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

• Urge Congress to support Medicare physician payment reform
• Initial 2026 House race ratings show more Republicans in Toss-up seats
• Three things that usually happen in midterms
• Authentic advocacy in a culture of disruption

Urge Congress to support Medicare physician payment reform

Congress has once again let down America's physicians and their patients who rely on them for quality care.

When is this never-ending cycle going to end? On January 1, physicians received another 2.83% payment cut, marking the fifth consecutive year that Medicare physician payment has been cut. In fact, since 2001, when adjusted for inflation, Medicare physician payments have decreased by 33%. 

Contact your members of Congress today and urge them to pass H.R. 879!

Recently, Congress had the opportunity to address the problem in its most recent spending package but lacked the will to help secure the viability of physician practices and instead threatened access to care for 66 million Medicare patients by not reversing the cuts. 

This is simply not sustainable – many physician practices were already hanging on by a thread and this latest round of cuts will only worsen the situation, forcing many struggling practices to make the hard decision of operating at a loss or closing their doors forever. 

America's physicians and patients deserve better - Early this year, Reps. Greg Murphy, MD (R-NC) and Jimmy Panetta (D-CA), along with a bipartisan group of legislators, re-introduced the "Medicare Patient Access and Practice Stabilization Act" (H.R. 879). This legislation, if passed, would, effective April 1st, prospectively cancel the 2.83% payment cut that went into effect on January 1, while also providing a 2.0% payment update, helping to stabilize physician practices and protect patients' access to care.

This bipartisan legislation has over 120 cosponsors and was recently endorsed by the Republican "Doc Caucus" and we need your help to get it over the finish line! 

Please join the thousands of physicians from across the country who have already taken action by contacting your members of Congress and urge them to pass the "Medicare Patient Access and Practice Stabilization Act (H.R. 879) today! 

The Medicare physician payment model is hopelessly broken, and these yearly cuts are having a negative impact on physician practices while leaving patients' access to care at risk. It's time Congress finally did something about it! 

America's patients are counting on Congress to provide this much needed relief and work toward achieving long-term Medicare physician payment reform.

Initial 2026 House race ratings show more Republicans in Toss-up seats
By Nathan L. Gonzales of Roll Call 

Even though the midterms are 20 months away, it's not too early to project that the headliner of the 2026 elections will be the fight for the House majority.

Republicans' three-seat Senate majority and a dearth of competitive races puts next year's battle for the Senate on a side stage compared with the House elections. After gaining a seat in 2024, House Democrats need to gain just three seats to claim the majority next year. 

According to Inside Elections' initial individual House race ratings of the 2026 cycle, the fight for the majority looks to be a close, district-by-district battle. But cycles, particularly midterms, can evolve and sometimes even change dramatically.

The initial 2026 House battleground consists of 64 seats rated as either Toss-up (10 races), Tilt (13), Lean (22) or Likely (19), with two or three races in Ohio currently outstanding over a pending new congressional map.

The initial playing field is disproportionately Democratic turf, with the party defending 34 vulnerable seats compared with 30 currently in GOP hands. That makeup aligns with the high correlation between presidential results and House outcomes and the fact that there are 13 Democrats who represent districts where President Donald Trump finished ahead of Kamala Harris and just three Republicans who represent districts where Harris beat Trump. 

But Republicans are defending a disproportionately larger share of the Toss-up races. Seven House Republicans are in races rated a Toss-up, including Reps. Juan Ciscomani (Arizona's 6th District), Gabe Evans (Colorado's 8th), Mariannette Miller-Meeks (Iowa's 1st), Tom Barrett (Michigan's 7th), Ryan Mackenzie (Pennsylvania's 7th) and Jen Kiggans (Virginia's 2nd). The contest for New York Rep. Mike Lawler's 17th District is also rated a Toss-up, and the seat would be even more vulnerable for Republicans if he vacates it to run for governor. 

On the Democratic side, Reps. Adam Gray (California's 13th District), Derek Tran (California's 45th) and Don Davis (North Carolina's 1st) also start in Toss-up races, but they might soon have company from colleagues in the Buckeye State.

Ohio's 15 districts are not included in the initial Inside Elections ratings because of redistricting anticipated this cycle. Democratic Reps. Marcy Kaptur (9th District) and Emilia Sykes (13th) will either be at some or significant risk, depending on the new lines. It's also possible that Democratic Rep. Greg Landsman in the 1st District is vulnerable as well, but that's less likely. 

Continue reading 

Three things that usually happen in midterms
By Kyle Kondik, Managing Editor, Sabato's Crystal Ball

Midterms: Smaller, whiter electorates; larger non-presidential party vote share
The 2026 midterm is still more than a year and a half away. Yet there are a few things we can already predict about it with at least a reasonable amount of confidence:

• The share of eligible voters who participate in the midterm will be smaller than the turnout in the 2024 presidential election.
• The electorate should be whiter, older, and have a higher share of four-year college graduates than the 2024 electorate.
• And the Democrats, as the non-presidential party, should do better in the overall House popular vote than they did in 2024.

1. The electorate will be smaller
Midterm electorates are not as big as presidential electorates, and there is no modern precedent for a midterm electorate having a higher turnout rate among eligible voters than the turnout rate in the most-recently held presidential election.

According to data from turnout expert Michael McDonald of the University of Florida, the average turnout rate for eligible voters in the 43 presidential elections held since 1856 is about 64%, while the average turnout in the 42 midterms held since that year is 49%. So, the turnout is on average about 15 percentage points higher in the presidential than in the midterms, and the midterm turnout was never higher than the immediately previous presidential election. We went back to 1856 because that is the start of our modern two-party system, with the Republicans first fielding a presidential candidate that year to join the Democrats, a party that had existed in various forms prior to that year.

Of course, those who would have been an "eligible voter" was much different back then than it is now, with the franchise later expanding to previously disenfranchised groups like women, Black voters, and, in advance of the 1972 election, 18-20 year olds. Figure 1 shows the presidential and midterm turnout rates for this more modern time period.
Figure 1: Turnout of eligible voters, 1972-2024
Average turnout for presidential elections from 1972-2024 was 58%, and average midterm turnout in that timeframe was 41%, or a 17-point gap that’s very similar to, but slightly larger than, the presidential to midterm gap in the longer time period since 1856.

Note that turnout in both the last two presidentials and last two midterms have been high by recent standards—but even comparing the 2016 presidential election to the historically-high turnout 2018 midterm still showed a 10 percentage point smaller turnout in the midterm.

The bottom line is that the electorate in 2026 will be substantially smaller than 2024, it’s just a question of how much smaller.

2. The electorate should be whiter, older, and more educated
Because midterm electorates are smaller than presidential electorates, it stands to reason that demographic groups that have historically had better turnout rates would make up a greater share of midterm electorates than presidential electorates. We see this with white voters in general, voters with a four-year college degree, and voters aged 65 and over.

Continue reading 

Authentic advocacy in a culture of disruption
By Jen Daulby, CEO of The Congressional Management Foundation 

Every new administration, in its own way, brings about change. However, the new administration, elected in part on the promise of disrupting the status quo, is moving swiftly to make sweeping and consequential changes to federal agencies and programs. These changes—whether through restructuring, cuts, or complete overhauls—have left stakeholders in a kind of paralysis, uncertain about how best to respond and advocate for their priorities.

For a long time, whether through grassroots campaigns, grasstops advocacy, or astroturf efforts, advocates for specific federal programs and agencies have primarily targeted a narrow group of decision-makers in Washington. However, insufficient attention has been paid to engaging the broader public, who are often unaware of the impact of these programs on their daily lives and communities.

Furthermore, the incentives of our current political environment have encouraged the last several Administrations to bypass or ignore Congressional oversight, consolidating policymaking and fiscal policy through executive actions. At the same time, a few vocal members of Congress seem focused on social media trends and media appearances, rather than upholding the checks and balances essential to effective governance.

Stakeholders and advocates must acknowledge that voters inherently harbor skepticism toward federal programs and agencies. This skepticism, compounded by a lack of information about how specific programs impact individuals or communities, makes the electorate susceptible to oversimplified talking points and misleading narratives. As a result, advocates are caught flat-footed in a fast-moving, disruptive policy environment, where understanding and engagement are more critical than ever.

Continue reading

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. 

AMA Advocacy

25 Massachusetts Ave. NW | Suite 600 | Washington, DC 20001

Copyright © 2025, American Medical Association

If you no longer wish to receive our emails, please unsubscribe