By Ron Rocky Coloma
Guam’s gubernatorial candidates have raised concerns about the current administration entering into contracts for the proposed new hospital as it approaches its final months.
Sen. Therese Terlaje, the Democratic Party's candidate, said any agreement entered into by the Leon Guerrero administration could limit the succeeding government's flexibility to modify the project.
Sen. Tony Ada, the Republican candidate, agreed. “Perhaps that should be something that should be left for the incoming administration to deal with,” he said.
Gov. Lou Leon Guerrero, whose term ends in January, is proposing to build a new medical campus in Mangilao, using the remaining balance from the American Rescue Plan Act funds.
What she hoped would be her legacy project, however, was stalled by legal questions about the project location, the process employed to acquire the target properties and the use of federal grants.
In May, the Supreme Court ruled in favor of Leon Guerrero, paving the way for the project to proceed.
Guam's next governor will inherit the responsibility to build a new medical facility to replace the aging Guam Memorial Hospital.
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At Thursday’s debate hosted by the Guam Medical Association, Terlaje and Ada agreed that Guam needs to build a new hospital, but they differed over how they would handle decisions made by the outgoing administration.
While agreeing that construction must proceed, neither Ada nor Terlaje committed unconditionally to the current administration's chosen site.
The medical community maintains that the new hospital must be built at Oka Point, the site of the old hospital in Tamuning, where most doctors' clinics are located.
In 2024, the legislature overrode the governor's veto of a bill designating Oka Point as the site of the new hospital.
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In 2025, the Guam Land Use Commission approved rezoning the Mangilao property for public facility use.
At the GMA debate, Ada said he would continue the project if the outgoing administration had advanced permitting and design work, regardless of the location.
If no site had been finalized, he would explore other available locations and the findings of the Matrix study evaluating potential hospital sites.
Terlaje said her administration would examine existing agreements before determining the quickest and most affordable way to proceed. She pointed to legislative action supporting a new hospital and financing for the project.
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Besides the long-stalled hospital project, the GMA debate held at the Hyatt Regency Guam also tackled the shortage of physicians, limited insurance coverage and beds for patients.
Hospital oversight emerged as another major concern. Terlaje called for stronger financial transparency and continuous compliance with accreditation requirements, particularly federal certification standards tied to Medicare and Medicaid.
Ada proposed greater accountability for hospital administrators and board members, along with broader use of performance-based budgeting to track government spending.
Edward John Calvo, Ada's running mate, said their administration would focus on hospital accreditation, healthcare leadership and greater coordination with private providers.
The debate also highlighted an immediate capacity problem that cannot be solved simply by constructing another building.
Terlaje pointed to a newly renovated assisted living facility with 30 rooms that she said was awaiting a Medicaid waiver before it could accommodate patients leaving hospitals. She also proposed opening shelters to their full available capacity.
Ada called for better staffing and funding at transitional facilities, while Calvo proposed assessing the island's homeless population during the administration's first 100 days and expanding behavioral health and addiction treatment.
The candidates also confronted the shortage of physicians and nurses, including complaints that government facilities can offer compensation packages private practices cannot match.
A central disagreement involved internationally trained physicians. Current legislation permits a program in public facilities, while private clinics have sought access to the same recruitment pathway.
Sen. Sabina Perez, Terlaje's running mate, said the public-sector program was intended as an initial phase, with private clinics to be included after regulations and safeguards were established.
Debate organizer Dr. Thomas Shieh pressed the candidates on the effects of the current restriction, arguing that private practices face the same specialist shortages as government facilities.
On Medicaid, both gubernatorial candidates emphasized prompt payments to providers, who may otherwise be reluctant to accept patients covered by the program.
Terlaje also proposed improving reimbursement, expanding coverage and recruiting physicians through scholarships, loan repayment programs and better working conditions.
Ada called for the removal of federal Medicaid funding limits and for ensuring vendors are paid consistently.
Insurance for working families presented another challenge.
Asked whether employers should be required to provide health coverage, both candidates emphasized incentives to encourage businesses to insure employees rather than committing to an immediate universal mandate.
Terlaje discussed possible subsidies and expanded Medicaid eligibility. Ada said his own company provides full medical coverage and argued that uninsured workers ultimately impose costs on the government and hospitals.
Maternal care received particular attention as candidates discussed limited prenatal services, physician availability and the needs of pregnant women.
Terlaje called for expanding community health centers and improving prenatal access. She also cited planned upgrades to Guam Memorial Hospital's labor and delivery facilities and neonatal intensive care services.
Perez advocated greater access to healthy food and preventive care, while Calvo emphasized developing the local healthcare workforce through educational partnerships.
On abortion policy, Ada and Terlaje both said they would follow existing law.
Terlaje said changing abortion restrictions was not among her priorities, instead emphasizing prenatal care and support for pregnant women.
The candidates also addressed off-island medical treatment, which remains necessary for residents with conditions requiring specialists unavailable locally.
Ada proposed strengthening government medical referral offices that assist patients with transportation and appointments. Terlaje emphasized maximizing insurance benefits, preserving assistance programs and recruiting more specialists to reduce the need for travel.
Both candidates were cautious about proposals to promote casino gambling as a source of healthcare revenue.
Ada opposed introducing casinos without renewed public approval, while Terlaje cited previous voter opposition and said any specific proposal would require careful review.
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