NASHVILLE, Tenn. (AP) — With less than three weeks to go before the Tennessee primary election, the top Republican candidates vying for the state's open Senate seat have notably stepped up their attacks against each other.

Bill Hagerty, a former U.S. Ambassador to Japan, released a new television ad Tuesday accusing trauma surgeon Manny Sethi of being “too liberal” for Tennessee. The ad follows Sethi's constant bashing that Hagerty is a Washington establishment candidate.

The back and forth between the two Republicans comes as early voting has opened for the Aug. 6 primary. The two are hoping to replace outgoing GOP Sen. Lamar Alexander, who is retiring from the position at the end of his term. Here is a look at the latest attacks in the race:

___

In Hagerty's television ad released Tuesday, a narrator claims “Trump conservatives can’t trust Manny Sethi" and argues Sethi once defended “Obamacare" by showing footage of Sethi giving a health care presentation in 2012 to high school students.

“Some people call this Obamacare, don’t say that in public circles because that’s a very political statement - Obamacare. It’s the Patient Protection and Affordable Care Act,” Sethi is seen explaining to the students in the ad.

Full footage of the presentation shows that Sethi later said a person's preference on health care reform comes down to their individual beliefs — which was not included in the Hagerty ad.

“If you believe that government is the answer to problems and it’s not a bad thing, then you know, that will work. If you believe that the private sector, meaning non-government, the individual, can solve this, then you know, you probably will think that it won’t work. It just depends,” Sethi says.

Sethi's campaign said he was asked to be nonpartisan in the speech. His team then tweeted a video of Sethi at a campaign event supporting the repeal of the Affordable Care Act — President Barack Obama's signature health care law commonly called Obamacare — as well as endorsing a “free market based system” for health care.

The Hagerty ad also criticizes Sethi serving on the board of the Massachusetts Medical Society, which the ad claims is “an organization that supported Obamacare." The ad fails to mention that the Massachusetts Medical Society supported the Affordable Care Act after Sethi had left the organization.

Dubbing him “Massachusetts Manny,” the Hagerty ad finally says Sethi “applied for a job in Barack Obama’s White House.”

Sethi did apply for a prestigious, nonpartisan White House fellowship under Obama. Meanwhile, Hagerty was actually a White House fellow under George H.W. Bush's administration.

___

Late last week, Sethi's team released an ad accusing Hagerty of being the political “establishment.”

“Folks are finding out Bill Hagerty is endorsed by Mitt Romney, donated to Al Gore, made millions off Common Core, tried to get Tennessee to do trade deals with China,” Sethi says in the ad.

Romney has not publicly endorsed Hagerty since the former ambassador joined the race, but Romney had previously supported the idea, according to the Wall Street Journal in mid-2019 before Hagerty had jumped in the race. He donated to Romney's 2008 and 2012 presidential bids.

Hagerty has since distanced himself from Romney. The Utah senator refused to support Trump during the impeachment trial, making him the only GOP senator to support removing Trump from office.

“(When) I see Republicans, like Mitt Romney, fall prey to this discussion, Mitt is flat wrong,” Hagerty said during a talk radio in late 2019.

Hagerty's team has further argued the Republican supported Romney in the 2012 election in order to defeat Obama, a Democrat.

“Of course, Bill worked to defeat Barack Obama in 2012, unlike Massachusetts Manny Sethi who applied to be in the Obama Biden White House," said Abigail Sigler, Hagerty's campaign spokeswoman.

Federal campaign finance records do show Hagerty donated $1,000 to Gore 2000 Inc. in December 1999. Gore is from Tennessee. However, Hagerty also donated $1,000 to the Bush-Cheney Compliance Committee nearly a year later, as well as $1,000 to the Republican National Committee.

Sethi's ad did not give specifics about Hagerty's involvement in trade deals with China or his involvement with Common Core. But on the campaign trail, Hagerty has said he has “no regard for Common Core whatsoever."

Yet as a former commissioner for Tennessee's Economic and Community Development agency, Hagerty participated in a trade mission to China in 2012 with former GOP Gov. Bill Haslam. Such trips are typical for state officials hoping to pursue more export options for businesses.