The messages in the phone calls and mail pieces targeting voters in one of the Sacramento region's most competitive congressional races vary, but the subject is the same: the future of Medicare.
The national debate over the federal health care program for seniors is expected to be a top issue in elections across the country. The efforts already are fierce in the 7th Congressional District, a high-stakes rematch between Rep. Dan Lungren, R-Gold River, and Elk Grove Democrat Ami Bera.
The issue is fueling attacks and efforts to shore up support from outside groups looking to influence voters in the east Sacramento County swing district.
"Even if Dan Lungren and Ami Bera made a mutual pledge not to utter the word Medicare it would still be a major issue in the campaign," said Dan Schnur, a former GOP strategist who serves as director of University of Southern California's Jesse M. Unruh Institute of Politics.
Congressional Democrats, who are targeting the seat in their effort to win back the majority in the House of Representatives, pounced on changes to Medicare outlined in the budget proposal released by House Budget Chairman Paul Ryan, R-Wis., last week.
The latest offensive, a round of robocalls targeting swing voters, slams Lungren for his support of the budget resolution, which would make major private health insurance plans an option for future seniors. It also cuts spending and lowers top tax rates for individuals and corporations.
Voters on the line are told the Republican budget "chooses millionaires over Medicare."
"We all agree Washington needs to cut spending, but it should be done the right way, not on the backs of seniors," the narrator says.
A group called American Action Network is out with its own mailer saying the Gold River Republican "is working to ensure that Medicare is preserved and protected for today's beneficiaries and for generations to come." Earlier this year, a mailer by a group called Retire Safe praised Lungren's record on prescription drug benefits under Medicare.
The focus isn't surprising given the demographics of the electorate. Californians over 55 make up 42 percent of the state's likely voters, according to the nonpartisan Public Policy Institute of California.
PPIC Executive Director Mark Baldassare says that fact leads many candidates to "tailor a message that will impact how older voters think about themselves as well as how they think about their opponents."
Baldassare's polling has shown resistance among California voters to changing Medicare, even if helps the country's fiscal problems.
"Medicare and Social Security are areas that people really want to protect," he said. "Not just the older voters, but voters in general feel that those are the entitlement programs that tend to get the greatest support from voters."
That's the case for Republican Barbara Burroughs, an undecided voter in Citrus Heights. While she thinks there is too much waste and spending in the federal budget, Burroughs wants lawmakers to target things other than Medicare for cuts.
"Being that I'm 62 and my husband's 66, of course we don't want Medicare to go away," she said. "We wouldn't want any changes that would limit what we would already be entitled to or take away from that."
Democrats are looking to capitalize on the feelings of voters like Burroughs with their messaging. They believe the approach resonates with voters, pointing to a 2011 special election for a New York congressional seat.
Attacks tying the Republican candidate to a similar Ryan proposal approved by House Republicans helped a Democratic candidate win in that GOP-leaning district.
But Lungren's supporters argue his record on issues important to seniors is strong. They also say changes to Medicare under the federal health care overhaul backed by President Barack Obama will hurt Bera, who said in 2010 he would be a "reluctant" vote for the legislation. Bera criticizes aspects of the health care law, but stops short of supporting a repeal.
"He wears that cut to current beneficiaries," Lungren consultant Rob Stutzman said, referring to more than $500 billion in reductions to future growth of the program included in the Affordable Care Act. "There's not enough lipstick in the world to put on that pig."
Stutzman says the results of a 2011 special election in Nevada, where Republicans rolled out that line of attack and won, shows their message on Medicare trumps Democrats' arguments against the Ryan budget.
"Republicans have now very successfully won the day on this issue in real campaigns," said Stutzman, who also worked on the Nevada race.
While both campaigns are likely to continue to push the issue, where voters land will likely be heavily influenced by both the presidential campaigns and whether voters find a longtime politician or a doctor more credible on the topic, Schnur said.
"Bera and Lungren will be arguing this out," he said. "But to a large degree, and ironically, their messages are probably going to be heard much less by the voters in this district than what the national campaigns have to say."
Voters in the 7th Congressional District, which stretches from the Galt area to Citrus Heights, aren't the only Californians hearing a lot about the issue.
Democrats are running robocalls with the same message against Rep. Jeff Denham, R-Turlock, in the Central Valley's 10th Congressional District.
Republicans are blasting Democratic Reps. John Garamendi and Jerry McNerney over votes against repealing an independent panel on future Medicare cost as part of the federal health care overhaul, seeking to tie those votes to Democratic candidates running against GOP incumbents. The repeal was tied to provisions changing medical malpractice payout limits, which made support difficult politically for Democrats.
Lungren voted this week to abolish the 15-member Independent Payment Advisory Board, which could mandate cuts to Medicare in the future if costs grow too high. Bera, a doctor and former county health official, said in an interview he would support a repeal, citing concerns about its effect on the ability of doctors and patients to make health care decisions.
Rivals in the 7th Congressional District are trading barbs over the budget proposal introduced by Rep. Paul Ryan, R-Wis. Here's a look at what the plan would do and where the candidates stand on provisions related to Medicare.
THE PLAN: The 2013 budget blueprint introduced by Ryan last week includes an overhaul of Medicare, the government system that provides health care coverage for seniors and people with disabilities.
Under the proposal, future seniors who would otherwise qualify for the current program would receive a stipend to use toward enrolling in the government-run system or a private health insurance plan. Supporters say the changes will increase competition and help control rising costs that could otherwise render the system obsolete. Critics say it compromises the essence of the program and could end up increasing costs for seniors.
Ryan's budget would also make steep reductions to federal spending and lower taxes, capping rates for individuals and corporations at 25 percent. It would also repeal the federal health care legislation approved in 2010.
The House is expected to vote on the plan next week. It will almost certainly face defeat in the Democratic-controlled U.S. Senate.