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While generally remaining more cordial than their counterparts at the top of the ticket have been during debates, the candidates for lieutenant governor of Virginia tried to emphasize their differences during a debate in Arlington Tuesday evening.

Republican candidate E.W. Jackson, a minister who also holds a law degree, took the opportunity to distance himself from his own controversial comments, made in the context of his religious sermons. For example, he has in the past referred to gay people as “perverted” and made headlines this past weekend when he expressed disagreement with Pope Francis, reacting to the Catholic leader’s softer stance on homosexuality.

Citing the state constitution, Jackson said that his religious beliefs would not affect his actions as lieutenant governor.

“I know the difference between what I do there [in church] and what I do here,” he said. “I’m not running to be bishop of Virginia.”

Democrat Ralph Northam, a state senator from the Virginia Beach area, seized on the opportunity to again highlight his opponent’s conservative beliefs, which Democrats have said are out of step with Virginia voters.

“What I do in church carries with me to what I do in everyday life,” Northam said, expressing skepticism that Jackson could separate the two. “Those kinds of statements, whether they are said in church or on the floor of the Senate, they are offensive.”

Northam suggested the state’s focus on social issues migh affect its success in business, arguing that having state leaders express conservative views on social issues and submit legislation on issues like women’s access to abortion makes the state less attractive to businesses looking to relocate.

Jackson countered that there is no evidence of this, saying he has asked the state’s economic development director if these issues come up in talking with businesses.

The candidates outlined starkly different positions on other issues facing the state as well, including health care, mental health treatment and education.

Northam, who is a pediatrician and an instructor at the Eastern Virginia Medical School, strongly supports expanding the state’s Medicaid program using new funding available under the Affordable Care Act. This will add an estimated 400,000 uninsured Virginians to the state’s Medicaid rolls, if the General Assembly approves the expansion.

“In order to address [health care] costs, you have to have coverage,” Northam said, saying that uninsured people using the emergency room and not being able to pay for treatment contributes to increasing health care costs.

“There is a time and place for the emergency room, but it is not where preventative care takes place,” he said.

Jackson opposes the Medicaid expansion and used it as one of several points during the debate to decry government interventions — remarks that drew cheers and applause from his supporters in the auditorium at George Mason University’s Founders Hall.

“I simply don’t think it’s the way to cover our poor citizens,” Jackson said of Medicaid. He said he doesn’t trust the federal government to continue funding the additional Medicaid recipients and that Virginia can’t bear the cost on its own.

Private solutions like free clinics are working well, he said, and can continue to meet the state’s health care needs.

When asked about mental health treatment in the state in the context of recent mass shootings, Jackson said the state should return to the era of institutionalizing mentally ill people.

“I’m not saying that it’s a blanket approach,” he said. But, he added, “I don’t think there is a choice in some cases.”

Moderator Peggy Fox asked Jackson how he would pay for the additional expense, and Jackson said that, like other areas of health care, this should be provided by the private sector and not government.

Northam countered that institutionalizing people with mental illness is not the right answer, and citing the tremendous expense associated with institutions.

“We can do better than that in Virginia,” he said.

Regarding the mass shootings, Northam focused more on gun restrictions than on the mental health aspect. A gun owner himself, Northam said he wants to sit at the table with people from both sides of the aisle and discuss the issue of gun violence.

Jackson opposes additional restrictions on guns.

Regarding education, Jackson is a strong supporter of parental choice.

“How long do you keep people trapped in a system that is not educating their children?” he said. “I think we need to introduce the principle of competition, so that parents have a choice.”

Jackson was vague about how this would affect funding for public schools.

Northam responded that he is supportive of parents having options, but he doesn’t want to see vouchers or similar mechanisms take money out of the state’s public schools.

“Diversity in education is a good thing, choice is a good thing,” Northam said. “Don’t have diversity at the expense of public education. … Public education in Virginia needs to be our crown jewel.”

The role of lieutenant governor will have heightened importance in Virginia for at least the next two years, as the state Senate is evenly split between Republicans and Democrats and the lieutenant governor can serve as a tie-breaking vote.

State elections are Nov. 5.