She spoke at an event hosted by axios where topics included health care, expanded insurance access, and the rise of coronavirus cases in the United States. Hello and welcome to axios virtual event, health care 2021. Im sam baker, the Health Care Editor at axios coming to you from my home in washington, d. C. Id like to thank the crew for making this possible and id like to welcome our audience on facebook, youtube, twitter, linkedin and axios. Follow along at axios. Next 30 minutes we will unpack the best way to expand Health Insurance access and Health Insurance coverage in the United States an what that path forward looks like following the president ial election and in the midst of a pandemic thats getting worse every day. Our first guest is senator tina smith from minnesota. Senator, thank you so much for joining us. Thank you, sam. Its really terrific to be with everyone today. Id like to start off to just sort of frame this conversation. Obviously Health Care Access and coverage has been a very hot topic for a very long time. The pandemic has highlighted and illustrated some of the gaps that were dealing with in the system. Weve seen millions of people lose their Health Insurance because they lost their jobs in the economic downturn. That obviously affects not just those people but also their family members and their Health Insurance. So im just curious, how has that shaped or changed the way that you view this problem specifically of health care coverage. Do you see that differently now . Well, i mean, i think you raised exactly the right point. Here we are in the midst of a Global Pandemic and, in fact, its a pandemic thats surging in minnesota and upper midwest and all across the country. We had yesterday 56 deaths from covid19, the highest count that we have ever had. As we see infections go up, we see hospitals 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 got to address. This is a long story for minnesotans and people all over this country, the struggle to figure out how to get health care you can afford no matter how are or where you live and have access to that health care no matter who you are or where you live. So covid, of course, we know is not the great equalizer. It is revealing fundamental inequities, especially as we see in my home state and all over this country the disparities that are revealed by frontline workers, black and brown and indigenous people, older people, rural people, who really struggle to get access to health care. This should be a moment for us to address this. First, weve got to be focused on getting this pandemic under control. Ive got lots of ideas for how to do that but then be able to look to building a Better Future for health care and americans. So this is probably the wrong way to describe it but somewhat Positive Side effect of this terrible experience has been an increase in telemedicine, which i know is something thats been very important to you. What needs to happen, whether its in congress or administration to make that stick . Yeah. Well, the point that this is a really important point, in the midst of crisis we make big leaps forward in innovation. We need to make sure that doesnt waste, go away as we work our way through this crisis. That is very much the case in telehealth, the inability of people and people not being able to go see their doctor. We see this massive expansion in telehealth. Not only for physical health but things Like Mental Health where we have a dramatic shortage of providers and shortage of access to care all over this country. So one thing that im very excited about is how we can make sure these innovations in telehealth, expanding it, doesnt go away when the pandemic is over. This is something that providers and patients have really appreciated and have described to me as a life line. I care a lot about the access to Mental Health. Certainly in the midst of this pandemic we know that the need for Mental Health has exploded, whether you are a Frontline Health care worker, or whether you are a senior who is 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 also help. Not as a complete substitution for inperson care but as a way of making care more accessible. And i want to come back to your point on Mental Health. Just real quickly on telehealth, do you think the challenge here, is it reimbursement . Weve seen medicare and medicaid trying to make this change happen. Is it patient attitude . Internalizing, this a way to see my doctor. Is it something that needs to happen among providers . Well, a crucial piece is reimbursement. The cms provided waivers for reimbursement for telehealth. A video telehealth and phone telehealth in order to make sure access to care stood. What we need to make sure is higher reimbursement rates on par with a personal visit dont go away. That will make a huge difference for providers who need to be able to have a reimbursement that is sustainable. Its also, i think, partly a shift in attitude toward patients. This is going to vary a lot depending on who the patients are. But here is just an example, one example of this, a story i heard about a person in rural minnesota who needed a Mental Health care. He was very this person was very unwilling to drive to the Doctors Office because it felt so exposed. There still is so much stigma around Mental Health. However, that ability to get care in the privacy of their own home made it actually 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 the providers as long as we have reimbursements that actually work. 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 increased during pandemic whether depression, abuse, anxiety, the whole list that you just articulated. Clearly, or at least the strong implication is that a lot of that has come from some of the lockdown measures and social isolation that is necessary to spare people from a deadly virus. What im wondering, is there a way to square that . Is there a way telehealth was part of it but necessary to ensure people can stay healthy in both ways. Yeah. We have to be aware of all of the risks and all of the costs of this pandemic, even the costs that are not i guess you could describe them as secondary. I think Mental Health is definitely in that category. Being somebody who is always looking on the bright side, i believe what were also seeing is a greater recognition and willingness to talk about Mental Health as something that is part of our whole health and not separate and apart. We need to take this as a moment to push through the discrimination and stigma that exists around Mental Health. It gets to something i think is very important about ways steps we need to take to suppress the virus. We have clearly moved past the point where the only tool that we have in our toolbox is to ask everybody to stay home and not go out. That is just not feasible. Think particularly of the impact of people who are Frontline Health care workers or other frontline workers. This gets to why it is so important that we have a Robust National testing and Contact Tracing and humane isolation strategy so that the people can be more likely to go about their business in ways that are safe. This has got to be testing that isnt just diagnostic testing but also surveillance testing, which will be a path towards 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 cassidy from louisiana that is built around the idea of establishing state purchasing compacts to dramatically ramp up access to testing, rapid testing, not only for diagnostics but for surveillance. Well, speaking of bipartisanship, just one final question here and well let you go. We are control of the senate obviously is up for grabs. Were going to be in a deeply divided washington no matter what. Health care isnt bipartisan, what is to expect . I come from the school of thought Bipartisan Legislation, bipartisan laws are always the most sustainable laws. It causes us to we need to find ways of coming together around these issues. Lets remember that earlier this year we successfully came together with some really significant responses to this Global Pandemic with the c. A. R. E. S. Act and broadly Bipartisan Legislation we passed. The onus is going to be on all of us, democrats and republicans and President Biden to address the needs americans have and put aside our partisanship. I will tell you in the conversations ive had with minnesotans, they dont see health care as a political issue, they see it as an economic issue. They see it as a hugely personal issue about the safety and wellbeing of their families, their kids, their parents. I think that has to guide us as we look for Bipartisan Solutions like bill cassidy and i have around testing and Contact Tracing. And, for example, supporting rural health, which is again another place where i think republicans and democrats can come together. All right. That seems like a good place to leave it. Senator, thank you so much for taking the time and joining us today. Really appreciate it. Thank you. Really appreciate it. Up next we have a view from the top segment with axios ceo vandehei and ceo of Unitedhealth Group heather cianfrocco. Thank you very much, sam. Its now my pleasure to bring you a conversation with heather cianfrocco, ceo of Unitedhealth Group. Heather, thank you for joining us. Great to be here. Thank you, jim. Can you give people a version of what unitedhealth is . Sure. Unitedhealth group serves people across the country and across the globe really working to make sure that people live healthier lives and make the Health System work better for everybody. Were basically in many aspects of health care. Our Health Insurance side of the business called the benefit side of the business, United Health care, which many people know about and then our Optum Services which encompasses data and technology, rx and pharmacy specialty businesses together with our Optum Health Services where we bring dplifelivery sers through optum care practices, 50,000 physicians enabling providers and practitioners across the country as well as our health businesses, which are Population Health, military and veteran support solutions, house calls programs, and other complex Care Management programs. And we offer those through United Health care and through other clients and customers, and we have a global part of our business that really services countries around the globe. So its a large enterprise with a large focus and dedication to health care. So you have some of the best data, one of the best sort of lenses into whats happening in the Health Care System. Talk about the effect of the Health Care System amid the pandemic, right . Sort of the defining part of our generation. What has it done to the Health Care System . Yeah, its a great question. So maybe just even thinking a little bit, i appreciate you asked about Unitedhealth Group and Unitedhealth Groups purpose and function. Maybe just a little bit of backgrounds, know that one of the things Unitedhealth Group is focused on and more amplified by the pandemic is really an approach to a next generation Health System. 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 for practitioners. Weve been advocating for that for over 20 years but also making sure were part of the solution working very hard to advance those components of a next generation Health System. I guess what i would say is what we learned from the pandemic was the things that already didnt work in the system were even more broken. But then we learned that as we come together with privatepublic partnerships we can advance very quickly. So maybe a couple examples. We noticed that we saw surprise billing. Surprise billing was an in before the pandemic. It became an additional anxiety for consumers when during the pandemic people may have experienced a surprise bill. We know theres a solution to that. A Publicprivate Partnership working together creating a median innetwork rate will resolve a lot of surprise billing for people, anxiety and reduce cost to consumers and employers by about 40 billion. Those are examples of things that, you know, continue to be exacerbated by the pandemic. Then on the other side, telehealth. Telehealth, we needed telehealth before the pandemic. Pandemic we saw an even greater need for telehealth. How did it show up . It showed up in a way we were able through federal and state regulatory support, Publicprivate Partnership to actually bridge the gap in telehealth. We were able to provide more virtually as a result of removing site requirements, state boundaries and can say in our own business, take our optum care business, we have about 50,000 physicians. Weve already provided more than a million telehealth visits as a result of being able to just expand to health services. So i think weve seep things that we needed to address as a result of the pandemic. Weve been Unitedhealth Group working with partners, working with policymakers to really advance and move that faster. Workforce, last example is workforce. We can see a workforce shortage, so advancing a 21st century workforce thats more virtual, addresses Population Health and can really go that extra step to address the Health Inequities we experienced with covid as well. 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 and saving people trips to the doctor . Is that a tiny percentage, half, hutch . Thats a great question. Another thing we might point out that were learning through this been is that were learning. Were learning what can be done virtually and what really is still required to be done in person. As we continue to adapt through better solutions, we found during the pandemic, lets take this, more than half of the Services Today as a result of the pandemic, half of the claims, have been virtual or telehealth, that nature. Obviously that was a result of shutdowns across the country. But in many cases what we found is were able 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 special Behavioral Services really couldnt access it. I guess i would say were 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 the spectrum of public and private partnerships, well be able to do even more. The biggest opportunity, i think, that we notice through this pandemic is the opportunity for people to continue to get their preventive services. Health care screenings are so important. The ability to do that, in many cases they will continue to be in person but we are committed to being part of the solution, to make that even easier to access and bring it closer to home for people. The final question m, maybe e most important question for people who dont have Health Insurance, how do you i have Health Insurance. If im sick or need to get tested, thats fine. Those people who dont have coverage yet, how do you think about that . What is the easiest way to get to a place where we do have 100 of the population covered in a way it doesnt showdown innovation inside the Health Care System . I think thats a great question and on top of mind for everybody as we look for opportunities to expand coverage. I think one of the things thats really important to start with, although the goal is 100 , lets not forget that 90 do have coverage today. The 90 that have coverage have really stable coverage that gives options and based on success. Its really the result of proven Publicprivate Partnerships. Again, for example, the medicaid program, medicaid and Medicare Program and employer sponsored program. Working from what we already know works. Start with medicaid. Medicaid already covering over 70 million individuals. Unitedhealth group through United Health care is one of the largest participants in that program across the country. Think about just expanding it, expanding it in the 12 states that continue to expand medicaid and ensuring that individuals that are eligible are presumptively in roll lly enrol. They are eligible, expand medica medicaid. Another advantage, we found individual consumers save dollars on Medicare Advantage. Continuing to fund and support a stable Medicare Advantage program. Then taking exchanges, modernizing them. An Exchange Program today, were in exchanges where Unitedhealth Group is committed to being part of the solution and expanding them but modernizing them. Giving the opportunity for people who would be eligible for subsidy to if they can be presumptively enrolled. Always an option to opt out but be able to presumptively be enrolled. That adds 18 million individuals to coverage right there and allowing states to expand and find sometimes flexible options like short duration plans are necessary for individuals in a certain situation. So i think thats how we expand coverage, then making sure its more affordable for people. So being thoughtful about, you know, the Exchange Programs, making sure exchange coverage, it allows younger, healthy individuals to pay rates that are commensurate with their Actual Health experience and Health Care Status and ensuring if we work electric that base, i think thats an opportunity to continue to expand whats already a strong coverage platform and really get every individual covered. Heather, thank you for a fascinating conversation. Thank you to opt um health for making this broader conversation about health care possible and back to you, sam. Thanks, jim. Our final guest today is avik roy, foundation for equal opportunity and Senior Adviser at the y debate here in washington. Thank you for joining u debate here in washington. Ovick, thank you so much for joining us. Hey, sam, how are you . Great. To kind of dive in here when were talking about coverage and access, a point ive heard you e make many times is thatra e universal coverage does not necessarily have to mean government coverage c when you look at the u. S. You know, i feel like these distinctions can get sort of tt blurred for a lot of people, you have millions of people get coverage from their employer, which they perceive as private o but they dont realize its subsidized by the government. Millions of people get insurance through medicare which they perceive as public but dont realize a lot of it is actually private. And so, you know, im wondering if you can just sort of, from a big picture level, walk throughv whereel in your view the privat sector and the Public Sector sort of belong in the pursuit of universal coverage. Thats a great point, a the 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 dont appreciate thag universal coverage is not the same thing as single pay or pra government run health care. Te a lot of countries in europe or pr least a number of them have achievediv universal coverage wh private Insurance Companies or private insurers. Thats an important distinction, that doesnt mean theres an absence of government involvement in all these countries in europe where they have a universal private ve insurance system theres an rt effort topr provide financial e ansistance in the form of subsidies and other things to o low income folks who otherwise wouldnt be able to afford coverage, there are regulations and other elements of the system, rules of the of the road, you might say, that bracket how the insurance peakin coverage is defined. But broadly speaking, the way i look at it, and what ive triedt to d persuade free marketeers oa market 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 you buy, and from whom you buy it. And the flaw of a single payer system is its one system, its one insurer, and you really havt no choice if that insurer or ed that benefit or that system isnt workingicare for you, you nowhere else to go. In a system like Medicare Advantage, which you alluded to earlier, sam, its a governmentn sponsored system,ta government subsidies for people who cantt afford their coverage but you plve dozens of choices into the kind of plan you buy. Thats why the Health Reform approach weve talked about at free op is called Medicare Advantage for all because it highlights the point that when Bernie Sanders said medicare for all hes talking about abolishing the Health Insurance that 40 of seniors use, which is private insurance. Where do you think the think Republican Party is right now on health care . That its an issue that worked really well for conservatives, from the beginning of the Affordable Care act era, the pendulum has swung somewhat back in democrats direction. Why do you think thats ything i happened, and is there anything in the near term you think that can reverse that . Well, at the bottom line to your question is, you know if the question is where are republicans, theres no right answer to that question. Theres no wrong answer to that question. Republicans are all over the place. Theres no consensus among republicans as to what they think about health care. There are some leaning into the kinds of ideas ive talked about, theres actually a bill thats been introduced by senator mike braun of indiana, and bruce westerman, our congressman from arkansas, thats he fair care act based on a lot of the work that weve done that tries to achieve universal coverage through private insurance so there are s people on that you might say ent of the spectrum and those who say lets go backaina toe obamacare, not sustainable and then theres sort of people in the middle who, you know, i think are ack f certainly dont like being hammered on their lack of a plan or solution for the uninsured or the affordability of Health Insurance, looking for answers and they havent figured out what they believe in yet. E thats part of what think tanks are for and part of why weve built the foundation for equal opportunities, trying to solve those problems. Fair enough. This next question is actually one from our audience, the f question from a reader who askse how can we reframe the discussion to address actual total cost, not prices, or negotiated discounts . So i guess to try to put sort of a finer point on that, one of the few things that people from bothon parties and really everybody outside the industry sort of agrees on is that some kind of Price Transparency in health care would probably be lr great fore patients, but at the same time, as you know, trying to actually achieve that, and find some actual number that yos cann give people that will be useful to them individually, is very difficult. Is Price Transparency in health care possible and is it worth doing in your view . Well, before we even talk ic about pricee of transparency, l make very clear that the price of health care in america is extremely high, its nd not t unsustainable, its unaffordable, and its not the kind of system that you would want in terms of the prices, if you had a true free market or market oriented system or if you had a single payer system. Whatever side of the ideologicaa or philosophical spectrum youre on the prices we have are the worst of both worlds. H no we have a system in which we subsidize health care for almost everyone but we have no accountability built into the system for the prices that patients are charged. By often monopoly providers of h those services. Thats a huge problem and reformers on both sides have different ideas on how to solu addressti it. Price transparency is part of the solution but its not the whole solution. Let me get into why. First of all, its worth noting, sam, and youve talked about this some in your work, and some of your colleagues have as well, the Trump Administration has uia actually done quite a bit on s pricee transparency, the rules that are going into effect starting in january of 2022, s that require all hospitals and insurers to disclose the rates with each otiatedd other for various health care services, thats a revolution, and i guarantee you there are people in Silicon Valley, in fact, i know for a fact, there are people in Silicon Valley today and people in the existing Health Care Industry that care i recognize hownd 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 different people in america. So thats really important reform, thats still winding its way to the courts. Survi but if it survives Court Challenges from the hospitals and others its going to be really important. Now, theres something thats tp reallyle important to understan about Price Transparency people dont understand. If hospitals post the price or a knee surgery or heart surgery on their window thencouple well ae better ability to shop. Thats not true for a couple of reasons, one, 80 . If you take an employerbased he plan, 80 plkt of your Health Care Dollars arent paid for by you the patient directly, theyre paid for by the employer or by the Insurance Company that the employer contracts on your behalf. So if your deductible is 1,000 or 2,000 and the Knee Replacement is 15,000 in one lt place and 10,000 in another, youhe that dont care, once you your deductible, the difference to you is not that great. Where you need to have e of transparency as a consumer is ie the price of the Health Insurance that you buy, and we dont have that because if you get insurance from your employer its taken out of your paycheck pretax, you dont actually have any idea how much money is taken out of your wages to pay for that insurance and if you get it through the government, even more so, its ironic only the i peopler in the Affordable Care actt exchange that have a real sense of how much theyre paying for their insurance. A big part of our approach to Health Reform is to increase the number of people shopping for their own coverage and get the reward for finding the value. Ege if they can reward the insurers doing a good job of negotiating lower prices on their behalf, then the insurers will have a stiffernd tho spines to negotial stronger or more carefully with hospitals and doctors and pharmaceutical companies, they dont have that incentive today. Yeah, i dont need to tell you this, but that is a you get a lot of incoming from a lor of different sides, trying to get more people shopping on their own, ideological, but also resistance for employers, you know. Some, resistance from some employers. Because, yes, the chamber of commerce and the fortune 500 fo companies, they love thert stat quo, because they think its a barrier, if youre an engineer at apple and you know that thatp apples going to pay for this very expensive employerbased plan and you have a thought of leaving to start your own company and youre going to have to buy your own Health Insurance you might be intimidated by thag so you stay at apple even though you could actually extract more value for yourself working on m your own. Of course big business loves this system. But you talk to smaller businesses, you talk to startups, midsize businesses, they hate the current system. M i hear from employers all the time who say im 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 the t insurance its justru the tax ce makes that hard, another thing the Trump Administration has done that hasnt gotten a lot of attention, theyve created a regulation through the Treasury Department that allows employers now to fund health reimbursemenn arrangements like hsas where you could use the 3,000, 5,000 or 10,000 to buy your own insurance, thats a step in the right direction and our plan hei builds onll that and would reque all startups to use that approach if they wantt to draw down the tax salute so evolve ut more in the direction where the worker controls the dollars than an hr bureaucrat at your oining employer. All right, i think that is our time but ovick, thank you so much for joining us. Its always good to talk to you. Sam, same to you. And thank you all for joining us this afternoon for s another virtual a conversation that i hope has made everyone smarter. Faster, and thank yoo our sponsor, United Health group for making this event possible. For all the news that matters, on health care and everything else, check out axios. Com and the axios app. Id like to p