Virginia's lieutenant governor candidates -- as starkly different in style as they are in politics -- clashed Tuesday night over health care, how to care for the dangerously mentally ill and women's access to reproductive health services.
Democratic state Sen. Ralph Northam was generally the aggressor in the evening debate at George Mason University's Arlington campus, hammering Republican E.W. Jackson, a conservative Chesapeake minister, over what he called Jackson's "social agenda'' on abortion, gay rights and strident rhetoric.
Jackson, a polished speaker, stood by his opposition to abortion, gay marriage and an expansion of Medicaid in Virginia that would be mostly federally funded, and appeared not to allow Northam's accusations to rouse him.
The sharpest clash came in questioning about legislation that holds Virginia abortion clinics to stringent architectural standards that apply to hospitals and that forced the closing of many stand-alone women's reproductive services clinics in Virginia.
"We need to be in a position in Virginia where we're welcoming people,'' Northam said. "I talked about the assault on women's reproductive health care. Let me ask you all: What woman in her right mind would want to come to the commonwealth of Virginia when most forms of oral contraception have been criminalized and in-vitro fertilization has been criminalized.''
He was discussing so-called "personhood'' legislation supported by Jackson among other Republicans, which would outlaw almost all forms of abortion by conferring the full rights of personhood to an embryo from the instant of conception. Destroying such an embryo, under such a law, could be construed as homicide.
Jackson held his ground, saying that he opposes abortion and that, at least in his view, life begins at conception. "I am unabashedly pro-life. I make no apologies for that.''
Positions were just as opposite on the state's expansion of Medicaid to eventually cover an additional 400,000 Virginia working poor who lack insurance. Currently, state law allows the federal-state partnership that helps pay medical costs for the elderly, disabled, blind and low-income families with small children only if a legislative panel verifies that several cost-cutting and efficiency reforms have been achieved.
If Virginia rejects Medicaid expansion, Northam argued, federal taxes that Virginians pay would be used in other states that approve expansion. It would also cost Virginia more to leave people uninsured, said Northam, a Norfolk pediatric neurologist by profession.
"The cost of health care is driving the country to its knees, and the secret to controlling cost is coverage,'' he said. When the poor fall ill and lack preventive care or access to a doctor, they go to emergency rooms.
"There is a time and a place for the emergency room, but preventive medicine is not it,'' he said. "If you want to talk about ringing the cash register, that's where you do it.''
Jackson called Medicaid expansion a federal scheme sure to fail in precarious economic times with $17 trillion in federal debt and cuts certain to come. When that happens, he said, it would saddle Virginia with unbearable debt.
"I oppose the Medicaid expansion because I simply don't think that is the way to cover our poorest citizens,'' Jackson said. "What happens is the federal government is borrowing money - taking money from Virginia - and then giving that money back to us.
The issue of mental health policy melded with that of gun control after last week's fatal shooting of 12 people at the Washington Navy Yard by a gunman with a history of mental problems who, nonetheless, was able to buy his shotgun legally in Virginia.
Jackson rejected restrictions on firearms sales such as a waiting period or closing the "gun show loophole'' which allows private gun aficionados at gun shows to sell or barter firearms without the background checks required of federally licensed weapons dealers. Instead, he suggested more institutionalization for some, reversing Virginia's two-decade trend toward greater community mental health care for people with potentially dangerous mental disorders.
"We have got to go back to a system where people who are clearly incapable of living in our culture safely and without harming others have some other opportunity to be housed,'' he said. He dated the trend away from institutions for the mentally ill to the 1975 film "One Flew Over the Cuckoo's Nest.''
"People said, 'You know, mentally ill people are really not mentally ill, we just don't understand them, and we don't need to have them in institutions,''' he said. "We are finding out, for some, we absolutely do.''
Jackson said there are mentally ill people in his family and that a federal program is not what they need.
In rebuttal, Northam turned toward Jackson and noted his admission that some in his family need mental health services.
"How sad to think that you would have to go visit them in an institution,'' Northam said.
While the lieutenant governor's race rates amounts to little more than a junior-varsity warm-up for Wednesday night's Fairfax County Chamber of Commerce gubernatorial debate, there are real political and policy consequences at stake. Because lieutenant governors have no voice in legislative issues short of casting tie-breaking votes in the 40-seat Senate, the victor could determine the fate of major initiatives of the next governor and General Assembly.
Democrats and Republicans now hold 20 seats each, but Republicans exert an organizing majority because of Republican Lt. Gov. Bill Bolling's decisive vote.