LAS VEGAS — Democrat Kate Marshall is not letting up when it comes to Republican rival Mark Amodei's Medicare record.

Marshall released a new TV ad Tuesday that continued to link Amodei to a Republican plan to overhaul Medicare weeks after he distanced himself from the measure. The spot comes as northern Nevadans are casting early ballots in the Sept. 13 election. Marshall, the state treasurer, and Amodei, a former state senator, are competing to fill a House seat left empty when Republican Dean Heller was appointed to the Senate in May.

In Marshall's latest ad, a narrator states that Amodei once called Republican Rep. Paul Ryan's Medicare overhaul "excellent." The ad also states that Amodei voted for the largest tax increase in Nevada history. Marshall has made both topics a central focus of her campaign, claiming Amodei has changed his positions to secure votes.

"Only a mother could defend what lobbyist-politician Mark Amodei has done: Supporting an end to Medicare to give tax breaks to millionaires," the narrator states in the ad, a reference to Amodei's television spots that feature his mother responding to Marshall's previous attacks.

Amodei initially said he supported Ryan's budget but later said it would hurt rural doctors. He also has signed an anti-tax pledge. Amodei's campaign spokesman, Peter DeMarco, accused Marshall in a statement of "regurgitating talking points that make you look like you have no idea what you're saying."

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The new ad comes days after early voting began on Saturday. State election reports suggest Marshall is not benefiting from the Democratic party's unrivaled turnout machine in Nevada. Overall, Republicans have a registration edge in the largely rural district, with nearly 172,000 voters compared to 140,133 registered Democrats.

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