In September, even before Justice Amy Coney Barrett was nominated to the U.S. Supreme Court, stoking fears that the Affordable Care Act could be erased, Connecticut Democrats stood on the front steps of the state Capitol and declared that “health care is on the ballot.”
They were referring to the national races, saying Republican leaders at the White House and in Congress had “absolutely no plan to replace your health care” if the ACA were to vanish. But over the last few months, that mantra has also made its way into many state House and Senate campaigns, with Democrats pledging to expand protections at the local level if the decade-old health law falls and promising to fight for a bevy of other reforms, including lower drug prices and a public health insurance option.
“Let’s say there’s a scenario where the court strikes down the ACA, and the same partisan gridlock that we’re seeing in Washington right now continues. We need to act at the state level,” said Rep. Sean Scanlon, a Democrat from Guilford who is co-chairman of the Insurance and Real Estate Committee. “That’s why I think these national health care issues are relevant to state races. I know my friends on the other side of the aisle don’t want to hear that, but it’s true. And I think candidates are campaigning accordingly.”
Connecticut codified into state law several provisions of the ACA, including its “essential health benefits” – such as emergency services, hospitalization and prescription drugs – a mandate allowing young adults up to age 26 to remain on their parents’ insurance, and protections for people with pre-existing conditions. But those laws apply only to policies that are state regulated, or about 30% of the plans in Connecticut. Self-insured policies, which represent about 70% of plans, would not receive the protections.
Other benefits, such as a ban on lifetime insurance caps, federal subsidies for policies on the state’s health exchange, and the expansion of Medicaid in Connecticut, are not guaranteed if the ACA disappears.
Though Scanlon is running unopposed this year, he has joined fellow Democrats in discussions about the stakes for health care on the campaign trail. A week ago, he appeared at a virtual town hall organized by Rep. Stephen Meskers, a Greenwich Democrat, to talk about the future of health care in Connecticut. Meskers is trying to fend off Republican challenger Joe Kelly.
“We had a couple dozen people on there. And the No. 1 question I kept getting is, ‘What if the ACA goes away? What’s the plan?’” Scanlon said. “There will be millions of Americans and hundreds of thousands of people here in Connecticut without insurance and without the protections they have under this law. They’re really scared about what that means for them and their families in the middle of the worst health crisis we have faced in a century.”
House Majority Leader Matthew Ritter, a Hartford Democrat, said state lawmakers would move quickly to help people who lost out on insurance if the ACA were struck down. Candidates are talking to voters about the need for more protections at the local level.
“We would be scrambling to figure out a way to insure people if Congress were unwilling or unable to act in a rapid fashion,” Ritter said. “I can’t think of a more pressing issue for the Connecticut General Assembly to address than that.”
Earlier this year, when the legislative session was suspended amid the pandemic, a package of health care bills – including measures that would permit the importation of cheaper prescription drugs from Canada, establish a public option, and create a reinsurance program to mitigate risk from large claims – fell into limbo. The fate of those proposals has become a selling point for some Democrats as residents complain of soaring medical expenses.
Sen. Matthew Lesser, who heads the Insurance Committee with Scanlon, said if he were re-elected he would push for legislation that addresses access to and affordability of care, including boosting subsidies for plans on the exchange and expanding Medicaid. He also would look to revive the public option bill.
Lesser, a Middletown Democrat, is running for a second term against Republican challenger Richard Ruglio, a Rocky Hill businessman.
“Even if there weren’t a pandemic, I would be talking about health care,” he said. “It was the top issue two years ago when I was running for Senate the first time, and it’s the only game in town right now. It’s top of mind for everybody.”
Campaigning looks a little different this year. Lesser is still door-knocking, but he’s also reaching constituents through virtual chats, calls and emails.
Some Connecticut voters are upset at the Trump administration’s handling of the COVID-19 crisis, and Democrats are tapping into that frustration. In a Facebook post last week, Lesser shared a picture of himself with a constituent and wrote: “When she answered the door, a woman named Olga broke down in tears. She hasn’t seen her grandkids in seven months because of the pandemic. She’s a Vietnam-era veteran and she’s voting for the Democratic team. This election is about health care.”
Republicans say they, too, are focusing on health care during their re-election efforts. But they criticized Democrats for provoking fear on topics like the Affordable Care Act.
“They like to weaponize health care so they have a political issue on the campaign trail,” said Sen. Kevin Kelly, R-Stratford, a ranking member on the Insurance Committee. He called the Democrats’ declarations about the ACA “speculative.”
Kelly has spent his time reminding voters of the protections in place locally and is sharing his hopes for lowering the cost of care. He is a staunch supporter of the reinsurance program, among other measures.
“Health care, to Republicans, is very important,” he said. “It’s not just something that’s happening now. It’s been the No. 1 issue for several cycles.”
Senate Minority Leader Len Fasano, R-North Haven, who is not seeking re-election, said his colleagues have done a good job fielding questions and breaking down “the myth” that Republicans don’t care about health issues. He pointed to bipartisan support for several health bills adopted over the last decade, including the local protections for people with pre-existing conditions.
“Democrats try to use fear factors. They run with those talking points even though they’re not true, and even though they disfigure what really happened in Connecticut,” Fasano said. “Health care has been a bipartisan deal in our state.”
Debate surrounding the future of the state’s religious exemption from mandatory school vaccinations has also surfaced on the campaign trail. Many Democrats have supported a repeal of the exemption, starting in 2019 when measles cases were reported in Connecticut and outbreaks were recorded across the country. Some Republicans have spoken out against a rollback, arguing that it is an infringement on religious freedoms.
Under the proposal, children who forgo immunizations for religious or personal reasons would no longer be able to attend the state’s public schools. A bill on the matter was paused when Connecticut suspended its legislative session last spring.
Rep. Jonathan Steinberg, a co-chair of the Public Health Committee, said the pandemic has brought fresh urgency to the issue.
“Vaccines were a big issue this year, and you can bet they’re going to be a big issue going into next year,” said Steinberg, a Democrat who is seeking re-election in Westport. “I’ve got to think that’s going to be one of the top agenda items.”
While candidates have pledged to move on several timely proposals, advocates are urging them to also address health equity measures if they return to office next year. The death of George Floyd at the hands of police and the protests that flared up nationwide turned a spotlight back on pervasive and systemic disparities that have long existed in the health care system. Those disparities have worsened during the coronavirus pandemic.
Making health equity legislation a priority will be key to winning the support of many voters, advocates say.
“What I’m expecting and hoping in 2021 is that on a state and federal level, we will have policymakers who are going to stop giving lip service to health equity and to the health care needs of people when they’re running and then not doing anything when they’re in office,” said Tekisha Dwan Everette, executive director of Health Equity Solutions, a research and advocacy group in Hartford. “We need to go to the end of our capabilities in this state to make sure people have all the tools necessary to attain their optimal health. And we need to hold our Congressional folks from Connecticut accountable to keeping that going on the federal level.”