Facing steep odds in Senate race against Maria Cantwell, physician Dr Raul Garcia’s unconventional campaign focuses on health care

WASHINGTON – It’s not easy to get elected to statewide office as a Republican in Washington state. When voters don’t know your name, it’s just about impossible.

That’s the problem Raul Garcia, an emergency physician from Yakima, faced when he ran for governor in 2020 and finished fifth out of 36 primary candidates.

“A lot of people knew me as the doctor from Eastern Washington who was running for governor,” Garcia said in an interview Wednesday. But when they saw the crowded ballot, he wasn’t sure they recognized his name.

So before running for Senate against incumbent Maria Cantwell in 2024, the doctor came up with an outside-the-box solution: He legally changed his name to “Dr Raul,” so his professional prefix would appear on the ballot. The downside, Garcia joked, is that when his wife wants to give him a hard time, now she just calls him “Durr.”

This year, Garcia made it to the general election, but that may have less to do with his name than his decision to leave the gubernatorial race in 2023 and secure the state GOP’s endorsement to challenge Cantwell, a Democrat who has represented Washington in Congress since 2001. With Garcia’s message focused on health care and tackling the fentanyl crisis – some of the same issues Cantwell has prioritized – the race offers voters a chance to compare different approaches to some of the state’s most pressing policy challenges.

The August primary – when Cantwell took about 57% of votes and Garcia 22%, splitting the GOP vote with other candidates – suggested the race isn’t particularly close. In a poll conducted in July by SurveyUSA for Seattle’s KING-TV, the Seattle Times and the University of Washington’s Center for an Informed Public, 58% of voters said they planned to vote for Cantwell in November and 37% for Garcia, with just 5% saying they were undecided.

Cantwell also has a large fundraising advantage, having raised $11.7 million and spent less than half that amount as of July 17, according to Federal Election Commission filings. Meanwhile, Garcia reported raising about $597,000 and spending $428,000.

Despite not facing a serious threat to her re-election, Cantwell has received more campaign donations than any other senator has from the airline and telecommunications industries – both of which she oversees as chair of the Senate Committee on Commerce, Science and Transportation – according to the campaign finance tracker OpenSecrets.

Cantwell, a native of Indiana who worked as an executive at the Seattle-based tech company RealNetworks after a single term representing northwestern Washington in the House ended in 1995, has pitched herself to voters as a pragmatic Democrat who is willing to work with Republicans to tackle policy challenges. As head of the Commerce Committee, she has played a major role in crafting the Biden administration’s signature legislation aimed at upgrading the nation’s infrastructure, creating more manufacturing jobs and speeding the transition to renewable energy sources.

Knowing he can’t compete with Cantwell’s spending or rely on GOP votes in a state where no Republican holds statewide elected office, Garcia has taken an unconventional approach to reaching voters with his message, which pairs traditionally conservative views on taxes, guns and policing with relatively liberal positions on abortion, immigration and health care.

In July, Garcia walked more than 150 miles in triple-digit heat from Astria Hospital in Toppenish, where he works as the medical director, to Seattle in an effort to call attention to the scourge of fentanyl. To reach more voters in the state’s biggest urban center, he said, he temporarily moved on Labor Day from his home in Yakima to Seattle’s Belltown neighborhood, where the city’s homelessness and addiction crisis is on display next to upscale restaurants and luxury condos.

A political moderate who idolizes the late Sen. Bob Dole of Kansas, for whom he interned after fleeing Cuba with his family as a child, Garcia is not the typical GOP candidate in 2024. In a moment when the party is largely defined by loyalty to its presidential nominee, Donald Trump, Garcia won’t say how he plans to vote in the race for the White House, which he called “the most divisive thing in America today.”

His opponent, however, is not exactly an avatar of the divisiveness that pervades so much of American politics today. In contrast to Sen. Patty Murray, her fellow Washington Democrat and a prominent critic of Trump and the GOP, Cantwell’s recent news releases tout bipartisan bills and federal funding for things like job training, cancer research and airport upgrades.

The result, at least so far, has been an unusually civil Senate race based more on policies than personalities. With health care playing an outsize role in the race to represent Washington, here’s where the candidates stand on three key issues.

Fentanyl and other opioids

Addiction to heroin and other opioid drugs isn’t a new problem in the United States, but a surge in the availability of fentanyl – a synthetic opioid that is far cheaper and up to 50 times stronger than heroin – has driven a sharp increase in overdose deaths in the past decade.

According to data from the Centers for Disease Control and Prevention, fentanyl and other synthetic opioids killed roughly 75,000 Americans in each of the last two years. While drug overdose deaths decreased nationwide between April 2023 and April 2024, according to CDC data, Washington state saw the opposite, with an increase of nearly 14% during that period.

Cantwell has made fentanyl a major priority in recent years, convening a series of 10 listening sessions across Washington in 2023 and 2024, directing federal funding to the state and co-sponsoring several bipartisan bills aimed at combating the crisis. Much of that legislation aims to stem the flow of fentanyl into the country, which comes primarily from China and Mexico, according to the Drug Enforcement Agency.

In April, the Senate passed the FEND Off Fentanyl Act, Cantwell-backed legislation that uses sanctions to punish fentanyl traffickers and cut off the supply of the chemicals used to make the drug. In August, Cantwell and Sen. John Cornyn, R-Texas, introduced a bill aimed at cracking down on counterfeit pills made with fentanyl by requiring pill presses to be engraved with a serial number.

Cantwell spokeswoman Ansley Lacitis said the senator will soon introduce another bipartisan bill intended to improve the information available to first responders by establishing grants for states, tribes, cities and law enforcement task forces to implement overdose data collection programs. The legislation would encourage grantees to adopt a free application, which isn’t currently used in Washington state, to monitor and map overdoses.

“Sen. Cantwell has already passed legislation to expand sanctions on fentanyl traffickers and creators of precursor chemicals, give law enforcement more tools to disrupt fentanyl-related money laundering, and deploy advanced screening technology at our border crossings,” Lacitis said in a statement, referring to the FEND Off Fentanyl Act and the annual government funding package Congress passed in March, which included about $1.7 billion for various programs designed to intercept fentanyl from entering the country.

In May, Cantwell and Sen. Bill Cassidy, R-La., introduced the Fatal Overdose Reduction Act, which would expand a program that was developed and piloted in Washington state based on “health engagement hubs,” a sort of one-stop-shop where people addicted to opioids can quickly access buprenorphine, a medication used to treat opioid use disorder. A University of Washington study estimated that the six pilot sites reduced fatal overdoses by 68% in a year.

The opioid crisis is personal for Garcia. As an emergency physician, he said he sees overdoses in virtually every shift at his hospital on the Yakama Reservation, which has been hit especially hard by fentanyl. As the stepfather of a son whose opioid addiction left him homeless, Garcia said he wants to tackle the fentanyl crisis by mandating long-term, comprehensive rehab programs for addicts while imposing federal felony charges on drug dealers.

“I believe a lot in lived experience. And hearing him talk about his time in the streets, the free accessibility of the drugs, we have to understand something really important with fentanyl,” Garcia said. He went on to explain that the abundance and low cost of fentanyl means that an addiction that would cost perhaps $100 a day for heroin now costs $5 a day for fentanyl, making it even easier for people to be trapped by the synthetic drug.

He acknowledged that many addicts also sell drugs and said his plan, which he calls the Americans Against Fentanyl Act, would apply those federal felony charges only to “the purposeful and conniving dealers that are doing this to make a profit and knowing that they’re killing people.”

“I strongly feel that we need to be harsh in that part of the problem,” Garcia said, referring to drug dealers. “And then open up our hearts and arms to the addiction world and say, ‘OK, we need to make tough decisions here as well.’ ”

He opposes the “harm reduction” approach used by some drug treatment programs, which can include providing clean needles, arguing that it enables drug use. Instead of the housing-first model that has become popular in recent years, Garcia proposes involuntary rehab programs lasting several months that include medication-assisted therapy, counseling and other mental health treatment before placing people in housing.

Abortion and reproductive health care

After three Trump-appointed justices allowed the Supreme Court to overturn nationwide protections for abortion in 2022, some Republicans in Congress introduced a bill to ban terminating a pregnancy after 15 weeks, which would require 60 votes in the Senate to overcome a filibuster. But Garcia said he would vote against any federal restrictions on abortion, because they would limit doctors’ ability to treat miscarriages and other potential fatal conditions.

“I have seen it with my own eyes,” he said. “With ectopic pregnancies, with fetal demise, with complications from pregnancy that warrant the medical profession to do what they do to save that woman’s life. And so, no, I will never be one of the 60 senators that are needed to put any restrictions on abortion nationwide.”

Americans have complicated views on abortion, with Pew Research Center polls showing most want the procedure neither banned outright nor legal in all circumstances. That nuance is seldom seen in Congress, but Garcia said he believes Republicans and Democrats can come together on abortion because they all want it to be rare.

The solution, he said, is to keep abortion legal, bolster the foster care system and make adoption easier and less expensive while giving “resources, education and support to women that are pregnant and in crisis.” He told the Seattle Times in June that he would vote in favor of restoring nationwide abortion rights previously protected by the Roe v. Wade decision that was overturned in 2022.

“I will explain it to my Republican Party,” he said in an interview with The Spokesman-Review. “And I think that they will be more open to hearing that from me than to hearing that from a Democrat.”

Another pillar of Garcia’s platform is keeping OB-GYN clinics open in rural areas, informed by the experience of his own hospital being forced to close its maternity center at the beginning of 2023, citing rising costs, a staff shortage and reduced Medicaid reimbursement rates.

In June, Cantwell and other Senate Democrats released draft legislation that would increase Medicaid payment rates for rural and other high-need hospitals’ labor and delivery services. In a news release announcing the bill, Cantwell cited Garcia’s hospital to illustrate the need to pass it.

Since the Supreme Court overturned the Roe v. Wade ruling’s protections for abortion, Cantwell has put a spotlight on the decision’s fallout. In a series of reports, her office highlighted how women from Idaho and other states that have restricted abortion have strained the resources of Washington state clinics and hospitals. Cantwell’s staff also led a nationwide report, released in July, that found “allowing states to ban or restrict abortion is causing an unprecedented flow of pregnant patients across state borders, at times endangering their lives and financial security.”

With many of her fellow Democrats, Cantwell has introduced numerous bills in response to the high court’s decision, including legislation to codify the abortion protections removed by the Supreme Court, to undo a ban on federal funding for abortions, to increase access to contraception and to prohibit anti-abortion state governments from restricting women from traveling to other states to get abortions or from making it illegal for other people to help them. None of those bills have passed, and they would require Democratic control of the House, Senate and White House and a majority of senators willing to undo the filibuster rule, which requires a 60-vote supermajority to pass most legislation.

Health care access and costs

Washington state has fewer hospital beds per capita than any other state, according to data from the Kaiser Family Foundation. On average, Americans spend nearly twice as much on health care as citizens of other wealthy countries but have worse health outcomes than nearly all of those countries, according to data from the Organization for Economic Cooperation and Development, a group that includes the United States and 37 other advanced economies.

That problem has long vexed federal lawmakers, with some calling for dramatic changes to a U.S. health care system built largely on profit-driven insurance companies and hospital systems. Like other Democrats, Cantwell has worked to defend and bolster the Affordable Care Act, the Obama administration’s signature health care reform law that expanded coverage by both private insurance plans and taxpayer-funded Medicaid programs.

During the Trump administration, Cantwell was a vocal champion of the law, urging the Justice Department to defend it against legal challenges and inviting a Spokane high schooler with type 1 diabetes to the State of the Union address in 2020 to highlight the high cost of insulin. She was also one of the architects of the Inflation Reduction Act, a broad package of legislation Democrats passed in 2022 that capped insulin prices at $35 a month.

Since the law often called “Obamacare” took effect in 2010, Democrats – and some Republicans – have staved off GOP efforts to repeal it. Garcia said he would vote against repealing the law, adding that its requirement that insurance plans cover patients with preexisting health conditions is especially important, but he thinks Congress should do more to lower health care costs.

“I have been in it for 26 years, so this is my wheelhouse, and certainly have had my frustrations as a physician to be able to deliver care to my patients,” Garcia said. “I feel that we are in a situation now where insurance companies have a lot to say on our health care every day, instead of having that power be in the hands of patients and physicians, and I will do everything possible to balance that out.”

Garcia said that although he sees supporting free enterprise as a key tenet of being a Republican, he has “conflicting thoughts” about health insurance companies being publicly traded firms whose profit motive is at odds with providing the best health care to Americans.

“I would have discussions about insurance companies not having the option to have a public offering in Wall Street,” he said. “Because as a physician, I could tell you that you are now satisfying investors instead of approving an MRI for my patient. And to me that’s just conflicting, when at the end of it all, we’re human and we want the best for our people.”