Health care policy is a frequent topic on the Maine gubernatorial campaign trail, with issues such as Medicaid expansion and the opioid crisis turning up in campaign literature, advertisements, on the stump and at debates.

Maine voters approved Medicaid expansion by a 59 to 41 percent margin in November 2017, which would make 70,000 low-income Mainers eligible for the free health insurance.

But Republican Gov. Paul LePage has blocked expansion by refusing to implement it, prompting a slow-moving lawsuit by expansion advocates. As the legal battle continues, the issue could fall to the next governor to decide as LePage is termed out and a new governor will be sworn in in January.

Democrat Janet Mills, Maine’s attorney general, Republican Shawn Moody, a businessman, and independents Terry Hayes, the state treasurer, and businessman Alan Caron are vying in the Nov. 6 general election to become Maine’s next governor.

The next governor must also confront the opioid crisis, which has claimed thousands of lives of Mainers over the past several years. Drug overdose deaths reached an all-time high of 418 in 2017, and there were 180 through the first six months of 2018, down slightly from last year.

The two issues are tied together: Medicaid expansion would greatly increase access to drug treatment for low-income Mainers, as treatment programs are part of the suite of health care benefits available under Medicaid. A U.S. Substance Abuse and Mental Health Services Administration survey estimates about 25,000 Mainers struggling with all forms of drug addictions don’t have access to treatment programs.

The winner of the Nov. 6 election will also inherit a Department of Health and Human Services that has been remade in the LePage era, with impacts that have affected public health initiatives and child protection services.

Here’s how the four candidates responded to questions by the Portland Press Herald/Maine Sunday Telegram on health and human services topics.

Q: What will you do as governor for Medicaid expansion after taking over the executive branch in January?

Caron said he would take up Medicaid expansion shortly after he’s sworn in, perhaps even encouraging lawmakers to approve the $60 million expansion funding bill that LePage vetoed.

“The argument that we don’t have enough money is an ideological argument, not a fiscal argument. Why would we say no? For every $1 we spend on Medicaid expansion we’re getting $9 from the federal government. This is simply a matter of priorities. We haven’t been making health care a priority.”

Hayes said she would propose wellness and prevention programs to help keep Medicaid costs down.

“We are going to get this done. I don’t think you should have to sue your government to make it work. We have the money, but the challenge is not can we pay for Medicaid expansion in 2019 but can we pay for it six to eight years out from now?” Hayes said.

Mills accused LePage of “obstructing the will of the people.”

“My opponent, Shawn Moody, has said that he will work to repeal the law. I agree with the Maine State Chamber of Commerce that Medicaid expansion is good for business and good for the people of Maine,” Mills said. “It will improve the health of Mainers. It will inject millions of dollars into our economy. It will create jobs, lower health care costs for Maine people and keep our rural hospitals open.”

But Moody said Medicaid expansion is the law, and he will implement it in a “responsible” way, echoing LePage.

“I will implement and enforce the law with sustainable and responsible funding from the Legislature. Our view is the debate at this point centers around the funding mechanism. It is the constitutional responsibility of the Legislature to appropriate the funds. I do not believe that a sustainable and responsible funding plan requires raising taxes, raiding the state’s rainy day fund, or using other one-time budget gimmicks. Adequate funding means that we do not jeopardize the long-term fiscal health of the state.”

Q: Do you support the LePage administration’s pending Medicaid waiver, which if approved by the federal government would impose work, volunteer or school requirements on some Medicaid recipients?

Moody said he supports the waiver in part to help employers fill jobs.

“I believe that individuals who are able to work, should work, volunteer or receive training in order to receive public benefits. We are at virtually full employment right now and employers need help,” Moody said. “I am supportive of requiring that those who are able to work or volunteer, are required to. It is not unreasonable to require those who are able-bodied and working to contribute to the cost of their health care.”

But Mills said most Mainers who have Medicaid cannot work.

“More than 75 percent of Medicaid recipients in Maine are elderly adults, disabled adults or children,” Mills said. “For those who could work but are not working, I support apprenticeships, vocational education, and computer science training to put them to work to fill the jobs available. Incentives work better than bureaucratic mandates as a first step. And making people healthy allows them to work, so first things first.”

Hayes said she needs to read the waiver application, but in general she believes work and receiving health care should not be related issues.

“Tying these two issues together is disingenuous. There are many people who are working jobs that don’t have health insurance that comes with the jobs,” Hayes said.

Caron said he disagrees with the LePage administration’s Medicaid waiver.

“I don’t think we should treat health care as a welfare program. I don’t see what one has to do with the other. I would discard the waiver,” Caron said.

Q: What would you do to address the opioid crisis?

All four candidates said they had a comprehensive plan for opioids.

“We need to have a comprehensive safety net of services available so that we can have a treatment option for people when they need it,” Hayes said. “Sometimes the biggest risk for people is when they leave sober housing. I think we can negotiate solutions that make sense for everyone.”

Caron said his nephew died of a drug overdose, so the topic has a personal meaning to him, but he chided Maine state government for being slow to deal with the problem.

“It’s a nonsense argument that we haven’t been able to come up with a solution yet. Why couldn’t we find common ground? We need to find more money for treatment,” Caron said.

Moody said the crisis is “heartbreaking” and that “obviously we’re not doing enough.”

“We must take a multi-prong approach to tackling Maine’s opioid crisis. We must have adequate resources for law enforcement, and we need to prosecute drug traffickers to the highest extent of the law. We must educate our students at younger ages about the dangers of drug use by connecting them with real life stories of those in recovery. We must evaluate our recovery centers by implementing a ‘Dashboard’ consisting of not less than five and not more than 10 key matrices that will allow us to measure results and share best practices across the recovery community,” Moody said.

Mills said “what we are doing now is not working.”

“There is no silver bullet to this complex problem. This is not simply a public safety or law enforcement matter, but a full-blown public health crisis that leaves thousands of children without a parent, communities devastated, employers without a healthy workforce, and families torn apart. Last year alone, 952 drug-affected babies were born in Maine. My (10-point) plan includes expanding Medicaid; establishing an opioid emergency line to provide 24-hour-a-day referrals; making recovery coaches available on call at every emergency room and clinics; having effective prevention programs in schools in the early grades; expanding treatment options and supportive therapies, and addressing the stigma associated with substance use disorder,” Mills said.

Q: Two young girls died last fall and winter after suffering from abuse and neglect, and experts have said the state’s child protective system failed them. Do you support the LePage administration reforms so far, and what would you do to improve the child protective and foster care systems?

Mills as Maine’s attorney general has been handling the criminal cases surrounding the deaths of a 10-year-old Stockton Springs girl and 4-year-old Wiscasset girl.

“Because these cases are pending in my office, I am not at liberty to comment on them or on the recent legislation. As a general matter, however, accountability is important and fielding reports of abuse in a timely manner and being responsive to the needs of all our children are a top priority,” Mills said.

Moody applauded Gov. LePage’s work to address shortcomings in the system.

“The LePage administration and the Legislature acted swiftly and decisively to make changes in our child protective system to ensure Maine’s children are adequately protected. These changes included hiring additional caseworkers and giving more information about the cases, more funding, and ensuring the state is acting according to the best needs of the child. We need to carefully monitor how these reforms impact performance over the next several months to ensure that our children are not placed in harm’s way,” Moody said.

Hayes, a former guardian ad litem, a representative of foster children in the court system, said she believes the state needs to take a comprehensive look at a complex problem.

“The state is a poor parent. Good people are getting caught up in a system that is not resulting in the outcomes we need. We need to look at what works in other states. I need to spend more time studying the system, but I am not confident the solutions that have been proposed (by the LePage administration) will solve the problems at hand,” Hayes said.

Caron said he needs to study the issue more, but in general the LePage administration has cut programs that help the elderly and children, and the system has suffered over the past eight years since LePage first took office.

“The administration created these problems that it is now trying to fix. You don’t do change by taking a meat ax to programs. The people who get harmed the most are the elderly and the children,” Caron said.