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

• The House: Democrats favored on what starts as a small battlefield
• Battle for the Senate: Florida and Texas wait in GOP hands
• Why you shouldn’t contact Senators and Representatives who don’t represent you

The House: Democrats favored on what starts as a small battlefield 
By Kyle Kondik from Sabato's Crystal Ball

It would have been reasonable to believe that Democrats were well-positioned to flip the House in 2026 as soon as Donald Trump won the presidency last November. There is a longstanding tradition of the non-presidential party winning control of the House in a midterm—in fact, other than 2002, when Republicans held the House in George W. Bush's first midterm, the non-presidential party has either flipped or maintained control of the House in every other midterm since Ronald Reagan's presidency. Setting aside 2002, the last time the presidential party won the House majority in a midterm was 1978, when Jimmy Carter and the Democrats maintained their majority at a time when Democrats functionally held a permanent majority in the House (they held the House majority uninterrupted from the 1954 election all the way to the 1994 election).

Typically in midterms, the non-presidential party improves both their share of seats and share of the popular House vote compared to the previous election. The Democrats' path became clearer once all of the 2024 races were called and they captured 215 seats to the Republicans' 220, meaning they only needed to do 3 seats better in 2026 to flip the House.

Since then, Trump has taken office and governed much more aggressively than he did at the start of his first term. His overall approval rating, though better than it was in 2017, has turned net negative (meaning his approval number is lower than his disapproval number) in polling averages, and ratings of his approval on the economy have generally been worse than his overall approval ratings (his overall approval may be buoyed by maintaining positive marks on immigration). That dynamic was taking shape even before his recent unilateral decision to impose massive tariffs followed by his subsequent decision on Wednesday afternoon to delay most of the tariffs. So much about the economic situation is uncertain—let alone the practical implications of the haphazard Elon Musk-led cuts to the federal government or how Republicans craft an extension of Trump's first-term tax cuts. There is and will be plenty for voters to react to in the midterm: typically that reaction is negative, although it does not have to be.

Electorally, Democrats have been punching above their weight in special elections much like they did in 2017, and they just decisively won the first big statewide election of Trump's second term, maintaining liberal control of the Wisconsin state Supreme Court last week. Democrats are grappling with some internal strife, as their own voters are starting to express wider dissatisfaction with the party. But fortunately for Democrats, a party's voters don't have to love their own party in a midterm context in order to deliver wins—they just have to be motivated enough to turn out against the other guys. For instance, Republicans' internal issues didn't prevent them from strong showings in the 2010 and 2014 midterms, although fractious primaries did produce some candidates who kicked away key races, most notably in 2010 Senate contests (the quality of nominees coming out of primaries will be something to monitor during the primary season). Back then, the conventional wisdom was that the smaller midterm electorate had a generic Republican lean. Now that conventional wisdom has been turned on its head, given the migration of higher-turnout voters into the Democratic camp. In a recent episode of the Ezra Klein Show, Democratic consultant David Shor found that Kamala Harris would have beaten Trump in an electorate made up of only 2022 midterm voters, while Trump would have won the popular vote by close to 5 points if all registered voters had cast a ballot. Democrats clearly have some longer-term problems to work through, but that to us is more of a 2028 issue than a 2026 one, at least when it comes to the House.

To sum up this preamble, we would just say the following: Democrats became favorites to flip the House as soon as Trump won, and what has happened since then has not really changed that assessment.

Republicans do have a couple of sources of comfort that may matter if the overall political environment for them is not as bad as it seems like it could be. Continue reading 

Battle for the Senate: Florida and Texas wait in GOP hands
By Nicolas Anastacio of the National Journal
 
Democrats made a late push in Florida and Texas last year as the party sought to hold onto their narrow majority. Republicans won both seats easily. Looking toward the 2026 midterms, there isn't much buzz about Democratic recruits in either state.

• FLORIDA. Democrats are finding it hard to recruit a candidate to take on Sen. Ashley Moody (R), as a number consider gubernatorial runs instead. Rep. Cory Mills (R-07) could launch a primary challenge against Moody, but the senator has started to consolidate support among the state's GOP politicians.
• TEXAS. Democrats are hoping a messy GOP primary between Sen. John Cornyn (R) and state Attorney General Ken Paxton (R) could help the party make inroads, especially if 2024 nominee Colin Allred (D) makes a comeback. San Antonio Mayor Ron Nirenberg (I) and state Rep. James Talarico (D) could also consider bids.
• IMPLICATIONS.  "Abandoning Florida and Texas now could indeed have long-term consequences. Florida has the fastest-growing population of any state in the U.S., closely followed by Texas … Moving away from Democratic infrastructure building in Florida and Texas could mean having less ground game ready. " (NOTUS)
• BRACE FOR IMPACT.  "Senate Republicans are heading into the next midterm cycle bracing for contentious primaries that could hit both incumbents and favored candidates—a sharp break from 2024, when party leaders closely coordinated with " President Trump  "to keep spoilers at bay. "

ONE PICK SO FAR. NRSC Chairman Tim Scott said he would protect incumbents in tough primaries. But the NRSC could stand back as a messy primary occurs in Kentucky, and a potentially competitive primary occurs in Georgia if Gov. Brian Kemp (R) doesn't run. Scott endorsed 2024 MI nominee Mike Rogers (R) to replace retiring Sen. Gary Peters (D-MI) as Rep. Bill Huizenga (R-MI 04) considers a run. (Washington Examiner)

ENDORSEMENT ROUNDUP: Ruben Gallego Endorses Haley Stevens
Sen. Ruben Gallego (D-AZ) endorsed Rep. Haley Stevens (D-MI 11) to replace retiring Sen. Gary Peters (D-MI). Gallego is the second Senate Democrat to get involved in the race after Sen. Bernie Sanders (I-VT) endorsed 2018 MI GOV candidate Abdul El-Sayed (D) last week. (X)

• FLORIDA. Rep. Vern Buchanan (R-16) endorsed Sen. Ashley Moody (R) ahead of the 2026 special election. Buchanan is the seventh House Republican from the state to endorse Moody as Rep. Cory Mills (R-07) considers a bid. (Politico)

ILLINOIS: Durbin Retires
Minority Whip Dick Durbin announced his long anticipated retirement at the end of his term. The 80-year-old senator said in his announcement video that it was  "time to pass the torch " after serving five terms in the Senate. Durbin also emphasized the  "strong Democratic bench" in the state, confident his successor will be a Democrat. (release)

• WAITING IN THE WINGS. Lt. Gov. Juliana Stratton (D) and Reps. Robin Kelly (D-02), Raja Krishnamoorthi (D-08), and Lauren Underwood (D-14) are waiting in the wings to replace Durbin. The House candidates are sitting on a mountain of campaign cash. Krishnamoorthi had $19.4 million, Kelly had $2 million, and Underwood had $1.1 million, on hand according to last week's FEC filings. (Hotline reporting)

KENTUCKY: Andy Barr Gets in the Race
Rep. Andy Barr (R-06) launched his campaign to replace retiring Sen. Mitch McConnell (R) yesterday.

• RUNNING FOR HIM. The congressman went all in on his support for President Trump in his launch video, supporting the president's agenda on immigration and his elimination of federal DEI programs. Barr asked the president for his endorsement in the race as 2023 GOV nominee Daniel Cameron (R) leads in his internal polling.
• CUE ATTACK LINE. Barr criticized the  "woke left " while featuring Minority Leader Chuck Schumer and Rep. Alexandria Ocasio-Cortez (D-NY 14). Barr also focused on transgender rights in the video, emphasizing his opposition to transgender women and girls in women's sports and bathrooms.
• TWO TO THREE. Barr joins Cameron in the primary. Waste removal entrepreneur Nate Morris (R) is also considering a run for the seat, criticizing Barr and Cameron as McConnell's  "lackeys " ahead of Barr's announcement.
• HOUSE BACKUP. Barr has the support of Rep. Hal Rogers (R-05). House Majority Leader Steve Scalise and Rep. Elise Stefanik (R-NY 21) also endorsed Barr. (Lexington Herald-Leader/X/X)

MAINE: Jordan Wood Launches Campaign
Former congressional staffer Jordan Wood (D) launched his campaign to challenge Sen. Susan Collins (R). In his campaign launch video, Wood criticizes Musk's DOGE cuts and posits Collins' response as inadequate. Wood also highlighted his work as a former chief of staff to former Rep. Katie Porter (D-CA). (X)

• HOTLINE ANALYSIS. Wood is the first noteworthy Democrat to enter the battleground race, but he's not the one on senior Democrats' radar as Gov. Janet Mills (D) and Rep. Jared Golden (D-02) consider Senate bids.

NORTH CAROLINA: The Roy Cooper Coup
Senior Democrats are increasingly optimistic that they can recruit former Gov. Roy Cooper (D) to take on Sen. Thom Tillis (R) next year. DSCC Chair Kirsten Gillibrand is personally involved in the recruitment effort, and Cooper believes he's the party's best chance to take on Tillis as former Rep. Wiley Nickel (D) runs for the seat.  "Cooper is unlikely to make a decision until June, a source familiar with his thinking tells Axios. Until then it's 50/50, the source said. " (Axios)

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

Citizens—and the associations, nonprofits, and corporations they belong to—often wish to enhance their voices by contacting the Senators and Representatives they like best, the ones they're most angry at, the ones they see on TV, the ones who sit on the committees most relevant to them, or possibly all of them, for good measure. Unless the legislators also happen to represent them, however, the messages almost never get through. Why is this?

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 CMF's "Life in Congress: The Member Perspective" 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.

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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