Connecticut’s health care landscape has undergone some seismic shifts this year.
More than 2,000 people died of COVID-19. The General Assembly passed a bill expanding the pool of medical providers who can perform abortions, but with the reversal of Roe v. Wade, anti-abortion advocates are lobbying to impose new restrictions.
Hospitals have tried to end crucial services in some corners of the state, and the consolidation of health care services has accelerated. Insurers asked for an average rate increase of 20% on 2023 health plans, and debates over a public option and the legalization of aid in dying continue to brew.
Incumbent Gov. Ned Lamont, a Democrat, is facing two opponents in this fall’s gubernational election: Republican Bob Stefanowski and Independent candidate Rob Hotaling. The CT Mirror asked the three candidates for their views on several key health care issues, including how they would approach tackling rising costs, whether they would roll back abortion rights, and how they would respond to COVID-19.
The following has been edited and condensed for clarity.
How would you address rising health care costs in Connecticut? What approaches would you pursue to make health coverage more affordable?
Lamont: “Well, first, look at what we’ve done. We’ve expanded Medicaid, we’ve [launched] the Covered Connecticut program, [overseen] the expansion of the exchange … We tried to do something about pharmaceutical prices, but we didn’t get that through the legislature. Looking forward, I’m really enthusiastic about the health care benchmarking Massachusetts has done to bring real transparency, which we’re beginning to see when it comes to the underlying cost of health care.
“What I’d love to do is expand on what the comptroller’s office is doing with our 200,000 state employees and retirees, which is dealing with the underlying costs of health care, starting with hospitalizations. We are incentivizing our state employees to go to places where you get the most value. And there’s a big difference in the price and quality of one hospital to another, depending on which practice you may need. I really want to work with the private sector to do the same thing and work with the insurance guys to create a preferred network, so they in turn can drive people to places where we have less costs.”
Stefanowski: “We need more competition. This is not a knock on Yale [New Haven Health] or Hartford [HealthCare], but they have acquired a lot of the providers who used to be independent. I think having some more price sensitivity, or competition, would help. We’ve got to get prescription drug costs down. I think that’s a big part of it. I’m also personally very sensitive to senior care. My dad is 92, and I, obviously, I can help support him. But for him to be burning through his entire life savings, because he wants to stay home — I think we need to look at that. Another thing: Is there a way to reinsure some of these costs? There are big reinsurance providers you can work with to offload some of the risks. I think we should be looking at that.”
Hotaling: “First of all, we have 32 community health centers around Connecticut. They can serve patients based on their ability to pay with a sliding scale, and we should expand their access, either with more facilities or the ability to facilitate more patients. Secondly, I think we should focus on inefficiencies and lowering the cost of services. … The lack of data sharing creates redundancies. So I think if we improve our data sharing with technology and process, it would make a major dent in lowering the cost of services.”
The legislature this year expanded abortion rights, making Connecticut a safe harbor state and broadening the pool of medical providers who can perform abortions. How would you further expand or strengthen abortion rights in Connecticut, or what restrictions might you support?
Lamont: “I don’t support any restrictions, period. I support Roe v. Wade. I think they came up with a very responsible balance 50 years ago. The number of abortions went down, contraception was a more reasonable, better, successful alternative. I think the court has taken us in the absolute wrong direction. When it comes to reproductive choice and abortion rights, there is no ambiguity in where [Lt. Gov.] Susan [Bysiewicz] and I stand. If you wanted to do one more thing to strengthen that, our legislature could look into a constitutional amendment. Right now, what we have is legislation that protects a woman’s right to choose by law. And of course, that law is as good as the next legislature and the next governor. So there may be some incentive to do something constitutionally.”
Stefanowski: “Despite all the attack ads, I certainly won’t restrict the Roe v. Wade part of Connecticut law that was codified. I think that’s the right position to be. I’m not going to change it. The  bill that passed, I wasn’t in the legislature, but my Lt. Gov. [running mate] Laura Devlin voted for it. I would leave it where it is. I don’t think we should reverse it. I know it’s a scary issue nationally, but in Connecticut, it’s resolved. And I think we leave it where it is.”
Stefanowski has announced his support for parental notification, a move that would require people under 16 in Connecticut to notify their parents before seeking an abortion. Asked about that, he replied: “I don’t see it as a restriction. I do think there should be an exception to that for rape and incest. You don’t want someone trapped in a situation. But this is not consent, this is just notification. Most states have it.”
Hotaling: “I believe that abortion should be safe and legal, but rare. We should defend a woman’s right to choose. I disagree with the SCOTUS decision on Roe v. Wade because, in my opinion, it eliminated a national safety net and a consistency of health care access across our nation. There’s never been a more important time to have governors who support defending that health care access as a basic right. I support the current law and I support the legislature and Ned Lamont signing [the 2022 bill] into law … I would have signed it into law myself. And I have every intention, if I become governor, to maintain that law in its current form.”
Pressed on whether he would support any new restrictions, Hotaling responded: “At this time, none.”
When considering how the state should respond to COVID-19, what indicators would you weigh, whom might you talk to, and how would you make decisions?
Lamont: “I hate to say this, but I think more of the same. The degree to which we have the best health care minds in the country, a lot of them happened to be right here in the state of Connecticut, starting with [Yale School of Public Health professor] Albert Ko and [former Food and Drug Administration Commissioner] Scott Gottlieb. They were invaluable for me when it came to not only what we had to do to keep ourselves safe, but also how to explain that to people. … The metric has changed. It used to be number of infections. And then it really became, for me, hospitalizations and the degree to which we thought our hospital system couldn’t handle the stress. Hospitalizations have stayed relatively low, not zero, but 400 or so, up or down maybe 100 in either direction. I feel good about that. In terms of mandates — not so much. I think now, unlike two years ago, people have the ability to keep themselves safe.”
Stefanowski: “I think it’s a combination of the statistics … and talking to people. In Connecticut, we’ve got a lot of specialties at the different hospitals. To me, it’s also talking to people who are impacted. For example, I don’t think we should have put infected patients into nursing homes. I think that was not a great decision. I also think we focused on the health side, which makes sense because it’s a crisis, but we underestimated the mental health side. You have to talk not just to your clinicians but also to people who understand the impact of kids being out of school or at home for six months. We’re going to see this follow us for a while.”
On indicators, Stefanowski said: “I don’t think we can apply a ‘one size fits all’ [approach]. You’ve got kids with [a low] chance of mortality. You’ve got elderly people who are very susceptible to things like COVID. We shouldn’t follow ‘one size fits all,’ and I think we did a little bit. Certainly, deaths are the ultimate indicator, and you’d have to look at that; infection rates. The level of people in hospitals is another one. You want to make sure you’ve got enough capacity to deal with people and you don’t have to put them into nursing homes.”
Hotaling: “I am anti-lockdown. And I am not for mandates. We shouldn’t force people to put anything in their bodies. However, we should encourage our citizens to be healthy and protect our population from outbreaks of deadly viruses with certain precautions like testing, tracking, N95 masks, etc. But we should also provide options for remote work or schooling for those who don’t feel comfortable taking vaccines. In terms of who I would interact with and learn from, I think we have to look at everyone — obviously, the federal government, those in health care administration, the National Institutes of Health, but also doctor associations and administrators. We should talk to the spectrum. We should learn, listen, and build consensus. I would focus on gathering data. I know there’s a website where we talk about deaths, we talk about how many people have arrived at a hospital, who has been treated for or tested for COVID-19 or other viruses; we should gather all of that. And we should augment that with expert opinion and expert analysis, and then arrive at our decisions.”
What do you see as the government’s role when hospitals are looking to close, merge or end important services?
Lamont: “It’s really important that primary care and maternity care be widely and broadly available. If they don’t have good maternity care in Northwest and Northeast Connecticut, young families are a lot less likely to move there. Pregnancies could be more at risk. I think [the state’s] Office of Health Strategy understands getting that balance right better than anybody. We’ve said ‘no’ to a couple of efforts to close down maternity care. We’re now working to make sure there’s a basic level of care widely available within approximate distance throughout the state. … I’m willing to hear good ideas. I thought the [state’s] Certificate of Need process was pretty effective in keeping care widely available where we needed it to be and not letting hospitals shut down or curtail. If we need more muscle on that, let’s take a look at it.”
Stefanowski: “I think we need more options. And the government should be — I’m not sure what the right word is — facilitating independent practices. We should be providing the right certification programs, but not making it so that it takes 18 years to get a practice. And again, this is not anti-Yale, they do a terrific job. Hartford Hospital is great. But I also think there’s a role for the smaller, individual providers. We should provide more clinical opportunities, particularly in the non-acute categories — outpatient surgery, things of that nature — where we can train and get more people into this.”
Hotaling: “Hospitals are cutting services … or closing due to financial performance. I believe it should really be based on patient health performance. Many of these [closures] are also in less affluent areas, and health care should not be a matter of haves and have nots. We need to have the right measures of success for hospitals that are not solely based on financial performance. Mergers limit access to health care due to consolidations. We really need to take a look at, going back to my earlier point, expanding access for the community health centers around the state. … We definitely need oversight from a state-level perspective. … I think we need to look at why we are consolidating these hospitals. Can we move from a world of financial performance to a world of patient health performance and apply that to consolidations and closures, and see what we can do to augment that?”
The state’s Medicaid program will soon be open to undocumented children 12 and younger whose families meet the qualifying income. Would you support a further Medicaid expansion for all undocumented residents who meet the income qualifications?
Lamont: “I think we walk before we run. We are one of the leaders there. Obviously, I have to be very cognizant of the Feds, who will not support this in any way, shape, or form. So I’ve got to make sure we don’t run afoul of anything they’re doing. I like where we are and the direction we’re going. I’m not inclined to make any big changes right now.
“I haven’t ruled it out at all. I would like to see the federal government get a little more control over the southern border, so we’re being careful as we expand opportunity here in the state. … I think having health care available up to age 12 is good. If we change that, so that everybody gets everything right now, that would put us in a very different position at a time where the southern border is not very well secured. The two are sort of related to me.”
Stefanowski: “I would look at it. I would have to look at the cost. I think the more we can do for anybody in our state, the better off we’re going to be. But I’d be reluctant to make an open commitment on that until I see what it did to the budget. If we can do it and we can afford it, I’m all for it. But I think we need to look at the numbers.”
Hotaling: “We need a real path to citizenship. But in the meantime, we need to provide health services to people who need them, regardless of their status. The uncompensated care pool also needs to be addressed. I believe children should be covered. For the adults, we should show compassion and provide the services, but those with the ability to pay or work should be required to do so for the services rendered.”
Legislators have tried several times to pass a public option health insurance plan in Connecticut. Would you support such a proposal?
Lamont: “A public option means very different things to many different people. It’s sort of a cure-all to some folks. You’ve got to deal with the underlying costs of health care. You can change how you insure it, you can change how you regulate it, but if hospitalizations or pharma costs keep accelerating as they have in the last year — private options, preferred options, public options — you’re just putting a Band Aid on a wound. I love what we’re doing in the public sector in terms of a preferred network or sending people to centers of excellence where you get a lot more value. I think that’s what they’ve got to do in the private insurance market as well.”
Stefanowski: “I just think nine times out of 10, the private sector does it better. Public sector does not provide a great solution to people. It’s been proven time after time. I think we should keep it where it is.”
Hotaling: “The most significant legislative proposal I would have is, if you’ve been living and working in Connecticut for over 10 years, you’ve showed loyalty to our state and you’re of retirement age [65 or older], I believe health care should be free. We should have the public option for our retirees and people of retirement age. That would directly address cost of living in Connecticut. Why? Because most retirees are fleeing the state due to the cost of living, and health care-related expenses are the most significant impact on them. The largest set of bankruptcies for people who are retirement age are related to medical expenses. So it would completely alleviate that and give a benefit to those who have been most loyal to our state.
“We have a lot of surplus dollars, and we could look at inefficiencies and expanding the pool. I think the other part of it is keeping our graduates in the state … they help build the pool. The more younger people you have in the pool should lower overall the broad expenses for it now. We could broaden the sales tax and apply more use-based taxes elsewhere to help fund this.”
COVID cases in schools are substantially higher than they were at this point last year. Should the state add the COVID-19 vaccination to the list of mandatory vaccinations for children attending school?
Lamont: “Not yet. It’s still under emergency authorization. You know how ginned up everybody gets about vaccinations, not to mention masks. I’m going to do everything I can to encourage it, tying it perhaps to when people get the flu vaccine. … I’ll leave it up to parents and do everything I can, rather than create a headwind and a lot of resistance. I want to do it on a voluntary basis.
“I think I’m going to take a wait-and-see attitude on that. I do worry, though. Fewer people are getting vaccinated. I mean, look at the polio. Right across in Westchester County, you have cases of polio. We thought we had taken care of polio 60 years ago. I do worry about folks being too casual about vaccination. But I also understand the political blowback.”
Stefanowski: “No. I think they should be available, but I think it should be up to the parent to decide. I am an advocate of the vaccines. I’ve gotten it; my kids have had it. I do believe in the efficacy of the vaccines, but I think it should be up to the parent.”
Hotaling: “We shouldn’t force mandates [for] children. There are a lot of parents who are concerned one way, there are a lot of parents concerned the other way. And I disagree with mandates. What I believe we should do is encourage citizens to be healthy, to go get that vaccine. We should protect our population from outbreaks and the further expansion of COVID-19 cases through better tracking and tracing and other precautions. And we should ask our schools to provide options for remote schooling. … We should make investments collectively for schools to offer virtual [learning].”
Lawmakers have tried for years to pass a bill that would legalize aid in dying in Connecticut. Would you support that proposal?
Lamont: “I think I would. I’m tired of politicians getting between a doctor and their patient. I really believe in the sanctity of that relationship. You’d have to do it carefully and make sure [a person’s] rights were respected, but I’m sympathetic to that legislation.”
Stefanowski: “That’s a tough one. My mom had dementia, and I look at those last years of her life that she got to spend with my dad. Hospice came in and they gave us the morphine and said, ‘You’ll know when to use it.’ I think we need to invest more in hospice. We should invest more in providing the right services, but … the aid in dying, I don’t think we should support it.”
Hotaling: “I don’t know if I have a fully informed decision, but I do believe that if [adults] are in pain in hospice, or in an untenable situation, and they’re of right mind to make decisions about whether they would wish to end their lives early … they should be given the option. It’s their body, it’s their life. It’s an untenable situation. If they’re of sound mind and body, I would agree with at least providing them the option.”