VIP Insider: January 2025

Welcome to the new year edition of the AMA's Very Influential Physician (VIP) Insider. Read on for details about these topics:

Congress allows Medicare cuts for physicians starting Jan. 1
An early look at House members who could be vulnerable in 2026
Why you shouldn't contact Senators and Representatives who don't represent you
AMA political education updates

Congress allows Medicare cuts for physicians starting Jan. 1
On Dec. 20, President Biden signed a stopgap continuing resolution, the American Relief Act (HR 10545), a year-end legislative package designed to keep the government funded until March 14, 2025.

This legislation included extensions for various expiring health care programs until either mid- or late March, such as pandemic-era telehealth waivers, the National Health Service Corps, the Teaching Health Center Graduate Medical Education Program, community health centers, the special diabetes program, the geographic practice cost index (GPCI) work adjustment, and the hospital-at-home initiative.

However, the legislation did not include relief from Medicare physician payment cuts. An earlier draft of the year-end package had proposed mitigating 2.5% of the planned cuts to Medicare physician payments in 2025. Despite initial bipartisan support, this proposal was ultimately dropped due to political pressure and broader concerns about government spending. As a result, the scaled-down spending package passed without addressing these payment reductions.

As of Jan. 1, 2025, physicians are facing a 2.83% reduction in payments under the 2025 Medicare Physician Payment Final Rule. This cut marks the fifth consecutive year that physicians have endured reductions in Medicare payments, exacerbating long-standing financial pressures on medical practices.

Compounding this issue, the Centers for Medicare & Medicaid Services (CMS) projects that the Medicare Economic Index (MEI), which measures the cost of delivering care, will increase by 3.5% in 2025. Given this growing disparity between Medicare payment rates and the rising costs of providing care, the AMA has renewed the urgent call for Congress to reverse the new cuts as soon as possible and implement a payment update that reflects inflationary pressures.

With the gap between reimbursement rates and the cost of care continuing to widen, the AMA and other physician advocacy groups argue that these annual payment reductions jeopardize access to quality care for Medicare beneficiaries and threaten the financial stability of medical practices across the nation.

For more information and resources to take action, visit the AMA’s Fix Medicare Now website.

An early look at House members who could be vulnerable in 2026
By Daniela Altimari and Mary Ellen McIntire of CQ Roll Call

A new president with an ambitious agenda. Stark ideological divisions within both parties. And a deeply divided House with Republicans holding a slender majority.

Those are some of the dynamics that will be in play during the 119th Congress. But Democrats and Republicans are already looking at the 2026 midterm elections.

"[We're] going to be on offense to hold our House GOP majority in 2026," North Carolina Rep. Richard Hudson, who leads the National Republican Congressional Committee, said on social media last month. "Let's get to work!''

Democrats, meanwhile, are already looking for every opportunity to loosen the GOP's narrow majority, including the recent Republican infighting over the government funding extension. But their earliest chances to do so — special elections to succeed Republican House members, including two poised to join the Trump administration — will be tough lifts. Those are set to take place in deep-red territory.

"House Republicans have reminded everyone AGAIN that they only care about doing what Donald Trump & Elon Musk tell them to," Washington Rep. Suzan DelBene, who chairs the Democratic Congressional Campaign Committee, said on social media before the close of the previous Congress. "And the first chance voters will get to weigh in will be the midterms, and these irresponsible decisions will cost House Republicans the majority."

CQ Roll Call is taking an initial look at House members who could be vulnerable in 2026, grouped by categories. But with the midterm elections almost two years away, a lot can be expected to change between now and Nov. 3, 2026.

New York and California

Two blue states, New York and California, have been key House battlegrounds in recent election cycles, and 2026 should be no different, with both parties defending competitive seats in both states.

Eight districts in California were decided by 5 points or less in 2024. They include the Central Valley seat of Democrat Adam Gray, who defeated Republican Rep. John Duarte by fewer than 200 votes. Two Southern California Democrats — George Whitesides, who knocked off GOP Rep. Mike Garcia, and Derek Tran, who unseated Republican Rep. Michelle Steel by just over 650 votes — likely start off among the most vulnerable members.

A handful of districts in New York will likely be competitive again too. Democratic Rep. Laura Gillen, who defeated GOP Rep. Anthony D'Esposito on Long Island, will fight for a second term in an area where local Republicans have seen a resurgence in recent years, while fellow Democratic Rep. Tom Suozzi could also face another close race. Districts north of New York City, like the 17th, where Republican Mike Lawler won a second term, and the 19th, where Democrat Josh Riley ousted GOP Rep. Marc Molinaro, will likely be on party target lists. Lawler is considered a potential gubernatorial candidate in 2026, and an open seat might be easier for Democrats to flip.

One policy debate could shape the fate of Republicans in high-tax states, including New York and California: whether a 2017 tax law provision that placed a $10,000 cap on state and local tax deductions is renewed, and if so, in what way. Republican lawmakers in both states are among those leading the push to eliminate or raise the cap.

Why you shouldn't contact Senators and Representatives who don't represent you
By Kathy Goldschmidt of the Congressional Management Foundation

1. We are a representative democracy. Modern technology may be able to facilitate direct communication between any citizen and any Senator or Representative, but our democracy isn't structured that way. Our Constitution describes a system where Senators and Representatives are elected by—and represent—a portion of the nation's population. Senators represent everyone in their states, and members of the House represent clearly-delimited districts within their states (usually about 700,000 people). This helps ensure the interests of the people in a specific location are represented by specific people in each chamber. There are three people in Congress who are accountable to you. It may be the case that their ideologies don't align with yours, that you don't agree with their actions, or that they don't sit on the committee or in the leadership position that matters to you. That doesn't mean that other Senators and Representatives are beholden to you. It means that it's all the more important for you to engage with those who DO represent you to ensure your voice is heard, that the people elected to represent you do so, and that your Senators and Representative are in office long enough to attain leadership positions.

2. If you send it, it will be forwarded on or filtered out. Since the dawn of time when postal mail was the only way to communicate with them, it has been customary for Senators and Representatives to NOT communicate with people they do not represent. It is not considered courteous or appropriate for legislators to build relationships with their colleagues' constituents. When volumes were smaller, many forwarded non-constituent messages on to their colleagues. These days, the volumes are so high that the messages are generally filtered out either automatically or by the staffers who process the mail. Whether it's a perfectly-crafted and compelling letter or 5,000 emails, they will not be read or responded to.

3. It's BAD for democracy. With the average Representative representing 700,000 people and Senators representing anywhere between 600,000 (Wyoming) and 39 million people (California) they barely have the resources to manage their communications and relationships with the people to whom they are directly beholden. They cannot be responsive to all 323 million people in the nation. Even the act of filtering constituents from non-constituents takes considerable staff time that is NOT being spent legislating, hearing the concerns of constituents, and understanding the highly complex and very important issues before Congress and the nation. If you want democracy to work effectively and you want Congress to listen to you, you must communicate and develop relationships with those who represent you, whether or not you like them or their politics.

If you want democracy to work effectively and you want Congress to listen to you, you must communicate and develop relationships with those who represent you, whether or not you like them or their politics. Your Senators and Representatives ARE listening to YOU.

In a recent CMF study, 95% of Members rated "staying in touch with constituents" as being the job aspect most critical to their effectiveness. But they're having to filter through non-constituent voices to get to you. Our country runs on the belief that everyone deserves a voice, but sometimes if you're shouting too loud, no one is being heard through the cacophony of noise. So instead of shouting, communicate. And communicate to the right people so others can also have their voices heard by the Members trying to represent THEM.

AMA political education updates
AMPAC Candidate Workshop returns in person March 28-30

Ever wonder how Doctors get elected to Congress or your state legislature? Considering a run for office for yourself? The AMPAC Candidate Workshop will teach you how to run a winning political campaign, just like we taught many of your AMA colleagues over the years.

The AMPAC Candidate Workshop is returning in-person March 28–30 at the AMA offices in Washington, DC – registration now OPEN!

The Candidate Workshop is designed to help you make the leap from the exam room to the campaign trail and give you the skills and strategic approach you will need to make a run for public office.

At the Candidate Workshop, Republican and Democratic political veterans work together to give you expert advice about being a successful candidate and how to run a winning campaign. You will learn: the importance of a disciplined campaign plan and message; the secrets of effective fundraising; what kinds of advertising may be right for your campaign; how to work with the media; as well as how to build your campaign team and a successful grassroots organization.

Please note the following:

The Candidate Workshop is open to AMA physician members, member spouses, residents, medical students and state medical society staff.
Registration fee is $250 for AMA Member/$1000 for non-AMA members. This fee is waived for AMA residents and students; however, space is limited and the AMPAC Board will review and select four participants from the pool of qualified resident and student applicants.
Faculty, materials, and all meals during the meeting are covered by the AMA. Participants are responsible for their registration fee, travel to/from Washington, DC and hotel accommodations (AMA will provide you with a list of nearby hotels within walking distance of the AMA offices).
Participants will be required to bring a laptop or Wi-Fi enabled tablet with them.
All participants will be required to attest to being fully vaccination with at least one booster for the COVID-19 virus.

Registration for the 2025 AMPAC Candidate Workshop is now OPEN. Space is limited and the deadline for registering is March 7, 2024. For more information please contact: Politicaleducation@ama-assn.org

Deadline to submit nominations for AMPAC Award for Political Participation is January 31!
Awarded every two years by the AMPAC Board of Directors the AMPAC Award for Political Participation recognizes an AMA or AMA Alliance member who has made significant personal contributions of time and talent in assisting friends of medicine in their quest for elective office at the federal and state level.

These may include: volunteer activities in a political campaign or a significant health care related election issue such as a ballot initiative or referendum.

Nominees must be a current member of the AMA or AMA Alliance and AMPAC with preference given to members with a demonstrated history of AMPAC involvement. The deadline to submit nominations is January 31. The full criteria for the 2025 AMPAC Award for Political Participation including how to submit a nomination can be found here.

The winning nominee will receive special recognition during the AMPAC Board Chair's speech before the House of Delegates or during the AMPAC luncheon at the AMA Annual Meeting in Chicago. The winning nominee will also receive free admittance (including airfare and hotel expenses if held in-person) to a future AMPAC political education program (campaign school or candidate workshop) in Washington, DC.

Be sure to follow all the AMA's Physician Grassroots Network social media accounts for all the latest news on physician advocacy and what you can do to make sure your voice is heard on Capitol Hill.

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