Health care may lack the novelty of artificial intelligence, data centers, or surveillance cameras as a campaign issue, but soaring costs and collapsing services are giving voters little choice but to pay attention. Medicaid faces $1 trillion in cuts, Obamacare tax credits have expired, insurance premiums are climbing, and hospitals are struggling.

Republicans delayed the Medicaid cuts until after the election, but health systems must prepare months in advance. Hospitals are already cutting services or closing, while the effects of reduced Obamacare subsidies have been unfolding for close to a year.

That turmoil has created an opening in South Carolina, where Dr. Annie Andrews is mounting a competitive campaign for the U.S. Senate. Andrews, a pediatrician and mother of three, is challenging Sen. Darline Graham for a seat Democrats have not held since Strom Thurmond switched parties more than 60 years ago.

National prognosticators have reduced Graham’s advantage, while multiple pollsters, including Republican pollsters, have described the contest as a tossup. Donald Trump has attacked Andrews with anti transgender slurs, and the Senate Leadership Fund is spending $5 million in South Carolina to protect Graham.

Democratic groups are also investing in the race and attacking Graham for “kick[ing] millions of Americans off their health care, including families with seniors and children.” Andrews has spent more than $6 million on television advertising, much of it centered on health care.

Andrews campaigns on her experience treating children whose families had to choose between medical care and rent. She describes a broken system where doctors confront red tape instead of caring for patients, and she argues that health care is a right rather than a privilege.

Her platform supports a public insurance option without embracing Medicare for All. It also calls for reversing Medicaid cuts, restoring enhanced Obamacare tax credits, expanding Medicaid in South Carolina, and increasing Medicare negotiations over prescription drug prices.

The proposal becomes more aggressive when it addresses insurance company power. Current medical loss ratio rules require insurers to spend 80 to 85% of premium revenue on medical care, but Andrews argues that rising premiums can still produce larger profits and wants the ratio based on profit per enrollee.

Vertical integration offers insurers another path around those rules. UnitedHealth, the country’s largest employer of doctors, has been accused through evidence cited in the source of providing higher reimbursements to its own physicians, effectively shifting money between different parts of the same corporation.

Andrews stops short of seeking structural separation between insurers and doctors, but she supports banning private equity firms from owning hospitals. Her plan would also prevent arrangements that place ownership on paper with doctors who lack formal control.

She proposes stronger oversight of hospital mergers and action against UnitedHealth and other companies that game Medicare Advantage through upcoding. The practice costs the government $76 billion annually in overpayments, according to the platform’s account.

Andrews also wants to end prior authorization for routine and emergency treatment, saying it has “become an impediment that can delay, or even block, necessary care.” Her platform does not fully define routine treatment, but its target is unmistakably the insurance bureaucracy standing between patients and care.

On prescription drugs, Andrews seeks to prohibit “pay for delay” payments that pharmaceutical companies make to generic manufacturers to suppress competition. She also supports stronger regulation of pharmacy benefit managers and wants insurance plans to follow new Medicare rules barring them from “steering patients to higher cost drugs.”

Her sharpest proposal calls for criminal accountability for opioid company executives. The platform declares, “We send drug dealers to prison—unless those drug dealers are billionaire opioid company executives that misled the public about the dangers and addiction risks of their products for profit. We should pass legislation to create criminal liability for the wealthy executives who caused the opioid crisis.”

Other proposals include capping personal insulin costs in private insurance, requiring human customer service agents, demanding hospital price transparency, and setting price caps for the most expensive procedures. Andrews also supports site neutral payments, restrictions on surprise ambulance bills, and a ban on artificial intelligence making Medicare treatment decisions.

The platform includes separate sections addressing rural hospitals and veterans care, with proposals to attract doctors, improve reimbursements, and oppose funding cuts. Andrews has promoted the agenda at campaign events rather than leaving it to gather dust as another forgotten policy document.

“Too many families across South Carolina are running into a health care system that is expensive, difficult to navigate, and puts bureaucracy ahead of patient care,” Andrews said at the campaign tour’s first stop. Fresh Start PAC has likewise placed health care at the center of a $2.5 million campaign supporting her.

Andrews still faces a difficult path to victory in November, even with two minor party candidates from the right on the ballot. Her strategy is to align patients and doctors against concentrated corporate power, turning health care costs into a direct test for Graham and Republicans.