The divergent health-care visions of Maryland Gov. Larry Hogan (R) and Democratic gubernatorial candidate Ben Jealous are reflected in health-related campaign contributions made to the rival campaigns.

Jealous, former president of the NAACP, surged to victory in a crowded Democratic primary field in June with a platform that includes a vision for “Medicare for All” favored by progressive candidates this year in primary races across the country. Jealous’ campaign charges that his health-care plan would give coverage to more than 300,000 Marylanders who lack health insurance today.

The Democratic nominee may find a sympathetic constituency: Fifty-four percent of Maryland respondents to a Goucher poll released this week say they support Medicare for All. One-third of respondents were against the proposal.

Hogan, enjoying high approval numbers in a state where a mere 31 percent of voters identify as Republican, has taken issue with the Trump administration’s myriad efforts to undermine the Affordable Care Act (ACA), while supporting continued funding for the Children’s Health Insurance Program—a longstanding target of congressional Republicans’ economic austerity program. Hogan opposes Medicare for All, dismissing the plan as a drain on taxpayer dollars.

The candidates’ stances have drawn support from very different corners of the health-care sector: While Hogan gets support from the health-care industry, Jealous is backed by unions representing the workers providing care in hospitals.

Hogan has received campaign donations of $14,400 from the Maryland Hospital Association and $15,396 from the Health Facilities Association of Maryland; health care-related contributions account for around $532,000 of the $17 million the governor has taken in his re-election bid. Republican support from the Maryland Hospital Association is something of a rarity: the association has given around $188,000 to Democratic candidates and $58,000 to GOP candidates over the past decade. But no Maryland Democratic gubernatorial candidate has ever run on Medicare For All before 2018.

Jealous, meanwhile, has received more than $31,000 in health care-related contributions, and $16,000 from labor unions representing health-care workers. Labor has rallied around Jealous’ gubernatorial run: He has received nearly $100,000 in contributions from all sectors of labor unions. At $3.6 million raised this cycle, Jealous’ campaign has a fraction of the money Hogan has.

Pat Lippold, a spokesperson for 1199 SEIU United Health Care Workers, a labor union that has given $10,000 to the Jealous campaign, said health-care industry executives are backing Hogan’s re-election bid because “hospital and nursing home CEOs have an interest in making a lot of money—for themselves and a handful of top executives. They also do not want to assume any financial risks. The current health care system allows them to do that.”

“They view health care as a business,” Lippold said in an email. “Larry Hogan wants to protect big business.”

Critics of Hogan’s stance on health care point to his refusal to sign a 2017 Democratic bill aiming to lower the price of off-patent prescription medication in Maryland. The bill became law without Hogan’s signature, though the governor raised issues with the constitutionality of lowering prescription costs, calling the bill’s language “vague.”

Maryland is in a unique position to implement Medicare for All, according to a health-care plan published by the Jealous campaign. A federal government waiver in place for 41 years, known as “all-payer,” allows everyone in Maryland—no matter their health insurance—to pay the same rate at state hospitals. Maryland hospitals operate under what’s known as a “global payment” system in which hospitals are reimbursed for meeting health outcomes, and not for every service the hospital provides. The “all-payer” model, according to the Jealous campaign, would offer an easier transition to a universal health-care system, as the model could be expanded to every facet of health care in the state of 6 million people.

Advocates for Medicare for All and backers of Jealous’ platform said the state’s uninsured rate of 6 percent—the seventh lowest among states—shouldn’t preclude Maryland lawmakers from breaking the health-care status quo.

“There’s no excuse for the richest country on the face of the earth to have uninsured people,” Ken Zinn, political director for National Nurses United, which contributed $6,000 to the Jealous campaign, told Rewire.News. “The way to do that is through Ben’s proposal …. The for-profit insurance industry [is] a parasite on the system, and yes, there will be people who oppose [Medicare for All] because they’re doing the bidding of the health insurance industry.”

Maryland nursing homes have given more than $83,000 to the governor’s 2018 campaign.

The Maryland Hospital Association was among the health-care industry organizations to sponsor the governor’s inaugural gala in January 2015, according to the Baltimore Sun. CareFirst Blue Cross Blue Shield, United Healthcare, NMS Healthcare, and MedStar Health, which has given $21,738 to Hogan’s 2018 campaign, also contributed money to Hogan’s 2015 gala.

“Maryland’s hospitals strongly support the notion that all of our state’s residents deserve access to excellent health care,” David Simon, vice president of communications for the Maryland Hospital Association, told Rewire.News. “Broad-based insurance coverage is one of the factors in good access.”

Simon said the state’s “hospitals are continuing to work to reduce health care costs through more efficient, higher-quality care” through the Maryland Health Insurance Coverage Protection Commission, a body created by state legislators to track and respond to GOP attacks on the ACA, also known as Obamacare.

The ACA, while halving Maryland’s uninsured rate, has left many in the state underinsured, health-care union officials told Rewire.News. Maryland is hardly unique: About one in four adults in the United States with health insurance are considered underinsured, meaning they won’t access health-care service barring emergency because of cost barriers, according to a Commonwealth Fund study. The report defined underinsured people as having a deductible equal to at least 5 percent of household income or when out-of-pocket costs, excluding health-care premiums, account for 10 percent or more of household income.

Sky-high health-care deductibles mean many in Maryland have health care in name only.

“There are a massive number of people who are not getting the care they need. We see patients who have delayed care, who came in too late, who have complications from those delays,” Zinn said. “They cut their pills in half to make them go longer  …. They have to make a choice between taking their meds and buying their kids clothes or paying rent. That’s not a civilized way to live.”

The Trump administration’s mission to undermine gains made under the ACA won’t stop any time soon, Lippold said, making it imperative for governors and state-level legislators to fight the administration’s efforts to erode health-care access. Trump’s Department of Health and Human Services has gone as far as launching a social media campaign against the ACA—a move blasted by congressional Democrats.

“Without any action on the state level, we will see more and more people become uninsured and those who are insured will be paying more and getting less,” Lippold said. “Our goal isn’t 6 percent uninsured—we want zero.”

Jealous supporters acknowledge that a victory in November would only be the first of many steps in bringing a Medicare for All system to Maryland. The proposal would have to clear the Democratic-held legislature—which saw state Sen. Paul Pinsky (D) introduce a universal health-care bill this year—before securing a waiver from the federal government. Zinn said getting a waiver from the Trump administration would prove difficult since the administration “is hostile to quality [health care] and human beings.”

“We would expect them to push back” on a Medicare for All proposal, Zinn said.