Wide di­ver­gence on health care

3 gu­ber­na­to­rial can­di­dates of­fer con­trasts on piv­otal is­sue

Connecticut Post (Sunday) - - Sundaybusiness - By Macken­zie Rigg

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 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 Con- necti­cut — 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 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 law.

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.

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 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 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?”

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.

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.”

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 mul­ti­a­gency re­sponse, in­crease ac­cess to nalox­one, en­cour­age med­i­ca­tionas­sisted treat­ment, and con­tinue the work of the Con­necti­cut Opi­oid Re­sponse 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 said.

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 would not seek to limit ac­cess to re­pro­duc­tive choice.

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 free-

doms.”

Griebel’s ad­min­is­tra­tion, if elected, would “un­equiv­o­cally up­hold a woman’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.

La­mont

Ste­fanowski

Griebel

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