A Senate race in Kansas between two doctors sets the stage for an election hyper-focused on health policy — and on Covid-19

A Democratic doctor campaigning for Senate in Kansas is betting she can leverage her health care record into a stunning November upset — the latest sign that policies like drug prices, “surprise” medical bills, and health insurance costs remain top of mind for American voters.

The surprisingly close race, in an otherwise deep-red state, is hyper-focused on health care: The Democratic nominee, Barbara Bollier, is a former anesthesiologist and bioethicist, and has campaigned aggressively on policies to expand the state’s Medicaid program, allow Medicare to directly negotiate drug prices, and outlaw “surprise” medical bills. The Republican, Rep. Roger Marshall, is a practicing OB-GYN who figured prominently into his party’s 2017 attempt to repeal the Affordable Care Act, and continues to campaign on a “repeal and replace” health care platform.

The race could serve as a measure of health care’s outsized importance in the 2020 election, and of voters’ level of frustration with Congress, which has flailed in its recent attempts to meaningfully lower drug prices or cap medical expenses.

Bollier’s ability to run a competitive race in Kansas, pollsters said, is indicative of the power of her health care platform, and Democrats’ broader advantage on health care issues.

“Kansas is the quintessential state that proves health care isn’t a partisan issue,” said Jesse Ferguson, a campaign expert and longtime Democratic operative. “Only in Washington do health care costs break down along party lines. In most of America, there are people who want lower health care costs, and there are people who don’t. Those battle lines are more about whose side you’re on than which party you’re a member of.”

Kansas last elected a Democratic senator in 1932. But Bollier — who switched her affiliation from Republican to Democrat in 2018 — has kept the race competitive so far, and has focused most intensely on her advocacy for aggressive health care reforms. Perhaps most central to her campaign: Democrats’ efforts to expand the state’s Medicaid program, which Marshall has long opposed. Polls have shown significant majorities of Kansans support the expansion, an issue that helped to buoy the state’s Democratic governor to a surprise victory in 2019.

While the race focused on health care long before Covid-19 derailed American life in 2020, the pandemic has only given both candidates further reason to highlight their medical backgrounds.

Bollier gave up her career in anaesthesiology in 1999. Her campaign also proudly touts her medical background: She is married to a Kansas City physician, her mother is a trained nurse, and she worked with her late father, also a doctor, at his outpatient surgical clinic. She has touted her advocacy for Medicaid expansion and run numerous health-focused ad campaigns, including about a patient’s struggles to refill a prescription amid mail delays and about her own experience receiving a $30,000 “surprise” bill. (She later introduced legislation in the state senate to enact consumer protection laws that would shield patients from such charges.)

Marshall, in turn, has touted his volunteer work treating Covid-19 patients across the state, and campaigned on his votes to repeal the Affordable Care Act’s individual mandate, medical device tax, and “Cadillac” tax on employers that provide unusually expensive health insurance plans.

In campaign literature, Marshall is referred to in the third person as “Doc.” His campaign website includes the proclamation: “Obamacare, and now, government-controlled socialized medicine, are some of the most egregious examples of what Doc has fought against.”

While it is widely acknowledged that health care will serve as a defining theme in the race, even some GOP pollsters have conceded that Bollier likely holds a distinct advantage on several health care issues. The divide is accentuated by Marshall’s history of controversial comments on health care and Medicaid expansion in particular; he drew nationwide criticism following a 2017 STAT interview in which he cited Scripture to advocate for the repeal of the Affordable Care Act.

“There is a group of people that just don’t want health care and aren’t going to take care of themselves,” he said. “Just, like, homeless people. … I think just morally, spiritually, socially, [some people] just don’t want health care.”

While Bollier enjoys support from most Kansans on her advocacy regarding drug prices and Medicaid, she has also waded into controversial territory where she is more likely to face pushback: abortion rights. Throughout the race, she has run paid advertisements touting her endorsement from Planned Parenthood, a major women’s health care and abortion services provider that President Trump and Republicans have long sought to bar from receiving federal funding.

That stance could prove to be her biggest health policy liability in a state where voters skew socially conservative — a reality reflected by Bollier’s clear avoidance of the word “abortion” even as she highlights the support of pro-abortion-rights groups, including Planned Parenthood, NARAL, and Emily’s List.

Marshall, who faced baseless allegations during the Republican primary that he had provided abortion procedures as an OB-GYN, has touted support from anti-abortion groups and warned that Bollier’s election would allow for further taxpayer funding for abortion procedures.

“Barbara Bollier could be in the right position for Kansas on surprise billing, but it’s likely to get drowned out by her abortion position,” said Jon McHenry, a pollster for the GOP-aligned group North Star Opinion Research. “Similarly, ACA repeal may not be decisive here if the conversation skews to other issues.”

If Bollier’s biggest liability is her abortion stance, however, it is clear her campaign believes Marshall’s is his stance on Covid-19. Bollier has repeatedly criticized the congressman for his appearance at indoor campaign events without a mask, in defiance of local health orders. One appearance in suburban Wyandotte County, at which Marshall appeared bare-faced inside a room with several dozen maskless voters, earned him a sharp rebuke from the Kansas City Star’s editorial board. (Marshall has also campaigned with a mask, and his congressional office has encouraged Kansans to wear masks when in public.)

Marshall has also taken flak for spreading misleading coronavirus statistics. Facebook announced last week it had removed one of Marshall’s posts, which echoed a false claim that Trump recently amplified on Twitter: That the nation’s true Covid-19 death toll is “only 6%” of the federal government’s current tally of roughly 190,000. In the post, Marshall argued that recently published statistics showed Covid-19 is commonly listed as a cause of death alongside other health conditions, and that the virus’ true impact is therefore exaggerated. Marshall’s campaign declined STAT’s requests for an interview, and a campaign spokesman did not respond to written questions.

“Marshall has repeatedly spread dangerous misinformation about Covid and about the pandemic,” said Alexandra De Luca, Bollier’s communications director. “We see him out campaigning without a mask, without social distancing, inside shaking hands. We see him hawking hydroxychloroquine. We see him promising, without a scientific basis, that there is going to be a vaccine by Thanksgiving. We see him pushing dangerous misinformation on Facebook, and all but acting as though this virus is just going to go away, or that it’s overblown.”

Despite her more aggressive stance on combating Covid-19, however, Bollier has stopped short of advocating for a statewide mask mandate.

“Not every community in Kansas is the same, and Barbara believes that individual communities should be able to make their own decisions about the best ways to keep people safe,” De Luca said.

Even amid Kansas health officials’ current struggles to contain several Covid-19 outbreaks, Marshall has projected a more upbeat pandemic message. Soon after the pandemic began accelerating across the U.S., Marshall announced he would volunteer to treat coronavirus patients at a clinic outside Kansas City, and later added a stint as a volunteer at a hospital inside his district, in the state’s southwestern corner.

He has repeatedly told voters a vaccine will likely be available to high-risk Americans by November, and frequently touts the Trump administration’s ambitious, and perhaps scientifically impractical, vaccine-development timeline.

Such pledges echo Trump’s, but continue to spark fears among the public health community that the vaccine-approval process will hinge more on politics than on science. Large majorities of American voters across both parties view the vaccine process as driven largely by politics, according to a recent STAT poll, making it unclear whether Marshall’s pledge will help sway voters.

“There is a real hunger for a vaccine, and there should be,” said Ferguson, the longtime Democratic operative. “But people want to know that the vaccine was developed by science and scientists, not politics and political pressure.”

Despite voters’ broad coronavirus anxiety, Bollier could still face difficulty incorporating the country’s pandemic struggles into her broader health care message, given Republicans’ large advantage in voter registration.

“Often 80% or more of Democrats will say they are very concerned about the effect of the pandemic, but that will drop to 50% to 60% among independents, and maybe 25% to 45% among Republicans,” said McHenry, the Republican-aligned pollster. “For some Republicans and independents, it’s more of a government control and economic issue than a ‘health care issue.’”