Attorney Jason Rittereiser’s accusations over his opponent’s medical practice come as Kim Schrier is viewed by some as the Democratic front-runner in the 8th Congressional race, generating national media attention and an early endorsement from EMILY’s List.

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The primary race among Democrats vying for a shot at retiring Congressman Dave Reichert’s 8th Congressional District seat is getting personal — with a feud over a leading candidate’s medical practice.

During an otherwise cordial forum on trade issues last week at Bellevue College, attorney Jason Rittereiser turned to rival Democrat, pediatrician Kim Schrier, and accused her of hypocrisy.

“Dr. Schrier, how are we going to trust that you are going to fight for health care in D.C. when you built a practice here that has refused to treat the vast majority of poor kids on Medicaid?” Rittereiser said.

Before the question was finished, a visibly irritated Schrier reached her hand out to demand the microphone.

“That’s a little bit of jockeying with the truth there,” she responded. “I see kids from all backgrounds. I see kids on Medicaid… I don’t look at insurance when they walk through the doors.”

Rittereiser’s criticism — which he also raised at an earlier candidate forum in Sammamish — stands out as the most aggressive so far among the leading Democrats in the 8th District race, whose differences on major issues have been subtle.

His campaign sent out a news release the next day, saying he was holding Schrier “accountable for her medical practice’s policy of refusing to treat over 80 percent of children in King County on Apple Health,” referring to the state’s Medicaid program.

Schrier responded that Rittereiser is oversimplifying — and missing the point. She says her experience inside a flawed medical system is what is driving her to run for Congress.

The attacks come as Schrier has been viewed by some as the Democratic front-runner in the race, generating national media attention and an early endorsement from fundraising powerhouse EMILY’s List. Her campaign has raised more than $1 million through March, compared with Rittereiser’s $600,000.

A third leading contender, Shannon Hader, a former top global-health official at the Centers for Disease Control and Prevention, has raised about $600,000, including a $300,000 loan to her own campaign.

All three leading Democrats have spoken in favor of moving toward guaranteed health care through a transition toward a single-payer system like Medicare.

They’re competing to advance past the Aug. 7 top-two primary to face the likely Republican standard-bearer in November: former state senator Dino Rossi, Reichert’s endorsed successor, who has raised more than $2 million and faces little-known GOP challengers.

“Doesn’t get to choose”

A Sammamish resident, Schrier has worked for 16 years at a Virginia Mason clinic.

As a first-time candidate, that medical background has been central to Schrier’s campaign. She launched her congressional bid last year over deep objections to the controversial Republican health care overhaul.

So what about Rittereiser’s charge that Schrier turns away poor children?

In a nutshell: It’s true that Schrier’s practice does not accept all Medicaid plans. But experts say that’s not unusual, and that such decisions are not typically left to individual doctors.

Washington’s Medicaid program, called Apple Health for Kids, places most families in one of five managed-care plans. Schrier’s practice, as part of Virginia Mason, accepts patients from just one of those plans.

At Virginia Mason and other big medical networks, insurance contracts are worked out by systemwide negotiators.

“Dr. Schrier doesn’t get to choose what plans Virginia Mason works with. She doesn’t have that power,” said Sarah Rafton, executive director of the Washington Chapter of the American Academy of Pediatrics.

Preston Cody, assistant director the Washington State Health Care Authority (HCA), said medical practices are “all over the map” when it comes to seeing Medicaid patients: Some accept a few of the managed-care plans, some accept all and some refuse to see anyone on Medicaid.

Many doctors refuse to take Medicaid patients, or take only a limited number, because they don’t get paid enough to treat them.

The problem is acute in areas such as the Olympic Peninsula and southwest Washington, where Medicaid recipients often must drive long distances to find a doctor who will see them.

Some clinics seeing a large number of Medicaid patients have struggled and even closed. “It becomes really a financial crisis to figure out how to keep the doors open,” Rafton said. “We’re starting to see regions of the state have huge access problems.”

Medicaid, the federally and state-funded health-insurance program for low-income families, now covers about half of all children in Washington.

The Virginia Mason system as a whole treated 11,548 Medicaid patients in 2016, the last year for which numbers were available, said Gale Robinette, a Virginia Mason spokesman. That was more than three times the 4,470 Medicaid patients seen in 2012.

About 171,000 children were enrolled in Medicaid in King County as of December, according to HCA data.

Robinette said Virginia Mason’s Medicaid numbers may be lower than other medical centers because its Seattle hospital does not offer obstetrics, inpatient or specialty pediatric care, and does not have beds designed for psychiatric patients.

UnitedHealthcare, the Medicaid managed-care plan with which Virginia Mason has a contract, is the most widely accepted among King County pediatricians, according to the HCA. But Virginia Mason does not accept Molina Healthcare, which serves the largest number of children relying on Medicaid in the county.

A Schrier campaign spokeswoman said she could not provide specific numbers on the percentage or number of Medicaid patients the doctor has treated.

Katie Rodihan, the spokeswoman, said Rittereiser’s criticism is misleading at best. She said Schrier has worked with low-income families to ensure they can receive care, including donating time to patients facing financial difficulties.

“Values test”

Rodihan said Rittereiser’s arguments could be turned against his legal work, too.

“You could ask the same thing of why is he not a public defender if he wants to fight for the little guy in the legal system,” she said, noting that Schrier has built her practice in Issaquah while Rittereiser has been working as a lawyer in Seattle.

Rittereiser grew up in Ellensburg and has made his rural roots a big part of the argument for why he can beat Rossi. After graduating from law school, he worked for the King County prosecutor’s office from 2011 to 2014, before joining the Seattle office of a private law firm that represents workers in lawsuits against employers.

Rittereiser said he has “focused on living the career of my values,” including providing free legal representation for victims of child sexual abuse. “I think it’s a values test, because I have spent my career fighting for working people,” he said.

The 8th District runs from eastern King and Pierce counties across the Cascades to Chelan and Kittitas counties. It has always been represented by Republicans in the U.S. House, but Reichert’s retirement has turned it into a key pickup possibility for Democrats, who need to flip 23 seats to take a House majority.

The infighting among Democrats has drawn interest from Republicans, with a Rossi campaign spokesman contacting a reporter last week to seek a copy of the Rittereiser news release attacking Schrier.

Asked whether Democrats fear the feuding could hurt the party’s chances of winning in November, state Democratic Party spokeswoman Ansley Lacitis answered with a statement accusing Rossi of having a “track record of opposing health care for vulnerable, populations, especially for children” and saying a Rossi victory would be “the absolute worst possible outcome.”