RICHMOND, Va. (AP) - The major party candidates in Virginia's closely watched race for governor are both promising to improve the state's health care system.
But Republican Ed Gillespie and Democrat Ralph Northam differ sharply on how to curb costs and increase care.
Their biggest difference is on Medicaid expansion. Northam wants to expand the health care program for the poor to cover more low-income Virginians, with the federal government picking up most of the cost. Gillespie opposes Medicaid expansion, saying its long-term price tag will be unsustainable.
Northam, a pediatric neurologist, has made health care a major plank of his campaign and been critical of President Donald Trump's efforts to overhaul the country's health care system. Gillespie has largely avoided taking positions on specific federal GOP proposals but supports repealing the Affordable Care Act.
Also running is Libertarian Cliff Hyra, an intellectual property attorney who favors less government intervention in the health care system.
The next governor will have to navigate a shifting and uncertain health care market. Trump and top Republicans have not fulfilled campaign promises to repeal former President Barack Obama's health care law, but Trump has taken steps on his own to reshape the health care market. He jolted health insurers earlier this month with an abrupt cutoff of subsidies that reduce costs for low- and middle-income earners.
Federal action or inaction causes significant ripples at the state level. State officials had to scramble earlier this year to recruit a health insurer to sell individual plans in several Virginia counties. And Gov. Terry McAuliffe wrote to the state's congressional delegation Wednesday saying Virginia won't have enough money to provide government-funded health care to thousands of children and pregnant women by early next year if Congress doesn't reauthorize the Children's Health Insurance Program.
There's been little movement in a multi-year debate over expanding Medicaid to able-bodied low income Virginians, with most Republicans in the GOP-controlled General Assembly opposing expansion. McAuliffe, who is barred from seeking a consecutive term, has promised to put Medicaid expansion into his planned budget proposal next year before leaving office and has predicted that Republicans will pass it to avoid having to make major cuts in public education.
Other key state-level health care issues include mental health and addiction treatment, abortion regulations and whether to scrap or severely limit the state's Certificate of Public Need law. The law regulates medical facilities' construction plans which supporters say avoids unnecessary duplication of services. Opponents say the regulations needlessly stifle competition and limit choices.
WHERE THE CANDIDATES STAND:
Northam said it is "immoral" that Virginia has not yet expanded Medicaid and said he would make it a top priority of his administration. Northam said he would work to persuade Republican state leaders to switch positions.
"It's time to put the excuses aside and take the politics out of it," Northam said.
Republican legislators have consistently opposed Medicaid expansion and shown no sign of change.
Gillespie opposes it too, calling it a costly burden for the state. He's said his goal as governor would be a more robust free market in the state's health care system, which would include allowing Virginians to buy out-of-state health care plans. Gillespie wants to see Virginia enter into a compact with surrounding states to sell insurance plans across state lines.
"Bringing down costs through more competition in the insurer and provider market would make health care more affordable and more accessible to more Virginians," Gillespie said.
Experts say there's no guarantee that selling insurance across state lines would trigger competition that brings down premiums, partly because health insurance reflects local medical costs that vary widely around the country.
Northam and Gillespie clash on abortion issues. Northam is a strong abortion-rights advocate and said he would expand access to contraception. Gillespie opposes abortion and said he would work to stop state funding for Planned Parenthood.
Both candidates have plans to improve the state's mental health care system and move Virginia's response to addictions away from criminal prosecution toward more treatment options.
Gillespie and Northam both say they're open to reforming the Certificate of Public Need law, while also voicing support for hospitals' positions that the law not be gutted or scraped entirely.
Hyra, the Libertarian, opposes Medicaid expansion and says he favors a repeal of Certificate of Public Need regulations.