Democrats zero in on health care and electability in final days of race to challenge U.S. Rep. Michael McCaul

Pritesh Gandhi and Mike Siegel, the Democrats running for Texas' 10th Congressional District. The Texas Tribune

The Democratic primary runoff to challenge U.S. Rep. Michael McCaul, R-Austin, is reaching a tense conclusion with a focus on two issues that have dominated Democratic politics nationwide this election cycle: health care and who can win in November.

Austin attorney Mike Siegel, who ran an unexpectedly close race against McCaul in 2018, faces Austin physician Pritesh Gandhi as he looks to secure his party's nomination again — and show that an unabashed progressive can finish the job in November.

Backed by Bernie Sanders, Siegel is an ardent supporter of "Medicare for All," the single-payer health insurance program, while Gandhi backs a less sweeping proposal that preserves some private insurance. But the contrast that Gandhi is driving in the runoff's final days has as much to do about politics as it does policy.

“Ultimately we can’t make the change we need to make if we can’t put leaders in office," Gandhi said in an interview. "Mike failed in 2018 when Beto [O'Rourke] was at the top of the ticket and Mike underperformed" the U.S. Senate nominee as well as some other statewide candidates in the district.

Siegel said in an interview that the criticism is a "sign of desperation," noting he came within 4 percentage points of McCaul after the congressman won reelection two years earlier by 19 points.

"We outperformed everybody's expectations, and some jobs take longer than one electoral cycle," Siegel said. "We established the foundation. I understand that Pritesh would like to use that foundation to launch his own political career, and he has a right to do that, but I think voters of this district ... know the work I've been doing the last three years."

In making the case against Siegel, Gandhi's campaign points to his opponent's performance against McCaul as a share of the two-party vote in 2018: 47.8%. That was lower in the district than the same metric for O'Rourke and the Democratic nominees for lieutenant governor, attorney general and agriculture commissioner. It was also higher than the shares received by the party's nominees for governor, comptroller, land commissioner and railroad commissioner.

Siegel and Gandhi emerged from a three-way March primary, getting 44% and 33% of the vote, respectively. The third-place finisher, Shannon Hutcheson, had been the choice of the powerful abortion rights group EMILY's List, and her elimination provided something of a reset for national Democrats following the race.

Toward the beginning of the runoff, Gandhi picked up endorsements from two national groups: Planned Parenthood and Giffords, the anti-gun violence organization. But Siegel has been on more of a streak in the runoff, landing further in-district endorsements as well as the backing of two members of the Texas congressional delegation, Reps. Veronica Escobar of El Paso and Sylvia Garcia of Houston. Siegel also has won runoff endorsements from three former 2020 presidential candidates: Sanders, Elizabeth Warren and Marianne Williamson.

More recently, Gandhi countered with his own endorsement from a former White House hopeful: U.S. Sen. Kamala Harris of California, who called Gandhi a "progressive fighter who can win."

Gandhi has been the top fundraiser, raising $1.2 million to over $864,000 for Siegel as of June 24. However, the money race tightened considerably in the second quarter of 2020, with Gandhi's campaign saying he surpassed $256,000 and Siegel's saying he collected over $250,000.

Gandhi has also benefitted from six figures of outside spending by 314 Action Fund, which works to elect more people to office with backgrounds in science, technology, engineering and mathematics. The group attacked Hutcheson in the primary and has returned to the fray in the runoff to target Siegel as unelectable, airing a TV ad that says voters "can't risk more of Mike McCaul and the Trump agenda."

Like many runoffs, the overtime round in the 10th District has been disrupted by the coronavirus pandemic — and particularly so for Gandhi, the associate chief medical officer at a community health clinic in East Austin. He has leaned hard on his experience on the front lines of the pandemic to bolster his argument that Congress needs more doctors — and to assert a unique vantage point on health care and other issues that the virus has brought into sharp relief.

Balancing his clinic responsibilities with the campaign, he said, has been "excruciatingly difficult over these past few months, but it has provided a window into the very real challenges that Central Texas families are facing."

When it comes to health care, Gandhi's preferred route is Medicare Extra, a plan put forward by the Center for American Progress, the liberal think tank. The plan would create a public insurance program and automatically enroll newborns, the uninsured and every adult once they turn 65 years old. It would not get rid of private insurance — a key sticking point in the Medicare for All debate — and would let people keep their employer-provided private insurance if they would like to.

Siegel said he admires and respects the work Gandhi is doing at his clinic — "full stop" — but when it comes to health care policy, there is a "clear contrast" between the two. Especially now, Siegel said, "we need solutions that meets the scale of the problems we're facing. We don't need half-measures."

Gandhi accused Siegel of "leading by division, not addition" with comments he has made holding firm on Medicare for All, particularly taking issue with Siegel saying in a recent Houston Chronicle story that Gandhi's health care plan would "allow people to die who shouldn’t die."Siegel said in the interview that his comment was a matter of fact, pointing to a February study from Yale University researchers that Medicare for All would save 68,000 lives per year.

"These policy choices do result in life and death," Siegel said.

Siegel's ambitions on health care and other issues have cultivated stalwart supporters like Ramanjeet Gill, an Austin lawyer who has backed Siegel since the beginning of his 2018 campaign.

"I just really think that Mike’s imagination for what our country can be is much bigger and bolder than Gandhi’s," Gill said, adding that Siegel is "not naive" about the challenges his agenda would face in Congress but that he believes in setting bigger policy goals from the outset. "Make no mistake about it, Mike is the true progressive in this race.”

Gill called it "preposterous" to suggest Siegel cannot win this time because he did not win in 2018, saying she saw firsthand how hard Siegel worked to close the gap two years ago. And she noted she has seen his campaign grow and mature this cycle, which began with Siegel quitting his job to focus full time on the race.

In the homestretch, Gandhi is looking to gain more supporters like Shana Ellison, an Austin activist who backed Siegel in 2018. But she said she believes Siegel benefitted from O'Rourke's strength at the top of the ticket and was drawn this time to Gandhi because she considers herself a "big fan of science and getting more people who respect science to Congress."

Ellison lamented how contentious the runoff has become and said it particularly "frustrates the heck out of me" when Gandhi is criticized from his left on health care.

"People who don’t understand the details of it think he’s not for universal health care, and that is absolutely not the case," Ellison said, alluding to Gandhi's medical background. "I gotta believe he understands the nuances a whole lot better than politicians."

In a more specific area of health care, Gandhi's allies have taken aim at Siegel on vaccines, citing his support from Williamson, the former presidential candidate who apologized last year after calling mandatory vaccines "draconian" and "Orwellian." After 314 Action Fund seized on an event that Siegel did with Williamson last month, he said in a statement to The Texas Tribune that "vaccines save lives" and encouraged "everyone to listen to their doctors and appropriately make use of modern medicine that keeps them and so many others safe and healthy."

The final spats between the candidates and their allies are coming as national Democrats increasingly look toward the general election in the district.

While there have been previous tensions between the Democratic Congressional Campaign Committee and Siegel, there are signs they are closing the nominating process on amicable terms. Siegel said his campaign has been in close contact with the committee and he believes it is "ready to support whoever prevails" Tuesday. A DCCC spokesperson said the committee has stayed in touch with both runoff campaigns as the general election nears and still sees the 10th District as a pickup opportunity in November.

Waiting in the general election is McCaul, who won his March primary unopposed. His campaign announced Tuesday that he raised "nearly" $540,000 in the second quarter and ended the period with over $1.2 million cash on hand, dwarfing the reserves of Gandhi and Siegel. The seven-term incumbent has been preparing for November, his campaign said, while the "Democratic candidates are sprinting to the left while spending their time and money attacking each other."

Disclosure: Planned Parenthood has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.