SEATTLE — In the race for Washington attorney general, the two candidates can agree on at least one thing: Health care is getting too expensive for Washingtonians — and the next attorney general needs to be able to wield consumer protection laws to preserve access to affordable medicine and services.

Nick Brown and Pete Serrano generally agree on little else, whether it's gun regulations or how to address impacts of changing abortion laws around the country.

"There are very clear contrasts between Pete Serrano and me on a whole host of things, including health care issues," Brown said last week. Brown, former U.S. Attorney for Western Washington and a Democrat, also previously worked as legal counsel to Gov. Jay Inslee.

Serrano, the Republican mayor of Pasco, is a lawyer who has worked for the U.S. Department of Energy. He's also the director and general counsel of a legal foundation that has challenged COVID-19 vaccine mandates and certain state gun laws.

"I understand the nuances of the east and the west [parts of the state], and there are some stark and contrasting differences," said Serrano, emphasizing that although he's based in Eastern Washington, he's also spent time familiarizing himself with medical needs in the Puget Sound region.

While high health care costs, and what to do about them, were top-of-mind for Brown and Serrano, they're also thinking about how they might tackle other health-related topics, like the region's opioid crisis and growing hospital consolidation.

When it comes to health care in Washington, the state Attorney General's Office has some ability to regulate parts of the industry, mainly through enforcing laws against anticompetitive business practices, and can file lawsuits against businesses the office thinks are violating laws that protect Washington patients.

The Attorney General's Office can also throw its support behind health-specific state legislation and challenge other states, or the federal government, with legal action if Washingtonians are impacted.

In the past few years, for example, current Attorney General Bob Ferguson has become involved in lawsuits against states like Idaho over the effects of their abortion bans, or against the U.S. Food and Drug Administration over regulations around mifepristone, a medication abortion drug.

Here's how Serrano and Brown say they will take on four of the state's most pressing health-related issues.

Rising health care costs

Many Washingtonians have watched health insurance premiums jump nearly 50% over the last decade, while the costs of individual plans have more than doubled.

Both Brown and Serrano hope to use the state's consumer protection tools to keep an eye on pricing practices of health care systems and insurance companies. Not only can those tools be valuable to better understand how medication and service costs are set, they said, but could also be used to tighten distribution practices among pharmaceutical companies contributing to the region's opioid crisis.

"Consumer protection tools are the most proactive tools we have," Brown said. Using those tools, he said he would "make sure that providers are being honest about the cost of their medication, and transparent about how they're describing the impacts."

Similarly, Serrano said he would use the Consumer Protection Act to "make sure the individual recipient of services is fairly treated" and "say, 'Hey, the people of Washington are getting hammered here in the cost of health care again.' "

Many instances of fraud in the health care space, Brown said, "deal with the multiple types of costs that might be associated with medication that providers aren't always transparent about. [Patients] may not understand when they're signing up for certain things."

Brown added that he would love to see Washington tackle rising health care costs in more hands-on ways, but the main strategies the Attorney General's Office can use are to recommend legislation that caps costs on certain types of services or medications, and use consumer protection tools.

"Litigation is certainly one of the tools on the tool belt," Serrano said. "Hopefully it's the last resort."

Serrano also said one of his top priorities is to analyze insurance rates and reimbursement rates — "making sure those are fair and accurate and adequate."

"In the medical system, are they inflating costs of services?" Serrano said. "If so, it's time for the AG to step in. ... Obviously, businesses still have the right to make money, but we shouldn't be [allowing certain practices] if we're underserving our communities."

Hospital consolidation

As health care consolidation becomes more frequent in Washington and around the country, conversations throughout the state are intensifying around how those business deals might impact patient services and access to care.

According to a report from the state Office of the Insurance Commissioner last year, mergers and acquisitions are likely also contributing to accelerated health care costs.

"Consolidation often leads to price increases, lack of availability of services, particularly as many of those are faith-based institutions," Brown said. "That means lots of certain types of services — abortion being No. 1, and access to transgender [health] care — are often on the cutting board."

Brown referenced support for the Keep Our Care Act, which has been debated during the past several legislative sessions but has never been approved. The legislation aims to increase oversight — through the Attorney General's Office — of health care mergers and acquisitions in the state, which bill supporters say often worsen quality of care and drive up prices.

But opponents argue the bill introduces too many additional requirements for health systems interested in these transactions and could discourage future deals, which could come at the expense of smaller hospitals and clinics that need financial support if they want to keep their doors open.

Serrano also said he would want to have a "position at the table" in conversations around hospital mergers. He didn't mention specific thoughts around the Keep Our Care Act, which will likely return during next year's legislative session, but said one of his other large concerns relates to impacts on staffers, who might see changing work conditions before and after these deals.

"Many of these workers are unionized, so the question will be whether or not the union desires assistance from the AG's office," Serrano said. "And quite frankly, if they're not doing their job, maybe there's an opportunity for the AG to come in and start conversations about the union's failure to represent individuals. ... I'm here to represent these people too."

Brown added that he understands that the "realities of the health care industry" often push independent providers to seek financial support from larger systems, and that it's not because "they want to deny people services."

"Still, we need to find a way to limit the impacts on people," Brown said.

Opioid epidemic

The fight against the region's opioid epidemic lands in the state Attorney General's Office in different ways. Under Ferguson's leadership, that's largely involved litigation against opioid manufacturers that he says have fueled the rise in overdoses in the state.

Over the last decade, Ferguson's office has recovered more than $730 million through its opioid litigation initiative, which it has used to spend on addiction prevention resources and substance-use treatment in the state, the office said in 2022.

The total includes about $500 million from the state's three largest opioid distributors, which agreed to the payment in 2022 to resolve a six-month trial where they were accused of shipping huge amounts of prescription opioids into the state even when they knew, or should have known, those drugs were likely to be diverted into the illegal drug market. Other Ferguson lawsuits against drug manufacturers have alleged manipulative marketing techniques.

Ferguson's actions have "shown the impact the AG's office can have here," Brown said.

Still, "the data is pretty clear that we have not treated it with the urgency that we need to, particularly when it comes to our youth overdosing at an incredibly high rate," Brown added.

He envisions wide-scale investigations involving a number of jurisdictions and agencies to go after those bringing illegal fentanyl into the state.

"We also need to make sure that we're supporting people's root-cause addiction problems," Brown said.

Serrano said he also has specific concerns about doctors overprescribing medications. "These once-trusted institutes are kind of struggling to retain ... that status," he said.

"We need to make sure that these doctors are doing the right thing, and make sure that the drug companies aren't pushing products for gain," Serrano said. "That's where not only the Consumer Protection Act [comes into play], but also opportunities for criminal penalties."

Abortion and reproductive care

In the two years since the U.S. Supreme Court reversed the constitutional right to abortion, conversations around the topic have not stopped, making it again a pressing issue for Washington voters.

According to a recent poll that surveyed about 700 likely voters in July, about 70% of respondents felt a candidate's opinion on federal abortion restrictions would make them more or less likely to vote for that person.

Last year — a year after the Dobbs v. Jackson Women's Health Organization decision — the number of abortions provided in Washington rose 23%, to the highest level in a decade, according to state health data.

Brown's priority is to make sure "we not only continue to defend current Washington law, which I think is really strong, but continue to be an advocate for further protections," he said.

"We're seeing real big impacts now because other states have made abortion illegal or severely restricted it," Brown said. "The impact on our health care system now is real. Health care providers are really stretched thin, especially in Eastern Washington."

Brown said he has "serious doubts not only whether [Serrano] will defend current law, but will make sure we're protecting Washington against potential interference of those laws."

Serrano said he supports upholding state law that protects access to abortion, though he is "pro-life, with some exceptions when it comes to rape and the health of the mother of the fetus," he said.

Serrano also said he "struggled" with Ferguson's decision to become involved in a lawsuit against Idaho over its abortion travel ban — disagreeing with the idea that Washington should interfere with another state's laws.

"The Supreme Court says 50 states may have 50 different approaches," he said. "I would not have brought that lawsuit. All that does is open us up for a tit-for-tat on litigation."

He continued, "I think there are very rare instances where several states may want to sue each other individually. ... I understand the spillover and the connection with individuals in Washington, but to me, it didn't rise to the level of infringing on Washingtonians' rights."

Meanwhile, Brown said he's proud of Washington's efforts to "lead around abortion access," but is worried about "getting a little complacent sometimes."

"Washingtonians, despite our legal right to abortion here, aren't necessarily shielded from impacts of changing abortion laws in other states," he said. "Even though we've got good laws here, I do think it's important for the AG to be that shield against changes on the national level."

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