UPDATE, September 11, 2:55 p.m.: Republican Dan Bishop won the September 10 special election to represent North Carolina’s 9th Congressional District, beating Democrat Dan McCready.

Access to health care is poised to be a critical factor in North Carolina’s looming 9th Congressional District special election. The race, which features a GOP lawmaker notorious for sponsoring a virulently anti-LGBTQ “bathroom bill,” may showcase what issues matter to voters in the district ahead of the 2020 elections.

A new election was ordered in February after an investigation found that a political operative hired by Republican candidate Mark Harris’ campaign coordinated an illegal absentee-ballot collecting scheme. Democrat Dan McCready lost to Harris by just under 1,000 votes in that November 2018 race. The political operative has since been indicted on charges of obstruction of justice and possessing absentee ballots, and Harris announced he would not run in the new election due to health concerns.

McCready will instead face Republican state Sen. Dan Bishop, who received national criticism in 2016 for sponsoring North Carolina’s HB 2, one of many bathroom discrimination bills banning transgender people from using the bathrooms that match their gender identity.

North Carolina’s law also banned local municipalities from passing nondiscrimination ordinances to protect LGBTQ rights. The law led to widespread boycotts from major businesses, most notably PayPal and the NCAA. Though HB 2 was repealed in March 2017, the Associated Press estimated that it would cost the state $3.76 billion in lost business over the next 12 years.

While Bishop’s connection to HB 2 will likely be a deciding factor for some voters, access to health care is at the center of the September election.

Already, Bishop has focused some of his campaign on health care and his opposition to the Affordable Care Act, while McCready toured rural areas in what he called the “Affordable Healthcare Tour,” according to the Charlotte Observer. It’s an issue of critical importance in a state that has not expanded Medicaid, a program that helps people with lower incomes access health care.

McCready, who on Tuesday formally outlined his health-care platform, supports expanding Medicaid in North Carolina and stopping health insurance companies from raising premiums. He also has a comprehensive plan to lower the cost of prescription drugs. Bishop opposes Medicaid expansion and the Affordable Care Act, though he supports coverage for pre-existing conditions and the provision that allows young adults to be on their parents’ plans until they turn 26, according to the Observer.

Though the NC-09 representative won’t be able to work directly to enact Medicaid expansion in the state from Congress, McCready’s and Bishop’s views likely matter to North Carolinians. A 2017 survey by Public Policy Polling found that 63 percent of North Carolina voters support expanding Medicaid while 25 percent oppose it.

LGBTQ advocacy organization Equality NC has endorsed McCready, who called Bishop’s sponsorship of HB 2 “exactly the wrong kind of leadership.”But in addition to his overt support for LGBTQ rights, McCready’s health-care stance has important implications for LGBTQ North Carolinians, said Ames Simmons, policy director for Equality NC.

“LGBTQ adults are twice as likely to be uninsured due to factors like employment discrimination,” Simmons told Rewire.News in an email. “LGBTQ people need expanded Medicaid to cope with health disparities like depression, asthma, eating disorders.”

Bishop’s views on abortion are extreme, pro-choice advocates say. He is endorsed by National Right to Life, which stated in its endorsement that Bishop supported the “Pain-Capable Unborn Child Protection Act,” a federal bill that would have banned abortion at 20 weeks based on the false claim that a fetus can feel pain at that point in a pregnancy.

Bishop told the Charlotte Observer in May that he supports a law similar to Alabama’s total ban on abortions, but perhaps with exceptions for incest and rape. He has compared Roe v. Wade to the 1857 Dred Scott decision, when the U.S. Supreme Court decided that Black people could not be citizens—a decision considered by scholars to be the Court’s worst decision in history.

As a state senator, Bishop co-sponsored the failed “Born Alive Abortion Survivors Protection Act,” which would have required doctors to provide medical care to infants who “survived” abortions—though there is no evidence to support the idea that happens. Bishop did not respond to Rewire.News’ requests for comment.

“The majority of people in North Carolina do support access to safe and legal abortion,” Tara Romano, executive director of NARAL Pro-Choice North Carolina, told Rewire.News. Bishop not only doesn’t support that access, he has “pretty extreme views,” she said.

McCready, meanwhile, has said he supports Roe v. Wade. Though Rewire.News was unable to reach McCready, his website states, “Dan supports a woman’s right to choose because he does not believe it’s the government’s job to get between a woman and her doctor.

McCready told the Observer, however, that he would support some restrictions on abortion. “I’m opposed to partial-birth abortion. Broadly speaking, I’m a father of four. I’m a person of faith,” he said. “The thought of any abortion is tragic to me. But I do not think it’s the government’s job to get between a woman and her doctor.” While McCready’s statement was in support of the right to abortion, he used an anti-choice term, “partial-birth abortion,” that has no basis in medical reality.

The stakes might seem lower for an election where even if Bishop won, he would be sent to a Democrat-controlled House, but Romano said all elections “have consequences that you don’t necessarily foresee … in the long run.”

She noted that the 2018 midterms helped bring more pro-choice lawmakers to the House, and that “we’ve seen the differences that has made in terms of what they’ve been able to pass at the House.” For example, in late June the House passed a spending bill that would repeal the global “gag rule,” which prevents international organizations that offer or provide information about abortion from receiving U.S. foreign aid.

Romano said 9th District voters shouldn’t sit this one out, because the pro-choice majority in the House “is not going to continue forever if we don’t make sure to hold onto it.”

NC-09 is considered a Republican-leaning district by the Cook Partisan Voter Index, but it’s hard to tell how much of that is due to Republican gerrymandering in the state. The special election, scheduled for September 10, is rated as a “toss-up” and recent polling found the candidates to be tied.