Como eu me conecto ao Postgresql usando SSL do SqlAchemy + pg8000?

A conexão ao postgres via pg8000 do SqlAlchemy funcionou bem até eu ativar o SSL no postgres.

db = create_engine('postgresql+pg8000://user:pass@hostname/dbname', echo=True).connect()

Agora parece falhar com:

File "/Library/Python/2.7/site-packages/pg8000/core.py", line 872, in __init__
raise InterfaceError("communication error", exc_info()[1])
sqlalchemy.exc.InterfaceError: (InterfaceError) ('communication error', error(61, 'Connection refused')) None None

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