Pa. election 2022: Where governor candidates Mastriano, Shapiro stand on the opioid epidemic, medical marijuana, and other health issues

The next person who holds the gubernatorial office will have influence or direct control over many issues affecting health care.

A person holds up a sign in a crowd.

People gather on the steps of the Pennsylvania State Capitol in Harrisburg to honor lives lost to addiction during 2021's Overdose Awareness & Memorial Day. (Amanda Berg/Spotlight PA)

This story originally appeared on Spotlight PA

As a freshman state senator, Doug Mastriano (R., Franklin) rose to prominence by vocally opposing the Wolf administration’s COVID-19 shutdown orders, mask mandates, and other efforts to slow the spread of the disease.

Now a candidate for governor, Mastriano continues to tout that record and criticize his Democratic opponent Josh Shapiro for defending the restrictions as the state’s attorney general.

Shapiro recently told The Associated Press that his office is required to defend the state in court, and personally criticized shutdowns and mandates. Shapiro, in turn, has tried to put Mastriano on the defense for his opposition to abortion; Mastriano has sponsored legislation that would ban abortions at roughly six weeks of pregnancy. Shapiro does not support additional restrictions on abortion, and he’s promised to protect the state from an extreme ban through his veto power.

Those two issues — the coronavirus pandemic and abortion rights — have in many ways dominated the conversation surrounding the race for governor. But the next person who holds that office will have influence or direct control over many other issues affecting health care in Pennsylvania — from who qualifies for an insurance program serving millions of low-income residents to how the state responds to an opioid crisis killing thousands of people each year.

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Below we explain the major party candidates’ positions on a number of health issues ahead of the Nov. 8 election:


The number of people enrolled in Pennsylvania’s Medicaid program skyrocketed during the pandemic, and enrollment now exceeds 3.5 million, recent figures show. The health insurance program is massive — it cost over $38 billion in state and federal money in a recent fiscal year. It provides coverage to eligible low-income adults, children, pregnant women, older adults, and people with disabilities.

The next governor could exercise power over the Medicaid program in many ways — sometimes by signing or blocking legislation, and other times by controlling how the program works on a day-to-day basis or who qualifies for it.

One example: Earlier this year, Democratic Gov. Tom Wolf’s administration extended the period of time mothers are eligible for Medicaid after giving birth. He increased that postpartum coverage period from 60 days to one year, and he didn’t need legislative approval to do so.

An even bigger example: Wolf’s 2015 decision to expand Medicaid under the Affordable Care Act.

The federal health care law widened Medicaid coverage eligibility for low-income adults and provided states with related increased funding. A later U.S. Supreme Court decision made expansion optional for states. Shortly after taking office in 2015, Wolf opted into a traditional Medicaid expansion plan, discarding an alternative plan put in place by former Republican Gov. Tom Corbett.

There are over 1 million people in Pennsylvania who now have health care coverage through Medicaid because of the expansion, according to Wolf administration figures from early September.

Governors and lawmakers in several other states — including Texas and Florida — have resisted expansion despite incentives from the federal government.

Several health policy experts told Spotlight PA that states have the power to undo Medicaid expansion. Some suggested a governor might encounter significant obstacles from the Biden administration or in court if they attempted to do so, but that scenario hasn’t been tested yet.

Mastriano smiles in front of a sign bearing his name.
Doug Mastriano’s campaign website doesn’t mention Medicaid expansion or specific changes to the program, and his campaign didn’t respond to questions from Spotlight PA about the issue. (Tyger Williams/Spotlight PA)

So far, none of the 38 states that expanded Medicaid has asked to roll back the expansion, according to a spokesperson for the Centers for Medicare & Medicaid Services, a federal agency that approves changes to state Medicaid programs. The agency would not say whether it would approve such a change.

Mastriano’s campaign website doesn’t mention Medicaid expansion or specific changes to the program, and his campaign didn’t respond to questions from Spotlight PA about the issue. Mastriano co-sponsored a 2019 state Senate bill that would create a path to add work, education, or job search requirements for many adults in the program. (Wolf vetoed a similar measure in 2017, and the 2019 legislation went nowhere.)

Shapiro’s campaign praised Medicaid expansion in response to questions from Spotlight PA, saying that the move “greatly improved accessibility to health care” and that Shapiro “will fight to keep this vital safety net in place.”

The next governor will also have great power over a major Medicaid change.

As part of the federal government’s coronavirus public health emergency, states have received extra federal money in exchange for not removing people from Medicaid coverage unless they died, moved out of state, or asked to be disenrolled. Participants do not lose coverage, for instance, if their incomes exceed the usual limits.

When the public health emergency ends — which could occur in early 2023 — states must begin removing participants from the program if they are no longer eligible. That means hundreds of thousands of people in Pennsylvania are at risk of losing Medicaid coverage.

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But the federal government urges states to take about a year to determine who is still eligible for the program and who needs to be removed.

The Wolf administration says it has identified about 525,000 people who have remained enrolled in the program despite not meeting the normal eligibility criteria. Plus, there are about 314,000 cases in which people have not completed the mandatory, annual renewal process, so it’s not clear if they will remain eligible.

“There has never been a test on the system like this before,” said Becky Ludwick, vice president of public policy for Pennsylvania Partnerships for Children, an advocacy group. “It’s really imperative that Pennsylvania get it right.”

Mastriano’s campaign didn’t provide any responses to Spotlight PA’s Medicaid questions, and Shapiro’s campaign didn’t comment on the end of the public health emergency.

Medical marijuana

Mastriano wasn’t in office when lawmakers legalized medical marijuana in 2016, his campaign website doesn’t mention the issue, and he didn’t respond to questions from Spotlight PA.

As a lawmaker, he voted against or has not backed several cannabis bills that received bipartisan support, as an analysis from Marijuana Moment notes.

For instance, several Republican state senators sponsored a bill that would create legal protections for medical marijuana patients when they drive. The legislation would require proof of actual impairment in order to convict them of driving under the influence. Mastriano isn’t one of the sponsors, and the bill hasn’t come to him for a vote.

Mastriano was one of three senators who in 2021 voted against legislation that updated the medical marijuana law. The bill allowed patients to purchase a three-month supply, instead of a one-month supply, and permitted physicians to certify patients through telemedicine appointments rather than only in-person. The legislation, which Wolf signed into law, also made a number of industry-friendly changes.

Earlier this year, Mastriano was again one of a handful of senators to vote against another bipartisan cannabis bill — this one was designed to give marijuana businesses easier access to banking and insurance services. That measure was also signed into law.

Mastriano opposes legalizing recreational marijuana. In an interview in which he called legalizing recreational marijuana “a stupid idea,” Mastriano said medical use was already allowed. “So what else do we need?” he said.

Shapiro has supported both legalized medical marijuana and recreational marijuana.

As attorney general, Shapiro in 2018 promised to protect Pennsylvania’s medical marijuana program and patients from any interference from the Trump administration. Last year, when Wolf signed into law changes to the medical marijuana program, Shapiro praised the decision but urged lawmakers to go further.

“Making it easier for folks to access medical marijuana is good,” Shapiro wrote on Twitter. “Legalizing recreational marijuana, expunging the criminal records of those charged for possession, and righting the wrongs our Black and brown communities have experienced is even better.”

The next administration will oversee the medical marijuana program. Among other responsibilities, the secretary of health has the power to add new medical conditions that qualify patients for the program if they are recommended by the state’s Medical Marijuana Advisory Board. There are currently 23 qualifying conditions, and more than 400,000 active patients in the program.

Pennsylvania has stricter marijuana laws than many states. Nineteen other states have legalized recreational cannabis use for adults, and several others have decriminalized small amounts of marijuana, according to a recent analysis from the National Conference of State Legislatures.

Shapiro gestures as he speaks into a microphone.
Josh Shapiro’s campaign has highlighted his experience as attorney general. (Rebecca Droke/The Philadephia Inquirer)

Opioid epidemic

For several years, Pennsylvania has had one of the highest drug overdose death rates in the country. An estimated 5,272 people died from a drug overdose here in the 12-month period ending in May, according to federal data. The increased availability of illicit fentanyl, a synthetic opioid, has led to more deaths in recent years.

The candidates for governor have offered different plans for responding to the epidemic.

Shapiro’s campaign has highlighted his experience as attorney general. Campaign materials note his office has prosecuted drug cases, seized fentanyl and heroin, and taken legal action against pharmaceutical companies. In January, Shapiro’s office announced that all 67 Pennsylvania counties signed onto an opioid settlement expected to bring $1 billion to Pennsylvania.

His campaign has pointed to a mix of responses he supports. Some proposals focus on law enforcement, while others deal with addiction treatment and harm reduction, such as legalizing fentanyl testing strips.

One harm reduction effort that he has opposed is the creation of overdose prevention sites. These are places where people can consume previously obtained drugs in a hygienic and monitored environment without having to fear being arrested, according to the American Society of Addiction Medicine.

As attorney general, Shapiro criticized efforts to add an overdose prevention site in Philadelphia. “I think they’re illegal,” he said in 2018, according to The Inquirer. “There’s no safe way to inject yourself with this type of poison.”

In the state Senate, Mastriano proposed creating a mandatory-minimum sentence of 25 years in prison for anyone convicted of selling fentanyl that leads to someone’s death. The bill would offer immunity protections to people who attempt to get help for an overdose victim.

Mastriano has also sponsored legislation that he says would help local officials respond to a spike in overdoses by using a mapping system. The bill would require first responders to report overdose incidents within 72 hours.

Mastriano has called for other changes. At a Capitol rally in June, Mastriano handed the microphone over to speakers who called for more support of faith-based recovery programs, PennLive reported. Mastriano’s campaign website also promises that “he’ll hold Pennsylvania’s elected officials accountable for cracking down on the fentanyl being snuck across our southern border.”


Pennsylvania law currently allows abortion through the first 23 weeks of pregnancy. After that, abortions are allowed only if the pregnant person’s life or health is endangered.

In the state Senate, Mastriano has pushed for a ban on abortion at about six weeks of pregnancy, and he told WITF in 2019 that a pregnant woman who violated the proposed restriction should be charged with murder. He voted in favor of amending the state constitution to say that the “constitution does not grant the right to taxpayer-funded abortion or any other right relating to abortion” — a move that would clear a path for future abortion bans.

His bills to ban abortions at roughly six weeks did not include exceptions in cases of rape or incest, and he said during an April debate that he doesn’t support any exceptions. “I’m at conception. We’re going to have to work our way towards that,” Mastriano said.

Shapiro has pledged to veto any legislation that would further restrict access to abortion, Spotlight PA previously reported.

He has a long history of supporting abortion rights as a state lawmaker and attorney general, as The Inquirer described in a deep look at his and Mastriano’s records on the issue. The Inquirer also reported that, during a recent campaign stop, Shapiro would not say what he would do if lawmakers pushed legislation to broaden access to abortion beyond Pennsylvania’s current law.

As attorney general, Shapiro said he would “fight any attempt to erode women’s rights in our Commonwealth.” He also promised to fight to protect patients from other states who travel to Pennsylvania seeking an abortion.

Spotlight PA logoSpotlight PA is an independent, non-partisan newsroom powered by The Philadelphia Inquirer in partnership with PennLive/The Patriot-News, TribLIVE/Pittsburgh Tribune-Review, and WITF Public Media.

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