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From left, Oz Griebel, Ned Lamont and Bob Stefanowski.

The three leading gubernatorial candidates all agree that government must protect insurance coverage for pre-existing medical conditions — a key provision of the Affordable Care Act — and that the opioid epidemic is a major public health crisis that must continue to be a top priority.

They also all say that more needs to be done to bring down the costs of expensive prescription drugs and support Medicaid expansion — an issue being fought in elections outside of Connecticut — which extended coverage to low-income adults who do not have minor children and were not disabled.

But that’s essentially where the agreement ends.

The candidates diverge when asked their opinions on whether the state should have work requirements for certain Medicaid recipients or impose an individual mandate penalty, a question for state officials after the ACA tax penalty was eliminated in the federal tax bill last December.

While health care isn’t carrying the same amount of weight in Connecticut as it is in elections in other parts of the U.S., the state’s next governor could influence some important issues related to health care policy. For instance, in February, Texas and a coalition of red states filed a lawsuit challenging the ACA. A few months later, Connecticut and a coalition of Democratic states led by California intervened in that lawsuit to defend the ACA.

The CT Mirror sat down with Democratic nominee Ned Lamont and petitioning candidate Oz Griebel to discuss their positions on health care. This story includes comments made during those interviews, as well as official statements made by the campaign and information included in campaign literature.

Republican nominee Bob Stefanowski declined repeated requests for an interview in-person or over the phone. His campaign answered questions by email through his communication director, Kendall Marr.

Here’s where the candidates stand on some of the biggest issues in health care today.

CT’s legal defense of the ACA

In June, state officials filed court documents in defense of the ACA, arguing that the  federal law has brought the state billions of dollars in new resources, helping it expand health care coverage and establish new health programs.

In September, a federal judge in Texas heard arguments about the case.

Lamont was the only candidate to take a stance on the case. His campaign said in a statement that he supports the lawsuit and would defend Connecticut’s position in court.

Both Stefanowski and Griebel said they would review the suit and confer with the new attorney general.

Medicaid work requirements

The three candidates have differing views on Medicaid work requirements, which have been approved in a few states, according to the Kaiser Family Foundation.

In January, the Centers for Medicare & Medicaid Services (CMS) sent a letter to states, saying that it would, for the first time, allow them to craft programs requiring Medicaid recipients to prove they are working, training for a job, or volunteering in their communities before they receive benefits.

In Connecticut, a bill aimed at imposing work requirements for some Medicaid recipients failed to make it out of committee during the last legislative session. The state Department of Social Services opposed the bill.

The state can’t simply impose work requirements on its own, however. States must apply for a federal waiver before they can require adult, able-bodied Medicaid recipients to work or perform community service.

Stefanowski, alone of the three candidates, supports work requirements.

“I support efforts to encourage able-bodied individuals without dependents, and those who are not disabled or seniors, to engage in work or volunteer work in order to receive Medicaid benefits,” he said.

Lamont opposes the policy.

“Health care is a basic right … and the idea that you would make a prerequisite is the wrong way to go. And it’s not only wrong for that person, as I’ve said before, it’s not smart for the state of Connecticut,” he said at a health care panel discussion at the Yale Child Study Center in New Haven in October.

Griebel took the middle road, saying the idea should be examined. “It’s not to penalize somebody for Medicaid. Is there an opportunity if someone’s not working today, is there an opportunity to get them back into the economy in a way that gives them dignity, gives them an opportunity to learn skills?”

Individual mandate

The federal tax bill passed last December eliminated the tax penalty for not complying with the individual mandate established under the ACA, which required most Americans to have a basic level of health care coverage. The new law goes into effect Jan. 1, 2019.

Two bills that would have established an individual mandate in Connecticut failed to make it out of committee during the last legislative session.

Griebel supports an individual mandate in Connecticut.

“I’m a believer people should be taxed if they don’t get coverage,” Griebel said. “The devil’s always in the details on how does an individual mandate work, but conceptually the idea that we’re all responsible for having coverage in one form or another that’s adequate, I think is an important responsibility we have for one another.”

Stefanowski disagrees.

“I do not believe people should be forced to purchase something that they don’t want. Young adults who are healthy should not be forced to pay expensive insurance on the mandate,” he said in an email.

According to Lamont’s campaign, he has supported the individual mandate in the past, “but he is concerned about adding an individual mandate to Connecticut law at a time when the Trump Administration is working to sabotage the Affordable Care Act.”

Coverage for pre-existing conditions

Under current law, health insurance companies can’t refuse coverage or charge more because someone has a pre-existing condition, a provision of the ACA. The Texas-led lawsuit challenges the legality of this provision, among other aspects of the ACA.

All three candidates support coverage for pre-existing conditions.

“First thing I want do is give people confidence that we’re going to fight for the basic protections under Obamacare,” including pre-existing conditions, said Lamont, when asked what would be one of the first actions related to health care that he’d take if elected governor.

In a statement, Stefanowski said, “This is protected by state statute and I would not seek to change that.”

Griebel said this protection is “embedded in making sure that we’re keeping people as healthy as we can, and in our entire goal of providing the most accessible, affordable, highest quality health care to every state resident.”

Opioid crisis

Fentanyl continued to drive the state’s drug epidemic to new, deadly heights in 2017. The Office of the Chief Medical Examiner said accidental overdose deaths climbed over 1,000 for the first time in 2017.

Overall drug deaths in the state have nearly tripled over six years, from 357 in 2012 to 1,038 in 2017.

State officials have projected accidental drug deaths will remain virtually flat this year, marking the first break in the momentum of an epidemic that has shown double-digit increases year after year since at least 2012.

Lamont released a health care policy plan in October. In that, he said he will appoint a cabinet-level opioid czar to coordinate the state’s multi-agency response, increase access to naloxone, encourage medication-assisted treatment, and continue the work of the Connecticut Opioid Response (CORE) Initiative. CORE is Gov. Dannel P. Malloy’s three-year strategy to prevent addiction and overdoses.

Naloxone, commonly known as the brand name Narcan, is a medication designed to rapidly reverse opioid overdose. Medication-assisted treatment combines behavioral therapy and prescription medications to treat substance use disorders. It is seen by many as the most effective way to fight the opioid epidemic.

Stefanowski said he would “continue funding for mental health and substance abuse programs.

“I would meet quarterly with our department of public health, the department of mental health and addiction services, the medical community and law enforcement to develop a comprehensive plan of attack to face this problem head on,” he added.

Griebel recently released a plan to address the opioid epidemic, which includes the formation of a task force comprising state agency leaders, first responders, municipal officials and private providers; the expansion of data sharing between state agencies and clinical, administrative and research databases; and making naloxone available over the counter without a prescription to make it more widely available.

Roe v. Wade

All three gubernatorial candidates say they will not seek to limit access to reproductive choice.

With the confirmation in October of Supreme Court Justice Brett Kavanaugh, abortion is once again in the political spotlight. In the near future, the Supreme Court could hear a case that could challenge existing federal protections of abortion rights under Roe v. Wade, as well as other subsequent Supreme Court rulings, according to the Kaiser Family Foundation.

During his Senate confirmation hearings, Kavanaugh deflected questions about whether he’d vote to overturn Roe v. Wade, saying it was “settled law.” But as a White House staffer in 2003, Kavanaugh wrote in an email that Roe v. Wade was not “settled law of the land.”

In Connecticut, the protections in Roe v. Wade were codified in state law in 1990. Therefore, even if Roe vs. Wade were overturned, this state law would remain intact.

But some are worried those state protections are at risk, depending on who is elected governor and the future makeup of the General Assembly.

Stefanowski’s campaign used similar language to Kavanaugh in a statement about the GOP nominee’s views on Roe v. Wade.

“Bob believes that Roe is settled law. He would not seek to limit access to reproductive choice if elected,” said Marr in an email. “Connecticut state law has additional protections for reproductive choice that would continue to stand even if Roe were overturned federally.”

Lamont and Griebel support Roe.

“Republicans will continue to try to overturn Roe v. Wade and strike down the Affordable Care Act,” said Lamont in a statement. “Women – not the government – should have control over their own bodies and our state needs a leader who will make sure Connecticut is a state that upholds women’s reproductive freedoms.”

Griebel’s administration, if elected, would “unequivocally uphold a women’s right to choose … Abortion should be safe, legal and rare,” according to the campaign’s website.

Hospital tax

The state began collecting the tax in 2012, pledging to redistribute the proceeds to the hospitals as a way of drawing down matching federal grants. That year the hospitals paid about $350 million in taxes and received about $400 million in state and federal funds.

But when the state began experiencing severe budget problems, it started returning less and less money to the hospitals, which caused considerable tension between the hospitals and the Malloy administration.

Last fall, the legislature approved a new taxing arrangement between the state and the hospitals.

The U.S. Centers for Medicare and Medicaid Services, commonly known as CMS, approved a significant increase in the state’s annual tax on hospitals — from roughly $556 million to $900 million in fiscal years 2018 and 2019.

In return, the state gave the hospitals $671 million through Medicaid payments, which was also approved by CMS, in fiscal year 2018, and will do the same in fiscal year 2019. This change cut the loss to hospitals from $438 million per year to $229 million per year, according to the Connecticut Hospital Association.

All three candidates said they would strive to work collaboratively with the hospitals.

“We had a deal with the hospitals … we didn’t honor it and I cannot unwind all that in a year but I think we can do a better job of treating our hospitals more fairly and unwinding some of those costs over a period of time,” Lamont said.

Stefanowski said the Malloy administration has imposed “huge tax increases on our critical hospitals. I have spoken with the hospital association about their concerns, and as governor, I would work with them on a solution that is best for both parties.”

Griebel said part of the reason the tax exists is to generate more revenue for the state budget.

“But having the state pitted against the hospitals is not going to get us to the most accessible, affordable, highest quality health care. We’d have to sit down and work through the details,” he said.