no one was interested. so when the republican leadership bill failed, i had three or four weeks to put together an alternative. if you say did it happen too quickly, in one sense if you consider cassidy collins's approach i would say no but if you say graham cassidy which was different but still had at its core giving states the option to do that which worked for them i would say no. on the other hand, to get our policy changed and right we were working 18 hours a day 7 days a week, didn't have a

chance to push back on the left which was misrepresenting the bill and in that case clearly was done too quickly and it did not go through the committee process. i totally accept that. i did not control that, that was dictated by short term limits. >> in retrospect was that a mistake? what did you learn about what it takes to socialize and get people comfortable with such a massive change? >> i'm going to dispute the idea it is a massive change. some states in which the status quo is failing would do things differently but california if they love what they are doing they can do what they are doing. >> what do you learn about what works and what doesn't work? >> what i learned is some people are going to push back in a way in which -- john podesta's group contracted with him and got what they wanted. over 1120 years when we wrote 10, of course they had people becoming uninsured but it was

in year 11. we ran through the chip program when it had to be reauthorized like chip is regularly reauthorized there would not have been a fall off but if you score it over 20 years it does look like over 20 years it does look like trillion dollars in fewer resources for state. standard & poor's pick that up. you have to realize people are going to push back however misleading and that will be echoed by others. >> we can argue about different scores but to talk about reality, all kinds of protections for preexisting conditions are written throughout, tucked in all kinds of places and republicans have to figure out where to draw the line. more states, putting aside the specific quibbled you mentioned if more states have more control there are some sick people who will be worse off. >> i disagree with you.

that reveals the president in washington dc that you cannot trust the government. it is interesting. the thought that people who have to be protected against of venal, corrupt governor scheming to take away their health insurance even though that governor typically is up for reelection or has been recently elected. i say that because in our bill we specifically say if a state wishes to do something different, have a waiver, they must show that whatever they do is adequate and affordable for those with preexisting conditions. this agreement we just agreed to, i am told, i haven't read it myself, the waivers now just have to show themselves to be of comparable affordability. you could argue there is wiggle

room there. that is basically the language we have. let me contrast this. if there is somebody here on the individual market and earning 401% over federal poverty level for $82,000 a year you can't afford the policy now. in my state you could pay anywhere including deductible premiums, 30% to $40,000 a year. that is affordable for a family with a preexisting? of course not. glenn kessler fact check to me on that. glinted know beforehand, i did, turns out i'm right. no pinocchios. none whatsoever. it is context. i'm in a 30-2nd soundbite and have to give context but the fact is the fellow i referenced, he said the total could be $46,000. that is affordable?

of course not. that is status quo. under our conditions we actually give it to the state allowing them to come to the system which is affordable and with our way is better. >> pullback the camera a little bit. if you repeal and replace, the number of people who lose coverage won't be 0, how does the gop figure out where to draw the line? >> we could have more coverage under graham cassidy than under the status quo. for example, by the way, everything you are saying i am disputing but that was echoed by the left. if you think about what we proposed, we would allow states to do so called automatic enrollment. you are in unless you are out. the example is medicare. turn 65 your on medicare, call them up and say i don't want to be but otherwise you are on, 99% take out. we would allow states to do automatic enrollment. if you are eligible you would get a premium sufficient for

your annual premium, and that way all these young immortals are in the pool. helping lower the overall cost because you are spreading the cost over many helpings we would end up under that scenario more people enrolled than the status quo. >> you are committing yourself to introducing and supporting a plan under which the number of people who would lose coverage is 0. >> it would be up to a state because washington dc does not dictate but in the vested interest of the state to have as many people insured as possible and i am all about people having coverage. my background is a doctor in the public hospital system, trying to bring coverage to those who did not and right now we have families, 6 million people are paying a penalty as opposed to purchasing insurance, 78% of those households have adjusted gross

income of $50,000. i'm committed to those working families being able to afford insurance under status quo they cannot. >> do you plan to revise -- revive your effort in 2018 and if so how? >> yes. things have to change. we have one less year for our 10 year window. we are going to socialize. virginia, there should have been a better process, but under graham cassidy -- >> there should have been a better process. >> totally. i said that all along but as i mentioned earlier it was a function. the august failure gave us until the end of september to put it together and we were on recess for much of that time. my staff and i weren't but others were, doing other things obviously but no committee hearings. there should be a better process, totally agree with that. under graham cassidy, there would be billions with a be

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 would get billions more under graham cassidy. people said this was a partisan bill. i just listened two states represented by democratic senators but i could also list maine, florida, wisconsin, indiana and others would do far better under graham cassidy than the status quo and represented by democratic senators. >> 2018, the same congress, the same players, you don't have the votes. >> a couple things, some people complaining about that complaint about the process. we now have more time for a better process.

i would like to think we could socialize it among our democratic colleagues, they've shown willingness to give a little bit on the aca and so they have given a little bit and this deal senators murray and alexander worked out show maybe now, they say my state gets billions more for working families, families who cannot afford insurance now. maybe i need to look at this more closely not through the lens of partisan politics, but there is a lens of what is best for the families in my state. if that is the case. >> i will come to you in 30 seconds, what difference did jimmy kimmel make? >> jimmy kimmel, a couple things, a couple things. and first, a close encounter with jimmy kimmel. jimmy kimmel -- how can you not feel for this? was born with congenital heart disease, it has been sometime since i have been in a delivery -- my wife -- >> doctor lara, retired breast cancer surgery but i can

imagine what happened, the child was born, the nurse and doctor really realized the child was blue, quickly made a diagnosis it knew the child would die and probably for the mother and father, the baby was on the way, signing papers, who cannot relate to the emotional response? that first episode, referring to him, said we should have a test to make sure his child is addressed, helped define the terms of the debate. that was so positive. later came after me and talk to schumer on the new york times two times, never called me. i wish he had. i wish he had. not to confront but to explain. >> have you talked to jimmy kimmel? >> no. >> we will make that happen. >> please.

under graham cassidy, there will be families in virginia, texas, florida, maine, indiana, missouri, i could go down states, who would now have access, states would have billions of dollars of resources to help purchase insurance and help those families purchase insurance in ways they otherwise would not have. >> did the coverage of jamaican lab statements hurt support at the capital? >> i don't think it cost votes. the democrats were going to go forward anyway. could have been the best thing in the world but they were not going to vote for it. with 10 democrats when i was trying to push cassidy collins, all said we are not touching it. >> caitlin owens. >> there is a lot to go over but something i want to touch on, this ideas that -- you are saying -- who will lose coverage under your plan. >> stated have the ability to put in place plans to avoid or expand coverage but i can't dictate what a state does.

>> the thing about your plan is it shifted money among states and there is a big shift in who gets what compared to current law, the senate expanding medicaid, generally benefited, blue states that expand medicaid. they lost a lot of money. california a great example. i think shifting these resources even if it didn't result in a net loss of coverage, how do you justify that loss in california, people who would almost inevitably lose coverage there? and in turn, how do you ask democratic senators to support your plan? >> several things, work backwards. how do i ask a senator like senator warner whose state gets billions more in resources than other status quo to support our plan?

the way i phrase that begs the into? how do i ask where mccaskill who gets billions more under our plan than the status quo to support? it begs the answer. going to earlier, transfer of wealth from blue states to read, not really. red states which have not expanded do have a significant growth at the blue states which already expanded end up with far more money because they are getting a set amount over time and the red states are growing over time. by the way, red states including virginia, missouri, maine, florida, all represented by democratic senator so i reject the implication that it is partisan and work to medicate, under graham cassidy new york was held harmless, massachusetts was held harmless. a couple states did have money relative to current law that they lost.

should the federal taxpayer be on the hook for no matter what expense the state passes to the federal taxpayer? if you have a high cost state which is the liberally putting in a system of care which is known to be far higher costs than other states, should the federal taxpayer subsidize those decisions? if yes, there is no hope for controlling healthcare cost because state legislature could give a special deal to this union or those hospitals, the federal taxpayer should have the ability, there should be a cap on how much is going out if you compare the state to other states. one more thing i will say, state actually has the ability to reimpose some of the penalties graham cassidy did away with like the employer mandates and individual mandate. if you reimpose those penalties, that gave the state a lot more money they could use

to subsidize their system. the head of cover california was reinstituting the health insurance fee was going to be lost under trump's executive action. he was going to use that to subsidize politics. states could have done that which i just said, california the example, didn't have to lose resources but as opposed to getting it from the federal government. >> this has been a great conversation. he will stay at ground 0 on the front lines. six month, update on progress? >> absolutely. >> your time -- >> go tigers. >> is this something you have in common with james carville? >> he is a big fan.

>> is it dmz? >> you can rub shoulders with people you otherwise disagree with and who cares? you should put politics aside. thank you, appreciate it, see you in six month. now we hear from jason daughn, vice president of government relations and i will be right back. >> thanks, mike. this is the part of the program a guy reads to use so get ready. in all seriousness, i hope you enjoyed and were moved by the video we watched because it captures who we are at delta dental and what we care about. we are not here to talk about dental care but it is our belief the current conversation

needs to include oral health. polling shows 90% of americans view dental benefits as a welcome part of critical part of public debates around healthcare legislation and according to the kaiser family foundation, in 2015 more than a quarter of uninsured adults went without needed dental care due to cost. research from the institute of medicine, hhs and many other sources show oral health is a critical component of overall health. good oral health has a positive effect on health and well-being, fights general health conditions and social and medical impact of oral diseases in children is substantial. to be happy and healthy americans need access to high-quality medical and dental benefits. everybody needs both. healthcare reform discussions move forward we believe oral health must be a central part of the conversation to ensure americans achieve optimal

overall health. the largest and most experienced dental benefits provider in the us, 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 only priority. we consider this partnership with axios to be an opportunity to elevate this issue and the broader health policy conversation. that is why we are underwriting this event and another event we will hold next year. thank you for joining us and i will hand things over to mike. >> thank you for the partnership. thank you for making this possible. it is our honor to welcome to the axios stage senator lamar alexander, republican of tennessee, chairman of the senate health education and labor committee. thank you for coming. senator alexander, i have been covering you since i had hair

and you had flannel. >> that is a long time. >> senator caitlin owens has the news brief and whispered to me, you just got off the phone with donald trump. what did he say? >> he called me to say he wanted to be encouraging about the bipartisan agreement senator murray and i announced yesterday. he intends to review it carefully, see if he wants to add anything to it and he is still for block grants sometime later but he will focus on tax reform this year. i was thinking this morning, it is parlor game around washington, donald trump doesn't know what he is doing, in september, against the advice of paul ryan and mitch, cleaned out the last half of september so senate could consider the cassidy graham

deal you just talked about. he completely engineered the bipartisan agreement we announced yesterday, he talked to senator schumer and encouraged him to ask senator murray to do it and called me twice to talk to me about bipartisan agreement for the short-term so people are not hurt. and checked in this morning. >> the same sport? >> he wants to reserve his options. what we are going to do is a number of republican and democratic senators, we are going to introduce the bill thursday or put it on senate floor so people can see it. then we will see where it goes and my guess is it will be part of discussions between the president, speaker ryan, senator schumer, mitch mcconnell and will pass in some form before the end of the

year. usually the most ideas fail for lack of the idea and this is a very carefully thought out compromise that advances some republican principles that haven't been advanced in eight years and democratic oneness as well. i think it will happen before the end of the year and she encouraged me to do it and i understand the fact that a president, any president would want to review it, add something to it and make it part of a larger negotiation before it is done. >> what did he indicate as fare graham cassidy bill to repeal

and replace obamacare doesn't take effect in 2020 or 2021 so what do you do in the meantime? what you don't want to do is create chaos and millions of americans by skyrocketing premiums and some counties where they can't buy insurance, without the cost sharing payments 16 million americans might live in counties they can't buy insurance. what is chaos? a 4-lane highway to a single-payer solution? a birthday present for bernie sanders? the president is pretty shoot to understand there is a gap that needs to be filled and the only way to fill it is bipartisan agreement like the one we suggested yesterday. >> you alluded to questions about the president's mastery of policy but you said in healthcare and nobody is doing -- tell us about that.

>> i just did. in september he cleared the way to deal with the cassidy bill. he recognizes a gap. he worked with me so i would work with patty murray and produce a bipartisan agreement to fill the gap. >> based on what he said or what his big goal is, what he's trying to achieve. >>'s goal is the same which is to move more decisions about the kind of policies written for americans who buy health insurance out of washington back to the states so people have more choices and lower prices. >> do you believe -- >> 80% of the dispute that created the partisan stalemate in the last eight years and there are three or four steps in the alexander murray agreement that move in that direction and the first such steps we have in eight years. there is also a compromise so

democrats have something too. but you don't get a conservative win without a result and we haven't had any results. we had a lot of speeches and lost votes, that is not a conservative victory. >> you had some coffee this morning, have you had coffee this morning? >> no i haven't. >> you are relaxed, you can take this question. do you expect or want republicans to revive full blown repeal and replace in 2018? >> in 2018, i expect the president recommend that and senator cassidy to introduce a bill to do that and if he doesn't it is the same bill he introduced before i will vote for it. >> do you believe it will pass? >> i don't predict the senate very well. although i did just predict the alexander murray agreement in one form or another would pass before the end of the year.

i hope it will. the major problem with the affordable care act is what i said. too many decisions about the kind of insurance policies that are written are written in washington and it doesn't take into account what happens in the states. in the states, former governor, i know we wanted people -- even more than people in washington do. we can make decisions and lower prices and offer more choices. that is what that is about and why we vote for it. >> caitlin owens will ask a question in 30 seconds but first, is there a risk with the way this is done, with pieces and bridges, is there a risk that insurance companies will say this roller coaster is too much, exchanges are not worth the trouble? >> no. i think a two year bridge to

whatever comes next is something insurance companies can easily plan for. 2018 rates are mostly set but they now have plenty of time to make 2019 rates. what we try to do is find a mechanism to make sure consumers get the benefit of cost sharing payments in 2018, not insurance companies and in 2019 consumers automatically get those benefits. i would expect we pass our agreement before the end of the year it will have some affect on rates in 2018 and in 2019 rates will go bad. >> you are one of the great minds of the republican party, someone who knows the country. as you look ahead to the midterm election next year are you fortunate that repeal and replace didn't pass, that you don't own it? >> i don't think so. i don't look at life that way.

i may result oriented person. that is why we announced the agreement yesterday. i want to get something done while i am here, we did that with no child left behind, the wall street journal, the biggest evolution of federal power to state in 25 years, that was a result. i don't know if we get elected or unelected based on that but that is why i am here. i want to see us succeed on changing the affordable care act. there is a variety of ways to do it, a short-term agreement, to start with some executive orders are another way the president -- we need to take a new look at the affordable care act and i would like to see power move out of washington to the states. i don't know what the effect will be in the november elections in 2018 but it is what we ought to be doing. >> your point about no child left behind, you are talking to someone who once to be a leader and accomplish things. what is the secret to passing something bipartisan? the secret to something even modest?

>> get to know them. it is no secret. if you don't know each other you don't know about agreement and don't always try to do something comprehensive. that is a good way to get where you want to go. have a lot of patience. and keep your word. those are things that are important. i like working with senator murray, part of the democratic leadership. we don't agree on a lot but she can do all those things i just mentioned. >> caitlin owens. >> two questions i will ask at the same time so i don't get cut off. first is about the deal you raised yesterday. some conservatives are blasting it as a bailout. if the republican party and house senate president successfully passed this bill & it into law is this a win for

republicans and something trump gets to say he forced a deal or is it something especially in the november elections republicans say they only passed an insurer bailout? >> a conservative victory requires a result. it has been eight years. we have 50 votes to repeal obamacare and lost them all. we made 1000 >> and got no results. there are three or four results embedded in this compromise. one is a catastrophic time for people of all ages. medical catastrophe doesn't turn into a financial catastrophe. more importantly a change in the affordability, gives more states opportunities to do waivers like the alaska waiver, the iowa waiver, oklahoma waiver, minnesota waiver, new hampshire waiver, all of these

are different ways of doing things. the biggest objective of republicans is to move decisions back to the states and requires interstate compacts on health insurance and streamlines the system for results in this compromise agreement, four more results than conservatives achieved in eight years despite all the votes and speeches. >> if this passes the president can say this is a deal he directly influenced? is this a deal the president directly influenced? >> i'm sorry. >> if this happens, how much of an impact would trump have? is this something he can say he owns and is responsible for? >> the president engineered the

bipartisan agreement by calling me and asking me to work with senator murray to do it, we talked three times in the last we 10 days including 30 minutes ago so it is out there as an option. if he decides to make it part of something he signs, of course it will be something he supports. he has been shrewd in the whole process by giving himself a bipartisan option that could give him three or four conservative wins on the way to trying to get block grants again. >> longer-term, senator alexander, not speaking for your entire caucus, you said this is a bridge to whatever comes next. what is your ideal version of what comes next? >> i think bill cassidy did a good job with his bill. he has time to improve it between now and next time it comes up but the idea is fundamental, allow states to

make more decisions about insurance policies as the goal of having lower prices and more choices. that is most of the difference with obamacare. so step one in the progress is executive orders the president issued last week, step 2 would be a bipartisan agreement to make sure people aren't hurt, don't have chaos in the single-payer system, have a few conservative wins in the meantime and step 3 would be long-term change. long-term change won't take effect until 2021, 22. what will be due in the meantime? the alexander murray agreement is an option and one that i hope congress throws out. >> step 3 comes after. is that something you can work with senator murray on? democrats and republicans work together on the bigger longer-term. >> this is step one. there is probably step 2 and other issues can be considered

like the employer mandate is about to kick in and a lot of employers will get charged a lot of money, repeal that retroactively could cost some money, there's bipartisan support for changing 30 hour to 40 hour workweek standard in the affordable care act. there are smaller things that could be changed. when you get to things like block grant proposal in the senate bill or house bill there is a fundamental difference between republicans and democrats, democrats like decisions made here, republicans might like decisions made in the states, that is white is partisan. >> do you have anything you want? >> is it sustainable to have this debate every time the president changes? do you eventually have to decide on something both parties can live with? >> better to do something

durable. one of the advantages of the bill to fix no child left behind is nobody is trying to repeal it every year because we worked out a consensus. senator mcconnell said the 21st century cures bill we worked out last year with the most important bill in congress, probably was, medical miracles, speeding things through the fda, contentious and hard to do, no one is trying to repeal it because we had a consensus. we need to get to that on health care, hard to do. in the meantime the smart thing to do is take step one, recognize a win when you see it, make sure people aren't hurt, make sure there is stability, people like to see us get results and as i said, i have to say a lot, you don't get a conservative victory unless you get a result and you don't get a result in the senate unless you get 60 votes. to think we might get block grants with 51 votes but we will not get the results that are in the alexander murray

agreement require 60 votes. >> a fantastic tour of this 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 said goodbye, tell us who the amateurs are? >> the amateurs are tim kaine who has 7 harmonicas, one for each key that he knows and i have to change key when i play the piano but we performed quote at the rhythm and roots festival in bristol, virginia, bristol, tennessee, the state line a couple months ago and had a pretty good time. .. ourselves honestly the amateurs which is an accurate description. [laughter] >> is it like to thank delta dental for making this possible and kaitlyn owings and my colleagues for their great

coverage >> all night and are so fantastic. thanks c-span and your views for joining us, the people joining us online at hashtag actions through 60. and senator alexander thank you for fantastic -- thank you for joining us. [applause] [inaudible conversations] >> the senate h.e.l.p. committee will examine the link between health choices and outcomes of healthcare costs. watch live coverage starting at 10 a.m. eastern on c-span. later today, president obama campaigns with lieutenant governor ralph northrup who's running for virginia governor. our live coverage from richmond begins at 6 p.m. eastern on c-span.

you can follow both events online at c-span.org or with a free c-span radio app. >> c-span cities tour is in portland maine this weekend. join us as we explore the literary scene and history of this port city without of our spectrum cable partners. saturday at noon eastern on booktv. >> the lobster fish today is an example heralded in fishery circles around the world really as a sustainable fishery. but this came out of a terrible tragedy. this was a hard learned experience because none of those conservation measures one place at the end of the 19th century. >> we will visit the childhood home of poet henry wadsworth

longfellow. >> he was when he was alive and writing probably the most famous english-language writer in the world, if not the most famous person in the world. and today he is probably best remembered for poems like paul rivers ride, evangeline, the children's hour. he started much a part of our everyday lexicon and our american memory. >> sunday at 2 p.m. eastern on american history tv we will explore portland's state oldest lighthouse. watch saturday at noon eastern on c-span2's booktv. and sunday afternoon at 2 p.m. on american history tv on c-span3. working with our cable affiliates and visiting cities across the country. >> closure eyes for a moment. and stretch. closure eyes. i see you.

[laughing] trust me, empathy. and i want you to stretch your imagination. open your eyes. that's how fast it happens. in a blank no warning. >> sunday night on q&a executive director of paralyzed veterans of america and retired u.s. marine corps officer sherman gilland junior talks about his own paralysis and his work to help paralyzed veterans. >> on trying to tell them this is the problem. this is what i see from a a patient's perspective, from a policy perspective, from and advocates perspective. you have to empathize. that's what will make it the ideal provider for veterans of gone to combat and sacrificed. >> sunday night at eight eastern on c-span's q&a.

>> next a four-month opioid addiction and the effect it has on families, parents of a man who died from heroin overdose talked about their experience of losing a child to an addiction. we'll hear from senators hasson, portman and mansion and later a panel of journalists who cover the epidemic. this discussion hosted by the "washington post." good morning, everyone. i'm lenny bernstein, a health and medicine reporter here at the "washington post." i'm going to introduce to you today todd and dorothy burkey, the parents of that is one of the xmas 60,000 people who died of a drug overdose in 2016. and alice lee, the "washington post" video journalist who made that remarkable video you just saw. [applause]