Health care hasn’t gotten much attention on the campaign trail so far, but whoever leads Connecticut in the next four years will face a wide range of health care challenges.
The Mirror is sitting down with each candidate for governor to discuss health care issues.
Today: Senate Minority Leader John P. McKinney of Fairfield, one of two candidates in the Aug. 12 Republican primary. (Read our coverage of his Republican opponent Tom Foley’s views here.)
John P. McKinney, the state Senate minority leader, has pitched himself as the Republican candidate for governor with experience putting together budgets and doing the work needed to govern.
In his 16 years in the Senate, McKinney hasn’t been deeply identified with health care issues, although he was a key critic of plans to expand and renovate UConn’s John Dempsey Hospital using state funds. He also pushed for a tax incentive program to encourage people to get preventive care.
As governor, he said, he’d side more with consumers on insurance-related matters, privatize social services and ask state employees to accept less costly health insurance. He’s critical of Obamacare, but didn’t cite any specific ways he’d change how Connecticut handles it.
And he described personal experiences that shaped his views on physician-assisted suicide and the need to improve patient safety in hospitals.
Renegotiating state employee health care
McKinney has called for changes to the health plan that covers state employees and retirees, which costs the state $1.2 billion a year. He says it’s unaffordable, and noted that state employees pay significantly less toward the cost of their health care than workers in the private sector.
His suggested alternative: a plan consistent with a top plan offered in the private sector.
“I think we have to have a conversation about what’s fair,” McKinney said. “State employees deserve a good health care plan. But I don’t think it’s fair to the rest of the taxpayers to pay for what is sort of a platinum plan, a plan that’s too costly.”
Changing the plan would require re-opening the health care contract with state employee unions, which doesn’t expire until 2022. And McKinney acknowledged that the only leverage he’d have to get unions to the bargaining table is “the size of the workforce.”
Translation: the threat of layoffs.
A spokesman for one state employee union called McKinney’s idea “irresponsible,” and said the unions wouldn’t be willing to renegotiate.
The health plan now includes a wellness program that gets workers to use more preventive care, part of a 2011 concessions deal.
“An agreement is an agreement, and I think it’s puzzling why a candidate would want to re-open any agreement that is providing taxpayers with hundreds of millions of dollars in savings while saving lives and improving lives of state employees,” said Larry Dorman, spokesman for Council 4 of the American Federation of State, County and Municipal Employees.
Privatizing social services
McKinney also sees room to save money by privatizing the state-funded services provided to youth in the child welfare system, people with developmental disabilities, mental illness and addiction, and other groups.
Currently, the state relies on both public employees and private nonprofit agencies to provide the services.
“What I know clearly is that the nonprofit-run care is as good if not better than the state [care] and costs less,” McKinney said.
Private nonprofits generally provide services at lower costs than the state, in part because workers are typically paid significantly less and don’t receive benefits comparable to those provided to state employees.
But while replacing state-run social services with those handled by the private sector would likely save money, many nonprofit providers say their sector needs a boost in funds, not just more clients, to be sustainable.
After years of little or no cost increases in their contracts with the state, many nonprofits are at a breaking point, leaders say, struggling with high worker turnover and running out of ways to trim costs.
Part of the problem, they say, is that when state leaders face budget troubles, the money paid to nonprofits for social services is often one of the easiest pools of money to cut.
If more people who rely on social services are served by a sector that is especially vulnerable to budget cuts and already struggling financially, wouldn’t there be a bigger risk of people not getting the services they need?
McKinney said the nonprofits are vulnerable in tight budgets in part because they compete with the state to provide services.
“If you shifted to not, ‘Are you properly funding the nonprofits vs. the state’ to ‘Are you properly caring for people in need or not?’ I think they become less vulnerable because they then are the caretakers and delivery system for our most vulnerable,” he said.
Assisted suicide: He’d veto it
McKinney has a habit of trying to put his statements in context before declaring a position, letting listeners know he understands the other side or making clear what he isn’t saying.
But on the question of whether terminally ill people should be able to receive prescriptions for lethal doses of medication to end their lives — a controversial matter that’s drawn intense support and opposition in the Capitol in recent years — McKinney is uncharacteristically direct.
“I’m opposed to it,” he said.
“I try to be cautious in my words, but if I’m governor and the legislature passes an assisted suicide — aid-in-dying bill, to be fair to both names used by both advocates — I would not sign it. I would veto it.”
His views are rooted in personal experience.
He knows people who were given dire prognoses — and survived.
His father, longtime U.S. Rep. Stewart McKinney, struggled in the final months of his life before dying of AIDS-related pneumonia in 1987. McKinney was there as his mother died of cancer this spring at age 80. She received hospice care in her home and pain management. It seems that medicine has reached the point where it can help people from being in pain, McKinney said.
“There comes a point where, with my mom, we knew there was no turning back. We knew, ‘Now it’s just a matter of time,’” he said. “When she got to that point, at that point, she was not really capable of making the decision that you’d be required to make under the aid-in-dying bill.”
“I just see when you get to a certain point where you know there’s no turning back, you’re not at the point where you’re capable of signing off on that,” he added. “And I fundamentally can’t accept a doctor causing someone’s death earlier than it otherwise would happen.”
“I mean, I try to be compassionate about it, but I think it doesn’t send the right message about the importance of life and every minute, every hour, every day that you have here is still special,” he said.
Obamacare: No plans to change state’s course on law he considers failure
McKinney has been outspoken in his criticism of the Affordable Care Act, the law commonly called Obamacare.
He blames the law for causing health plans to be canceled and raising insurance prices for many state residents. (The majority of Connecticut residents who buy their own health insurance are eligible for discounted coverage as part of the law, according to the state’s health insurance exchange, but many whose incomes are too high for financial assistance now face higher premiums.)
McKinney is also critical of recent glitches at the state’s health insurance exchange, Access Health CT, including a problem that led some clients to have their insurance plans canceled.
But McKinney didn’t identify anything specific about the state’s handling of the federal law that he would change as governor.
Would he maintain expanded eligibility of Medicaid, which led to nearly 156,000 poor adults without minor children getting coverage through the program?
McKinney said he’d have to take a look at it, but added that the decision by then-Gov. M. Jodi Rell to expand the program in 2010 was the right one. The state already covered many poor adults, and expanding Medicaid allowed Connecticut to receive federal reimbursement for a portion of their coverage costs, he noted.
Although he said Obamacare precludes it, McKinney believes the state would have been better off taking its own approach to expanding health care coverage, like the Charter Oak Health Plan Rell began. The plan was open to people with pre-existing conditions and at one point enrolled just over 14,500 people.
Charter Oak faced heavy criticism, initially for offering limited benefits, and later from some members as the costs of the plan rose. The premiums initially charged for Charter Oak weren’t enough to cover the costs of members’ medical care. After legislators voted to stop subsidizing premiums for new members, costs rose dramatically and many people dropped out. In December 2013, Charter Oak’s final month before being discontinued, 3,546 people belonged to the plan.
Targeting health care costs
Asked about ways the government could help reduce health care costs, McKinney suggested efforts to increase transparency in insurance premium hikes, renegotiating state employees’ health benefits, and promoting health through preventive care.
Connecticut’s health insurance premiums are among the highest in the nation. But people in the insurance industry often point out that the premiums are largely a reflection of the state’s high health care costs, not the cause of them.
McKinney said government could help improve health and save money by encouraging people to get preventive care. He pointed to a 2008 proposal he and colleagues in the state Senate backed that called for giving tax credits to people who received recommended health care services. The measure didn’t get far in the General Assembly, but McKinney said he still thinks it should be considered.
Ellen Andrews, executive director of the Connecticut Health Policy Project, offered some caution about the idea. While getting preventive care might be the right thing to do, she said policymakers shouldn’t assume it will always save money. That’s because in some cases, the cost of screening a large portion of the population could outweigh the cost of treating an illness that’s likely to only strike a small number of people.
And she questioned how effective tax credits — delayed rewards — would be in getting people to get screenings or other care they otherwise would skip.
Consumers vs. insurers
McKinney says Gov. Dannel P. Malloy is too cozy with insurers. He called the governor a “puppet” of the insurance industry during a recent debate.
As proof, he cited Malloy’s veto of two bills the industry opposed: A 2011 measure that would have required a public vetting process for proposals to raise health insurance premiums by more than 10 percent, and a bill passed this year that would have required insurers to report data on coverage of substance abuse treatment.
McKinney noted that Malloy’s 2011 veto came after insurance company leaders wrote a letter supporting the Democratic governor’s controversial first budget.
“I think there are clear examples where he has vetoed legislation at the request of the large insurance companies,” McKinney said. “I don’t think that was the right direction to go in.”
Roy Occhiogrosso, who ran Malloy’s 2010 campaign and served as a senior advisor to the governor in 2011 and 2012, said it’s “ridiculous” to suggest the governor is a puppet to the insurance industry. He pointed to bills Malloy signed that the industry lobbied against, including expansions to the list of benefits health plans must cover.
“Something Sen. McKinney’s not likely to find out, but being governor requires you to strike a balance,” Occhiogrosso said. “And you can’t always come down on one side of an issue because that’s not the way the world operates.”
What would McKinney’s approach be to the industry, which employs more than 60,000 people in the state?
“Look, they’re important employers in the state, but I’m going to be fighting for the people who they insure, not so much for the insurance companies, because they’re the ones who need government to be fighting for them,” McKinney said.
Hospitals don’t all have to specialize in everything
While Connecticut has long been dominated by nonprofit, independent hospitals, many are now consolidating into larger networks, including five that are poised to be purchased by a national for-profit hospital chain. Meanwhile, hospital systems are buying up physician practices.
McKinney characterized the changes as things leaders should be mindful of, rather than something he had a clear opinion on.
What approach would he take as governor to changes in the hospital industry? Would he let the market drive changes or seek to intervene beyond the state’s existing regulatory process?
“I think you have to make sure as governor that hospitals aren’t closing,” McKinney said. “Because I don’t think we’re at a point where we have too many hospitals.”
But McKinney said the state might need to take a more holistic approach to how hospitals serve state residents. He noted that as a legislator, he heard appeals from hospitals trying to rally support to get approval to add a service, or to oppose a competitor’s bid to add a service.
“We ought to, I think as a state, be looking at a very high level at what makes the whole system work, versus what’s just right for one hospital or the other,” he said.
If more hospitals perform the same specialized services, reducing the number each one does, he wondered, could that reduce care quality?
“We’re a relatively small state, so not every hospital has to do everything in order to meet the needs of the people of Connecticut,” McKinney said.
The need for better patient safety protocols
A recent experience gave McKinney a new interest in patient safety.
His late mother, Lucie McKinney, was diagnosed with cancer earlier this year. She also developed a type of infection that is most commonly acquired in hospitals.
“I want to be careful because I’m not being critical of hospital people. The nurses were fantastic. The staff was fantastic. The doctors were fantastic,” McKinney said.
“But the protocols weren’t consistently applied in terms of how you interact with someone with an infectious disease in terms of wearing gloves, wearing masks, wearing robes. And it contributed to the end of her life.”
The experience prompted McKinney to look into hospital-acquired infections. He found the information available to be confusing and became concerned about a lack of transparency.
One recent survey found that one in 25 U.S. hospital patients had at least one healthcare associated infection. Connecticut law now requires hospitals to report the incidence of certain healthcare associated infections in their facilities, including those that occur after surgery and those associated with catheters and central lines. Patient safety, including avoiding infections, has become a major focus for Connecticut hospitals.
“One of the things that I want to do, whether I’m governor or not, is see if we can work on better education, better hospital protocols,” McKinney said. “It just seems to me that it’s preventable, that all the infectious diseases can be preventable and we need to do a better job. Hospitals need to do a better job.”
Keeping Southbury Training School open
Although McKinney favors privatizing social services, he doesn’t think the state should hasten the closure of Southbury Training School, a facility for people with developmental disabilities.
Southbury no longer accepts new residents and people who live there and their families have the option of moving out. But any of the 329 residents who choose to remain there can.
Budget cuts to the state Department of Developmental Services have made it harder for people with developmental disabilities to receive residential services, and some say more people could be served if the state could direct the money spent at Southbury to the rest of the system. In the 2013 fiscal year, care at Southbury cost $976 per day per person, compared to $452 at a private-sector facility providing the same level of care.
But McKinney said Southbury should stay open while it has residents who want to stay.
“I understand the costs of that, but it certainly seems to be what’s fair to the families and people who were there in terms of keeping the promise,” McKinney said.
Mental health: Parity and stigma
Asked how he’d assess the mental health system and what it needs, McKinney cited the need for parity in insurance coverage of mental health and for greater acceptance in society that mental health issues are just like other health issues.
“There’s a stigma about it and we need to remove that stigma,” he said.
In the wake of the Newtown shootings, some people have advocated for Connecticut to allow court-ordered treatment for people with mental illness who could pose a danger if untreated. Most other states have some sort of law allowing for the concept, known as outpatient commitment or assisted outpatient treatment. But mental health officials and advocates in Connecticut have staunchly opposed it.
McKinney said he hasn’t studied the issue, but said it’s a difficult matter.
“If someone’s an adult, they have their rights to live their life. And I don’t know that the system is perfect now in terms of that. Obviously it’s not,” he said. “But I think we have to be very careful at forcing people to take medication against their will.”