WASHINGTON _ During a global pandemic, Kansas voters will have a choice between two doctors offering competing remedies for the current crisis and the health care system as a whole.
In the race for Kansas' open U.S. Senate seat, U.S. Rep. Roger Marshall, a Great Bend Republican and OB-GYN, faces state Sen. Barbara Bollier, a Mission Hills Democrat who spent more than two decades as an anesthesiologist before shifting to politics.
Both are graduates of the University of Kansas School of Medicine who began their careers in the 1980s. Both routinely tout their medical credentials to voters. Marshall even unsuccessfully sought to be called "Doc" on the primary ballot.
One Marshall ad shows him in a white coat holding two newborn babies, while a Bollier video includes a close-up shot of her certification from the American Board of Anesthesiology on a mantle.
It's not just their shared background that is likely to elevate the focus on health care in the race; the two diverge sharply both in their messaging and their personal responses to the COVID-19 pandemic.
Bollier has run almost entirely from home, opting for virtual town halls and telephone calls over in-person campaigning as a precaution against spreading the virus. She told The Kansas City Star and the Wichita Eagle in a recent interview that there are key staff she has not met in person.
"I never would have believed I would be a candidate and not be able to be in person," Bollier said in June.
And while she misses pre-pandemic campaigning, she's not in a rush to shift gears as she moves into the general election.
"I take everything a day at a time and I will be following the best public health recommendations at the time. We all know things continue to change, so we'll see where they go," Bollier said Tuesday. "As of right now today, the best recommendations are for us to wear masks, socially distance, and avoid crowds, plus, of course, hand-washing."
Marshall briefly paused in-person events in March. But for the most part, he's run a traditional campaign with events where voters can meet him one-on-one.
"Kansas voters want to look you in the eye. They want to see the smile of your face, hear the tone of your voice and feel the firmness of your handshake," Marshall said.
He's been inconsistent about wearing a mask. It's usually on when he's in Washington, Wichita or the Kansas City suburbs. But images of a maskless Marshall at western Kansas campaign stops have appeared online in recent days.
Marshall said the risk of catching the virus during an outdoor event is low and that holding his meet-and-greet events outside is an even more important precaution than wearing a mask.
"Out here in Barton County, the incidence is really low," Marshall said Wednesday morning after securing the GOP nomination. "I think there's a time and place for a mask. I encourage everyone to wear them when they're in public places. ... But I think when you're outside in a private setting we let our guard down a little bit."
Marshall has previously said that local officials should decide whether to require masks rather than the state or federal government. The Kansas Department of Health and Environment said Wednesday that counties with mask mandates are experiencing a rapid drop in cases, while counties without them have not seen a similar decrease.
Bollier's campaign called Marshall's inconsistent use of masks disappointing, and also criticized him for promoting hydroxychloroquine, the anti-malarial drug President Donald Trump has promoted as a preventive treatment for COVID-19 despite warnings from the Food and Drug administration.
'A UNIQUE OPPORTUNITY'
The contrasting images _ Marshall crisscrossing the state shaking hands and Bollier sequestered in her Mission Hills home _ are likely to figure in each campaign's messaging.
Chris Reeves, Kansas' Democratic National Committeeman, said Democrats will hammer Marshall for a lack of caution.
"I don't know how much barnstorming Bollier really does," Reeves said. "I think she spends most of it on airtime and says, I respect you guys and I don't want you to get sick. I don't want to potentially bring illness into your community. I think the more Marshall runs around, the Democratic case is he doesn't care about your health."
But in a state where Republicans hold a 2-to-1 registration advantage, the question remains whether a Democrat can win without some in-person campaigning. Part of Democratic Gov. Laura Kelly's path to victory in 2018 was the aggressive road schedule she maintained in her campaign against Republican Kris Kobach.
Bollier's campaign confirmed that it is weighing the possibility of a return to in-person campaigning, but said it would only take that step with significant safety precautions.
"We are considering doing some in-person site visits across Kansas as part of a listening tour, but will only do so if we can ensure all safety precautions _ including masks and social distancing _ are met. Our number one goal is to keep Kansans safe," Alexandra De Luca, Bollier's spokeswoman, said in a statement.
Marshall often mentions that he was the first lawmaker to deliver a speech about coronavirus on the House floor _ in late January, several weeks before the pandemic shut down much of the country.
He's volunteered in clinics treating COVID-19 patients in both Wyandotte County and western Kansas, a move praised by former Gov. Jeff Colyer, an Overland Park Republican and plastic surgeon who was an early Marshall supporter.
"That shows a tremendous amount of concern. He understands what it means for a Kansan to have coronavirus. He's seen it firsthand," Colyer said.
"Barbara hasn't practiced medicine in more than a decade. Roger has a very fresh experience," Colyer said. "He's an OB-GYN. He has solid credibility on all of these issues and I would argue more than she does. He's going to be who he is. He's a professional who takes care of people."
But even as the number of cases continues to climb in both Kansas and nationally, Marshall is talking about a return to normalcy as the campaign moves into August.
"You can have your American dream back. We can get your family, your loved ones, safely through this COVID virus," Marshall said when asked about his message in the race. "This country has been through worse trials before. This is our time to stand up and lead as a generation."
Marshall said he believes Kansas is beginning to develop a "herd immunity," a term for when enough of the population has built up an immunity to disease to slow or stop its spread.
But many experts say that without a vaccine, herd immunity is unlikely to take hold. Sweden attempted to use a herd immunity strategy when most other European countries went into lockdowns earlier this year. but the country has faced one of the higher death rates in Europe relative to population.
Rachelle Colombo, director of the Kansas Medical Society, said health care would have been at the forefront of the campaign because of the pandemic even if the two major party nominees weren't doctors.
She said both candidates have the opportunity to bring crucial expertise to the Senate as it works on health care policy next year.
"They become a resource not only for medical issues and policymaking, but also for their colleagues serving in that role," she said.
State Rep. John Eplee, an Atchison Republican and family physician, said he voted for Marshall in the primary and supports him the general. But he offered praise for both candidates.
"They're certainly both subject experts on the health situation in this country and will bring a lot to the table, either one of them for this. I know them both and I know they both have a depth and breadth of knowledge about all of that that will make a real difference as they hopefully step up to the next level," he said.
"I think it's a unique opportunity for Kansas to have, if you will, an inside track to the health care evolution in the United States."
Both candidates come from backgrounds that have exposed them to multiple facets of the health care industry. Marshall spent his three-decade career as an OB-GYN in rural Kansas, helping found Great Bend Regional Hospital and serving as chairman from 2001 to 2016.
Bollier comes from a family of doctors. Her father, Robert Goolsbee, founded one of the first free-standing ambulatory surgery centers in the U.S. Her husband, Rene Bollier, practices family medicine in Kansas.
SHARP CONTRAST
But the two differ sharply on health care policy.
Even before she switched parties in 2018, Bollier was one of the Kansas Legislature's most outspoken champions for Medicaid expansion under the Affordable Care Act.
The program provides health coverage for disabled and low-income families. Under the ACA, the state could expand eligibility to those living at 138 % of the poverty line _ $17,600 per year for a single adult, or $42,300 for a family of five _ to insure roughly 130,000 additional Kansans.
Kansas is one of just 12 states to not expand Medicaid after bordering states Oklahoma and Missouri passed ballot initiatives during their recent primaries.
Marshall submitted testimony to the Kansas Legislature last year in opposition to expansion, contending it will "ultimately bankrupt our health care system, all while failing to meet the goals of providing meaningful health care for the most vulnerable of our society."
A March report by the Kaiser Family Foundation, based on a review of national studies, found that there were "no significant increases in spending from state funds as a result of Medicaid expansion." Single-state studies in Montana and Louisiana found that expansion led to "significant state savings" because of the positive impact to the states' economies, Kaiser reported.
Marshall voted to repeal the ACA as a member of the U.S. House during his first term when Republicans controlled the chamber and he has opposed Democratic efforts to shore up the law in his second term.
Bollier noted their differences on the issue.
"I think there's some very clear distinctions between the two of us, starting with he has a very long record of opposing Medicaid expansion as well as voting against the Affordable Care Act, even during a pandemic," she said. "And I have been always about expanding Kansans' access to health care."
Former state Sen. Jim Barnett, a physician who mounted unsuccessful campaigns for governor as a Republican in 2006 and 2018, said the division between Marshall and Bollier on the ACA reflects a larger divide within the Kansas medical community.
"There certainly would be those who would be more aligned with a conservative, less government approach as opposed to Medicaid expansion," Barnett said. "And I think you're going to find a significant proportion of physicians who do support greater access, including expansion of Medicaid."
Marshall inaccurately accused Bollier of supporting "Medicare for All," Vermont Sen. Bernie Sanders' proposal to replace the private insurance industry with a massive government-funded program.
"She is part of the party that pushes Medicare for All and she will vote yes for it, just like she voted for Medicaid expansion," Marshall contended.
Bollier has repeatedly said she opposes Sanders' plan, which also lacks the support of Democratic presidential nominee Joe Biden. She favors more incremental tweaks to the ACA to lower the costs of prescription drugs and premiums.
Marshall led a Republican task force last year that crafted a GOP proposal that would maintain the ACA's protections for pre-existing conditions, but shift its subsidies for premiums into state grants to help low-income people purchase insurance. The plan has not received a floor vote.
"We're both doctors but where we part really quickly is how we think health care should be delivered in this country," Marshall said.
