Where do the Delaware governor candidates stand on health care issues?

(Spotlight Delaware is a community-powered, collaborative, nonprofit newsroom covering the First State. Learn more at spotlightdelaware.org)

We asked the candidates for their opinions on several hot topics related to health care, and the three Democrats – Lt. Gov. Bethany Hall-Long, New Castle County Executive Matt Meyer and former chief environmental regulator Collin O'Mara – along with Republican Mike Ramone, responded directly to our questions. Meanwhile, Republicans Jerry Price and Bobby Williamson did not. We have compiled any relevant comments from other interviews on the campaign trail.

Below you'll find a quick breakdown on each topic along with abridged versions of each candidate's answers for context. They are ordered alphabetically by last name.

Hall-Long

We need to tackle all aspects of health care that influence pricing, including hospital, pharmaceutical and insurance industries, in order to meaningfully lower the cost of and expand access to care. To have a truly sustainable health care system, we need accountability. The law passed this year addresses one of those areas.

This multi-pronged approach will drive down costs for residents, increase delivery of services and improve outcomes for both patients and health care workers. I'm ready on day one to take on the issue of health care costs, bringing my experience, leadership and expertise in this sector to the table.

Take Sussex County for example, which has and continues to experience a huge growth in population, especially those who are retired. Patients are waiting months on end to even get an appointment, and some can't even identify a primary care provider because the demand is so great. We simply don't have enough health care providers.

That's why I fully support the recent study undertaken by the Sussex Economic Development Advisory Council to create a medical education program in conjunction with the hospital systems and higher education institutions. We need to create our own pipeline of health care providers that encourages and incentivizes them to learn and study here and to also make Delaware their home.

Meyer

My comprehensive plan on health care is available here, and I specifically address lowering the cost of and expanding access to health care on pages 8-17.

We must address the costs of inadequate availability, inequitable treatment, and insufficient health outcomes across the state. As Governor, I will:

● Increase hospital competition and investment, which will produce higher-quality health outcomes with greater efficiency.

● Push for greater competition on the health insurance exchange, which will help bring down costs.

● Allow businesses and individuals to buy into the state employee health care plan.

● Eliminate medical debt in Delaware, providing much needed relief to Delawareans.

● Invest in a public health system where preventative medicine is rewarded, not reactive medicine.

● Control prescription drug prices by creating a Prescription Drug Affordability Board and enacting a

● Drug Pricing Transparency Law.

● Ensure that all people eligible for Medicaid/CHIP get enrolled.

● Fund State Perinatal Quality Collaboratives, which are state networks that improve the quality of care for mothers and babies.

● Extend multi-year continuous child eligibility for children until they are 3years old.

● Promote enhanced access to preconception care for women.

● Decrease infant mortality by increasing awareness of the campaign Safe to Sleep.

● Defend reproductive freedom, including adopting Medicaid funding for abortion, and championing a constitutional amendment to enshrine a woman's right to choose.

How do you plan to help lower the cost of health care and expand access to it in Delaware?O'MaraIn addition to increasing competition (see question 3) and attracting more doctors, we need to move to a system of wellness and value-based care that simultaneously works to address the social determinants of health. Right now, we have some of the most challenging health care outcomes in the country. Some of this is due to the relatively high proportion of Delawareans (nearly 90,000), who do not currently have health care coverage, including undocumented Delawareans and children who are currently ineligible for Medicaid. The costs of emergency response are orders of magnitude more expensive than the ounces of prevention and will reduce costs overall. We also must be more mindful of the health impacts from social determinants like employment, food insecurity, access to education, housing, environmental factors/pollution, etc.My health care priority for access will be working together to ensure that every Delaware child and pregnant person has equitable access to quality health care and that we virtually eliminate infant mortality and pregnancy mortality (and the racial and income differentials) once and for all. Right now, more than 7,200 Delaware children (3-4%) and 12,250 people who can get pregnant (6.6%) are uninsured. About 5% of children and pregnant people who are eligible for insurance through Medicaid are not enrolled. There's also a gap of children and pregnant people who are ineligible for Medicaid whether due to income levels or immigration status (HB 150 will help address this). In addition to implementing the six bills of Rep. Minor-Brown and Sen. Pinkney's "momibus" package that passed in 2022 and passing HB 150, there are several additional policies that we can adopt, including expanding enrollment by establishing 12-month eligibility, enabling presumptive eligibility for Medicaid and CHIP for both children and pregnant people, allowing school reimbursement without IEP, starting CHIP eligibility at conception, increasing eligibility thresholds for various programs, coordinating all programs to ensure success by six, etc. I also want to begin a larger discussion about social determinants of health, especially for children, to show how the various pieces fit together.I also want to expand health care options and access for older Delawareans, especially our growing population of lower-income older individuals. Specifically, I want to massively expand overall access to service providers (by paying the student loans of doctors to relocate to Sussex and Kent) and to in-home care, regardless of income, to ensure that all people have the opportunity to age in-place, if desired, rather than transitioning to nursing facilities, hospice, or hospitals. By reorienting how we think about delivering health care to older Delawareans (including building an inclusive, statewide health care workforce of the future), we will achieve better health care outcomes and provide more cost-effective care, while honoring the wishes of older Delawareans.I'm also interested in exploring whether Delaware could enact an affordable, quality public option. While the existing public options (Colorado, Washington, Nevada) are private-insurer led (Colorado's public option is 30% less expensive than the non-public alternatives; Washington's public option has produced significant savings), I'm more intrigued by some of the newer approaches just adopted in Maine and New Mexico that are exploring a Medicaid Buy-In (requires a federal 1332 waiver). Minnesota is considering expanding their existing MinnesotaCare program that is offered for a portion of the population in the ACA marketplace.PriceFor the older people, is the nursing home issues. The fees are enormous, and it's a possibility that they might lose everything they ever work for in their life. It can't be handed down to their children. It's just going to these nursing homes.We have to sit down with most of the nursing homes where the financial committee and say, "This is what we need. What do you need?" How do we find middle ground so that our people are protected.[To increase access to health care, we may need to rely on temporary nurses and doctors for some time.] To attract more to come to this state, we have a great tax structure. It's great in the state. You And that's a good incentive to get people here.(DPM, Candidate Conversation)RamoneAfter 32 years of single-party rule, Delaware's health care system is in disarray and desperately needs reform. The rising cost of health care and decreasing access in rural areas are impacting Delaware families throughout the state. As Governor, I will work with the legislature to remove the regulatory burdens that drive up the cost of service and force competition out of Delaware. I would also promote the establishment of a medical school in Delaware that would recruit and retain qualified doctors to our state leading to more competition and better access to medical professionals.WilliamsonI think the government needs to reach out to the people that have the intelligence and the connections to find better calls for prescriptions, find better ways of treating the illnesses that we need to deal with, including diabetes, which is very rapidly growing.There are the right people to have the right knowledge to deal with it, not just somebody that happened to be elected into an office thinking they can control these situations. We need to let the professionals that deal with it and only deal with that situation, take a little charge, a little initiative, and then let them have a more say us to get us into the right direction.(DPM, Candidate Conversation)The state approved a controversial plan to add a new government oversight board on hospital spending this year. Do you agree with that plan?Hall-LongHealth care is a basic human right, and Delawareans deserve a health care system that puts patients above the bottom line. Patients should not be forced to pay exorbitant costs for lifesaving medications or face red tape every time they try to schedule an appointment with a specialist. The final agreement passed this year will help rein in costs for patients while making important changes to address concerns raised during the legislative process.As someone who has worked in health care for decades, I know that the system is multi-faceted and constantly changing. This law is one part of the solution. We must approach this from all angles, including the hospital, pharmaceutical and insurance industries. I will continue to engage with and work with all sides to improve the system and drive down costs for patients and ensure sustainability for both residents and the industries.MeyerI believe the oversight board alone is unlikely to significantly decrease the cost of health care for Delawareans. We must have a comprehensive approach and that takes leadership.O'MaraAs state health care spending continues to grow and crowd out all other state spending, we absolutely must work with the hospitals, insurance providers, and pharmaceutical companies to improve outcomes and reduce costs across the system. I believe additional transparency is needed to evaluate why Delaware has some of the highest health care costs in the nation with many procedures costing multiples more than federal Medicaid reimbursement rates. While I supported HB 350 with the proviso that experts and not politicians serve on the board, I would have preferred a more comprehensive and collaborative approach that included all major cost drivers of health care expenses, considered regional variations, and utilized the expertise and experiences of other states to make progress. As governor, I will lead a more collaborative process to make progress in the near term and not wait for years of litigation over HB 350 to conclude before resuming reform efforts. RamoneNo. As Minority Leader, I led the opposition to this controversial legislation to impose additional government regulations on hospitals. The proposed legislation would have immediate economic impacts leading to lost revenue for our state and lost jobs in an industry that is already struggling to retain talent. As Governor, I would not sign this legislation or similar legislation that put more unrestricted government controls on the health care industries.Does Delaware have enough competition in its health care market? If not, would you support the ending of the state's Certificate of Need process?Hall-LongHere's the deal: Too many people face long wait times for appointments or just flat out don't have access to basic care. Health care looks different based on where you live and we can't have these disparities.We must continually work to enhance our current suite of services and bring new resources to the state. We need to take a hard look at the current processes that exist to foster a strong health care system and make the necessary changes if things are not working.Growing up in Sussex County, for instance, I've seen how critical it is to make sure folks don't drive hours for pediatric care or if they need to go to the emergency room. I've strongly supported the creation of a medical education program in Sussex County to recruit and retain health care workers in not only this county, but across the state. Workforce development is one of my top priorities as Governor.MeyerWe must increase increase hospital competition and investment. Each of Delaware's counties has a single, dominant hospital system. Health care costs in our state are rising faster than the national average. Greater competition will produce higher-quality health outcomes with greater efficiency. We should be particularly concerned when the financial return generated from providing health care services to Delawareans is invested in expanding health care services to communities outside of our state. As Governor, I will:● Push for greater competition on the health insurance exchange. Highmark Blue Cross Blue Shield/ Delaware is often the sole health insurer offering plans on Delaware's Health Insurance Marketplace. More competition will help bring down costs.● Allow businesses and individuals to buy into the state employee health care plan, as Connecticut did. This will not only provide a lower-cost group option for businesses and individuals without other affordable insurance, it will help stabilize the state employee program by bringing in a broader, younger, and healthier pool of workers to cross-subsidize and lower costs for all participants.O'MaraNo, Delawareans would benefit from more providers and more competition in our health care market. I support eliminating our certificate of public review (i.e. certificate of need) or at least drastically reforming it to make it functional without the conflicts of interest and quorum challenges that have plagued it for years (many of which had recommended fixes that were proposed in 2021 but never enacted).We need to make sure that the playing-field is fair for the mixture of providers, including avoiding a situation where nonprofit hospitals are expected to absorb all costs from uninsured Delawareans. We should also not encourage any further consolidation of health care providers. If entities are willing to bring new providers and expand services, we should encourage competition that should increase access and quality, while reducing costs.RamoneYes, we should end the Certificate of Need process. This process inhibits investment and expansion of medical resources in underserved communities.How would you rate Delaware's current efforts to address the addiction crisis and what would you do to help lower the risk of fatal overdoses in the state?Hall-LongFor the first time in a decade, the number of overdose deaths in Delaware decreased in 2023. This news was cause for optimism in the face of an epidemic that continues to grip our state and impact thousands of Delaware families each year.As co-chair of the Prescription Opioid Settlement Distribution Commission, I'm proud of the progress we have made in distributing opioid settlement funds to expand access to substance use treatment services and combat the opioid crisis in Delaware. States are looking at Delaware as a model for addressing this issue.But the fact still remains that we have lost too many Delawareans to this crisis. We have much work to do. It has taken an all-hands-on-deck approach to get this far. We must continue to combat these issues head-on by empowering and enhancing the many grassroots organizations and nonprofits that are on the frontlines of this crisis. Our work is having an impact, and I am hopeful that we can continue to drive down the number of overdoses while increasing treatment, prevention and recovery options for all residents.MeyerDelaware leaders must do more to address the drug addiction crisis and lower the risk of overdoses in the state. As Governor, I will do everything in my power to break the cycle of addiction by:● Imposing stronger regulations on opioid prescribing. In 2017, Delaware ranked first in high-dose opioid prescriptions, with the top 1% of prescribers writing 25% of all opioid prescriptions.● Increasing access to xylazine testing strips and staying at the forefront of research on this threat.● Funding and expanding resources for marginalized communities most affected by the epidemic.● Increasing the use of drug courts and funding community interventions.● Ensuring law enforcement has access to and training for Narcan (naloxone).● Providing access and funding for syringe service providers in overdose epicenters.● Improving resources for those in the justice system by enhancing medication-assisted substance use disorder (SUD) services in correctional facilities and expanding re-entry programs with stable state funding.● Increasing reimbursement rates for outpatient, residential, and withdrawal management to be regionally competitive.● Increasing education on pain treatment, SUD stigma reduction, evidence-based opioid interventions, and SUD prevention for youth.● Expanding access to evidence-based treatment for adolescents, including medication assistance, to address the gap in care.● Establishing required competencies for each provider type and care level for substance use disorders proficiency.O'MaraDelaware has the third highest overdose rate in the nation, 40% higher than neighboring states. What we are doing isn't working fast enough.Leading states show we need a coordinated approach that expands access to integrated services, combining addiction treatment, mental health care, housing assistance, and job training. Investing in prevention and early intervention programs can reduce future needs. Strengthening transitional housing through the State Housing Authority and focusing on recovery-specific job training via the Workforce Development Board are key. Authentic community engagement and addressing systemic social determinants of health are critical for long-term progress.RamoneFor 32 years, Dover has failed to acknowledge the impacts that addiction has on our communities. Our state's proximity to major transportation hubs and the direct route major interstates take through Delaware put many of our communities at an increased risk for opioid-related addiction. Instead of punishing those who struggle with addiction, we should focus on rehabilitation efforts by expanding access to facilities staffed with trained medical professionals who can help rehabilitate addicts. I believe that those who struggle with addiction deserve our best efforts to help them get better, not to punish them.This is the fourth and last part in a series examining the candidates for governor's positions on issue-based topics. Coverage of their opinions on education, land use and government accountability are also available.