HILO, Hawai'i — The last Neighbor Island seat at the Legislature now held by a Republican will shift to Democratic control this year.

Longtime lawmaker Virginia Isbell and state House Health Committee Chairman Josh Green are facing each other in a primary race for the Senate district, which includes Kohala and Kona.

The District 3 Senate seat is now held by Republican Paul Whalen, but Green announced his plans to run for the seat more than a year ago. By the beginning of this year, Green had raised more than $100,000 for the contest, a feat that may have scared off much of his potential competition.

Whalen did not seek re-election, no other Republican filed to run in the district, and only Isbell filed to challenge Green as a Democrat. Isbell said she decided to run because she believed Green was taking credit for accomplishments when the credit ought to go to others.

"I jumped in kind of late because I started looking at his ads, and he was saying he did everything, he was everything to everybody, and I thought, 'That's impossible,' " said Isbell, a veteran of 16 years in the state House and two years on the Big Island County Council.

Isbell, 76, also criticizes what she calls a "conflict of interest" between Green's work as a contract physician at state-run Big Island hospitals, and his responsibilities as the House Health Committee chairman.

The health committee oversees the Hawai'i Health Systems Corp., the struggling quasi-public entity that operates the network of 12 state hospitals, long-term-care facilities and rural health centers, including the Kohala and Ka'u hospitals where Green works.

"The question has to be, are you a doctor or are you a legislator? You cannot be both," Isbell said. "That's what I'm saying is wrong."

HHSC officials say they are facing a $62 million deficit for the fiscal year that began July 1, and are expected to seek an infusion of state cash from the Legislature next year to avoid closing facilities or imposing additional layoffs. Kona Community Hospital already has laid off 55 workers.

Green said he confirmed with the state attorney general's office that his work as a doctor presents no conflict. He subcontracts on an hourly basis as an emergency room doctor in Kohala, and is paid by another doctor who has a contract with HHSC. When Green works at Ka'u, he is paid directly by HHSC on an hourly basis, he said.

"Everyone knows we need physicians, and it's been an honor to be the only physician in the Legislature, and because I'm educated on this issue, they made me health chair," Green said. "I've done a very good job making sure every child has health insurance, and we have doctors coming to the Neighbor Islands, so I think any criticism of those kinds of results is very misguided.

"The issue is who is going to fight for Kona, and who has expertise on issues like healthcare, not who can smear somebody," said Green, who is completing his second two-year term in the state House. Green said he has been able to haul in about $200 million for projects and programs in his Kona House district.

Isbell is focusing on transportation, citing the need for more mauka-to-makai connector roads including a connection between the Kealakehe Parkway and Mamalahoa Highway.

She also stresses the need for alternative energy, and advocates the use of geothermal, energy from ocean currents or waves, or other renewable sources to produce hydrogen for fuel. She also supports tax incentives to encourage production of biofuels, including fuel made from macadamia nuts.

Isbell also advocates boosting agriculture, incorporating agriculture back into the schools and encouraging people to plant backyard gardens to make Hawai'i more self-sufficient to guard against interruptions in the flow of goods from out of state.

She said she is familiar and comfortable with many state senators at the Capitol because Isbell worked with them while in the House, and said she will work well with them in the Senate. As chairwoman of the House housing committee in the early 1990s, Isbell led the push for public votes for decision-making in House committees, a practice that was later adopted by the Senate as well.

Green has focused on healthcare issues, and in particular what he calls the low reimbursements paid to doctors and hospitals by Hawaii Medical Service Association. HMSA has more than 700,000 members, or about two-thirds of Hawai'i's healthcare insurance market.

Those low reimbursement payments are to blame for the ailing finances of many Hawai'i hospitals, including the state's HHSC chain of hospitals, and for the decision by many doctors to leave the state, he said. Taxpayers are being forced to bail out the HHSC state hospitals year after year because insurance reimbursement payments to the hospitals from HMSA are too low, he said.

Green wants to require that HMSA and all private insurance plans increase their reimbursement payments to 135 percent of the federal Medicare fee schedule, and increase state and federally funded Medicaid payments to doctors and hospitals to 100 percent of the Medicare fee schedule.

The bill Green plans to introduce if he is elected to the Senate would strip HMSA of its nonprofit status if the insurer does not adjust its fee schedule.

"The healthcare crisis has to be dealt with firmly," he said.

A similar proposal was considered in the state House last year, and HMSA warned that increasing the payments it must make to healthcare providers would put pressure on it to raise the insurance premiums it charges to Hawai'i employers.

Green counters that HMSA "artificially keeps premiums low, and then refuses to negotiate with the hospitals, so the hospitals are underfunded. The crisis is perpetuating itself because reimbursements haven't gone up, and instead of putting Band-Aids on it, it's time for a solution."

He contends HMSA can reduce its administrative costs or spend down some of its reserves to offset the cost of the higher fees paid to doctors and hospitals.

To boost state and federally funded Medicaid payments to doctors, Green said the state should tap the money collected under the tobacco tax along with money being collected under a class-action lawsuit settlement with the tobacco companies.