Months before they began campaigning in earnest against one another in the race for governor, Gov. Kate Brown and state Rep. Knute Buehler had another showdown.

The politicians formed up on opposite sides of Measure 101, a January 2018 vote that decided how Oregon would patch a budget hole in its Medicaid program after membership swelled under the Affordable Care Act.

A “yes” vote on Measure 101 upheld taxes on hospitals and insurance plans legislators had passed to fill that hole. A “no” vote was a vote to kill them, leaving the state scrambling to find another solution.

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Buehler, an orthopedic surgeon, opposed Measure 101. Along with other Republicans, he believed a tax on health insurance providers was unfair and that better options could be found.

Brown, a Democrat, was a signature proponent of the measure, making the case that it was the best short-term plan for ensuring more than 300,000 people were able to remain covered under the Oregon Health Plan, the state’s version of Medicaid.

Oregonians wound up agreeing with Brown. Measure 101 cruised to victory with nearly 62 percent of the vote.

The fight is emblematic of a key difference between Brown and Buehler. Time and again in recent years, Brown has pushed expanding health coverage to more Oregonians. Time and again, Buehler has opposed the expansions — largely on fiscal grounds.

It’s the sharpest difference on health care between the two candidates, whose platforms on the subject are otherwise remarkably similar. But that contrast will be important in the near future. Once again, Oregon lawmakers face a huge gap in Medicaid funding next year.

Here’s a rundown of Brown and Buehler’s stances on health care, along with that of Independent Party of Oregon candidate Patrick Starnes.

Candidates are listed in alphabetical order by last name.

Kate Brown (Democrat)

Measure 101 isn’t the only recent health care issue Brown is hanging her hat on. She’s increasingly made the subject a signature piece of her re-election campaign.

Most prominently, she’s touted the 2017 Reproductive Health Equity Act, known as RHEA, which extended coverage for abortions to all women in Oregon — including undocumented women. The law has been looked to as a progressive policy that could be replicated in other states. Expansions under RHEA were expected to cost the state $10.2 million in the current budget cycle.

Less discussed is another bill that Brown signed last year, dubbed “Cover All Kids” by its supporters. The legislation expanded Medicaid coverage to undocumented children who hadn’t formerly qualified. The law was expected to reach roughly 15,000 kids in Oregon and cost the state $36.1 million in the current budget.

“Coverage for women and our children in this state, I think, are a reflection of Oregon values and I think they’re a reflection of Oregon priorities,” Brown told OPB recently. “A really good example of that is Ballot Measure 101. That measure won not just in Multnomah County. It won in Deschutes County, it won in Hood River County, it won in Curry County, because Oregonians understand how critically important it is for vulnerable Oregonians to have access to health care.”

But Brown’s record on health care has seen tumult, too. A state audit turned up $74 million in overpayments at the Oregon Health Plan, including coverage provided to people who didn’t actually qualify. The state has also recently struggled to limit Medicaid cost increases to its targeted 3.4 percent, failing in each of the last two years.

Not helping matters is the fact that the Oregon Health Authority, which administers Medicaid in Oregon, saw a leadership shakeup last year when former director Lynne Saxton resigned amid scandal.

If she’s re-elected, Brown will have another health care funding challenge to look forward to. The governor appointed a workgroup to consider funding strategies that will fill a looming $830 million Medicaid funding gap.

Options on the table to fill that hole include hiking taxes on cigarettes by $2 per pack, which state officials say could reap the state $293 million every two years. Asked about that proposal, Brown would only say she’s aware it’s “on the table.” One thing that’s not on the table, she says, is reducing benefits or the number of people covered under the Oregon Health Plan.

“I am absolutely committed to not making any cuts to benefits because I know that that hurts Oregonians,” she said.

In September, Brown revealed a list of health care proposals that include increasing access to mental health treatment, and ensuring that 99 percent of adults in Oregon have health insurance. Currently, 94 percent of Oregonians are ensured.

Knute Buehler (Republican)

As a physician and a member of the House Committee on Health Care, Buehler knows this subject better than most Oregon lawmakers. And as you might expect, Buehler says his signature accomplishment in the Legislative Assembly is a health care law.

In 2015, the Bend surgeon championed legislation that for the first time allowed Oregon pharmacists to prescribe birth control — a change aimed at increasing the ease with which women could obtain it. He helped push legislation expanding the policy last year.

Buehler says the law is “groundbreaking in terms of women’s health,” noting it was the first of its kind in the United States. But some have questioned whether it’s been as effective as expected. It’s unclear how many pharmacists have been trained to prescribe birth control, for instance, or how many women are even aware the service exists.

Buehler says he’s not worried.

“We can quibble about percentages but let’s not lose sight of really what this does for women’s health,” he said. “The proof will be in the pudding.”

Like Brown, Buehler has unveiled a health care platform that includes minimizing health care costs, treating the state’s opioid addiction woes, improving access to mental health and opposing federal cuts to Medicaid funding.

But Buehler has also repeatedly opposed expansion of health care coverage. He voted against the RHEA bill that guaranteed abortion coverage to Oregon women and also the “Cover All Kids” bill that allowed undocumented children receive coverage.

Buehler chocks up his opposition to fiscal discipline.

“I did not think we should be adding new benefits for new beneficiaries when Gov. Brown was failing to uphold the promises in programs to disabled kids, to our foster kids, to seniors and to veterans,” Buehler told OPB.

The lawmaker points to the expansions as part of the reason the state is staring down another budget hole for health care funding. And unlike Brown, Buehler isn’t ruling out cuts to coverage to plug it.

“Everything has to be on the table,” he says. “When you have an $800 million deficit, we’re going to have to look at all options that are available.”

Buehler is also proposing an expansion of taxes on hospitals, higher taxes on tobacco and a new tax on vaping products.

Patrick Starnes (Independent)

Starnes, a cabinet maker from Brownsville, has based the majority of his campaign on pushing reforms to Oregon’s permissive campaign finance laws, and hasn’t deeply fleshed out many other policy proposals. But the candidate believes he has an elegant solution to Oregon’s funding woes: a tax on junk food.

“The junk food tax is like a sin tax,” Starnes says, referring to existing taxes on alcohol and tobacco. “It’s not really anything new.”

Starnes does not have a proposal for precisely how his tax would work, or how much it would raise — he says that would be up to the state Legislature. But the candidate says he’d like the tax to raise enough revenue to extend single-payer health care to every Oregonian and patch a $22 billion hole in the state’s public pension system, a solution he calls his “grand bargain.”

Once those issues are taken care of, Starnes believes Oregon will have more than enough money to fund its troubled education system.

“Of course,” Starnes notes, “I would argue that you can’t do anything until you get campaign finance reform. You’ve got a lot of obstacles that own the Legislature.”

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