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In the 2020 Democratic primary, lawyer and ten-term incumbent Rep. Stephen Lynch defeated progressive challenger Dr. Robbie Goldstein, a medical doctor with expertise in infectious diseases and transgender healthcare. Several weeks before the primary, the Boston Globe noted the "stark contrast" between the candidates on several key issues, particularly healthcare and police reform. Goldstein, a proponent of Medicare for All, ran on a platform of expanding healthcare access during a campaign overshadowed by the COVID-19 pandemic. Lynch, who remains one of only three Democrats in the House who voted against the Affordable Care Act in 2009, advocates reforming the current market-based healthcare system. In the context of nationwide protests against police brutality and killing of unarmed black citizens, Lynch has stated support for efforts to modify qualified immunity for police officers, while Goldstein advocates ending qualified immunity outright.

Goldstein's campaign also highlighted differences between the two candidates on LGBTQ issues and reproductive rights. In the past, Lynch has identified as pro-life, a position he now deems too extreme.

Lynch has been positioned by several Democratic primary challengers over the years as being too moderate to serve the more liberal electorate of Massachusetts. According to the Boston Globe, Lynch responded to those critics in 2010: “Calling me the least liberal member from Massachusetts is like calling me the slowest Kenyan in the Boston Marathon. It’s all relative.’’