Italy's Prime Minister Silvio Berlusconi is at risk of losing his stronghold in Milan to the left for the first time in twenty years due to the fragile state of his centre-right coalition. The focus is on key battlegrounds in Milan and Naples as around 6 million Italians are eligible to vote in local elections. Results are expected in the evening after polls close, with the government facing pressure to cut the budget deficit. Defeat in Milan would be a significant setback for Berlusconi, who is already facing challenges from sex scandals, corruption trials, and economic issues. Italy has a high public debt of around 120 percent of gross domestic product, but has not experienced the same financial market troubles as Greece and Portugal. However, a recent warning from S&P served as a reminder of the consequences of not taking action. An editorial in business daily Il Sole 24 Ore questioned whether the current government would be able to manage the situation. Berlusconi's center-right party faced defeat in the first round of voting in May, leading to run-offs in Naples and Milan. A defeat in the upcoming elections would likely worsen tensions with his key ally, the Northern League, and may lead to challenges to his leadership of the center right, although senior ministers have stated that there will be no change in direction before the next national elections in 2013. Defence Minister Ignazio La Russa, a loyal supporter of Berlusconi, dismissed the possibility of an alternative government or early elections. In Milan, where Berlusconi began his political career, the outgoing center-right mayor is trailing behind the leftist candidate. Some residents noted a changing atmosphere in the city. Voters in Italy have been influenced by regional issues such as transportation and the ongoing garbage crisis in Naples, but the struggling national economy has been the main focus. Italy has been experiencing slow economic growth for over ten years, with high youth unemployment and a decrease in the average Italian's wealth compared to a decade ago. Berlusconi's government had to revise its growth forecasts for this year and next, and S&P's lowered its outlook on Italy due to failure to reduce debt and stimulate growth. Despite initial backlash for framing the election as a referendum on his leadership, Berlusconi has been vocal in criticizing his opponents on the left and accusing magistrates of being "communist." He predicted that Milan would turn into an "Islamic gypsyland" if the left wins. He also stated that leftist voters do not have brains, which led to Internet spoofs and a lawsuit from an offended voter. During a rant against Italian magistrates to US President Barack Obama at the Group of Eight summit in Deauville, France, Economy Undersecretary Daniela Melchiorre, a former magistrate, resigned in protest.