After several years practicing internal medicine, Bera took on a half-time role as the medical director of care management for Mercy Healthcare Sacramento in 1998. There, he says, he learned the extent of inefficiency within the health care sector and set about identifying and implementing "simple solutions" to reduce waste. He cited as an example a project in which his unit examined 911 calls that weren't actually emergencies and found that most originated from a small group of widows and widowers. By reaching out to that group, the unit dramatically reduced unnecessary calls.
Realizing that other hospital groups in Sacramento County faced similar challenges, Bera took on the role of the county's chief medical officer in 1999. He said he was motivated partly by a "desire to truly create that public-private partnership." At the time, the county was unprepared to meet the demands of its uninsured population, which became a top priority for Bera. He said that Obama's Affordable Care Act "is not the direction I would have gone," but believes the law offers a solid starting point for reform on such concerns as bringing down spiraling medical costs.
After his stint in county government, Bera entered academia as a professor and associate dean of admissions at UC-Davis Medical School. But he remained interested in government and in 2010 decided to challenge Lungren, who had had a close election in 2008, in the 3rd District. Bera showed surprising strength as a fundraiser, drawing on donations from Indian-Americans across the country to become the only Democratic challenger in mid-2010 to outraise a sitting House Republican. He accused Lungren of being out of touch with district voters, while the incumbent portrayed him as a rubber stamp for Speaker Nancy Pelosi's agenda. A late-breaking wave of nearly $700,000 in ads from GOP strategist Karl Rove's American Crossroads organization helped seal Lungren's win — a development featured on the syndicated radio show This American Life about how campaign money has affected politics.
Bera began almost immediately to consider a second run. In 2012, he was the only Democrat to garner a significant share of the vote in his district's open primary, receiving 41 percent to Lungren's 53 percent and setting up a general-election rematch. Redistricting put the race in a new 7th District, which was 3 percentage points more Democratic than before. He continued to outraise his opponent, and benefited from a Sacramento Bee endorsement that said, "Bera has matured, and Lungren has failed to meet local expectations."