VIP Insider: June 2025

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

The House: A big sort lowers the odds of a big wave
Don't miss out: Campaign School registration is now open!
Can Democrats rebuild trust with voters?
It's time to Fix Medicare Now – urge your Senators to support S. 1640

The House: A big sort lowers the odds of a big wave
By Kyle Kondik of Sabato's Crystal Ball

Democrats may very well win the House majority next year, but some of the typical factors that have featured in recent big numerical seat gains for the non-presidential party are absent in this midterm. Namely, Democrats are starting from a high point of seats already (they won 215 in 2024), and the House is already very well sorted along partisan lines.

In recent midterms, we have seen some wild swings in the House. Specifically, 2010 and 2018 come to mind, as both were years when the House majority flipped to the non-presidential party. As part of those elections, the presidential party lost more than 33 seats, which is the average midterm seat loss for the presidential party since the Civil War. In other words, while midterm seat losses for the presidential party have been very common, the numerical seat loss for the presidential party in both 2010 and 2018 was especially large.

Those 2010 and 2018 waves produced such turnover for a variety of different reasons, but there were three overarching factors present in both elections:

A good political environment for the House minority party.
The majority party held a lot of obviously vulnerable seats, based on recent presidential results.
The non-presidential party was starting from a deep minority.

Factors 2 and 3 are somewhat interconnected. As part of presidential victories in 2008 and 2016, the Democrats and Republicans (respectively) built substantial House majorities in which they held a lot of districts that were, on paper, hostile to them. The midterms thus served a politically realigning purpose.

The Democrats in 2008 provide a dramatic example. Table 1 shows the distribution of the House seats that year based on presidential results. Barack Obama won 53% (rounded) of the national vote that year, and so seats where he got 52%-54% (again, rounded) of the vote (or R+1 or D+1, as categorized in the table) are in the middle of the table, while seats where Obama did better are higher on the table and where he did worse are lower on the table. We made our calculations by using district-level presidential results from the Down ballot. For more information on how to interpret the tables and other details, see the note at the end of the article. Continue reading

Don't miss out: Campaign School registration is now open!
AMPAC is excited to announce that the 2025 Campaign School will be returning September 11-14 at the AMA offices in Washington, DC!

Running an effective campaign can be the difference between winning and losing a race. That's why the Campaign School is designed to give you the skills and strategic approach you will need on the campaign trail. Our team of political experts will teach you everything you need to know to run a successful campaign. Under the direction of our lead trainers, participants will be broken into campaign staff teams to run a simulated congressional campaign using what they've learned during group sessions on strategy, vote targeting, social media, advertising and more.

Attendees may include physicians, spouses of physicians, residents and medical students and state medical society staff interested in becoming more involved in politics. Participants range from those attracted to grassroots efforts to those considering becoming a candidate for public office. No matter where you are in the process, you will develop a new understanding of how campaigns are run. As a graduate of the AMPAC program, candidates will rely on you to give them advice on strategy, message, and campaign plans.

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 $350 for AMA members and member spouses/$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 (AMPAC staff 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.

Registration for the 2025 Campaign School is now OPEN. Space is limited and the deadline to register is August 8 (or sooner if maximum capacity is reached).

Can Democrats rebuild trust with voters?
By Charlie Cook of the National Journal

Following a panel hosted by the New England Council at Saint Anselm College's New Hampshire Institute of Politics on Friday, someone asked me, "What do Democrats need to do to win in 2026 and 2028?"

If I had to boil it down to one word, it would be: trust. The vast majority of voters cast ballots for either one party or the other year in and year out, whether or not they’re officially registered with that party. But what about that narrow sliver of voters in the middle? I’m sure they will look at Democrats with some questions:

Can we trust what you say?
Can we trust that you will be competent?
Can we trust that you will focus on repairing the damage to our government rather than trying to enact the next New Deal or the Great Society?

Can we trust that you will try to rebuild our relations with the rest of the world?

These voters in the middle have a healthy skepticism about what the political parties say. Democrats, however, have lost a lot of credibility in the past four years and will have to work to regain it. They were either oblivious or pretended to be oblivious to an aging, declining president until it was obvious for all the world to see during that June debate with Donald Trump last summer. They named a bill that had virtually nothing to do with inflation "The Inflation Reduction Act."

So it's critical that Democrats convey to voters that they’ll be competent in governing next time, rather than ideological.

President Trump left office in January 2021 with a Gallup job approval of just 34 percent and never reached 50 percent during his term. In January 2021, a CNN poll showed that 55 percent saw Trump's presidency as a failure (41 percent labeled it a success). The recession officially ended in April 2020, eight months before Biden took office, so Biden was playing with house money. But then Biden's presidency sailed into the political Bermuda Triangle of the border, the botched U.S. exit from Afghanistan, and a 40-year high inflation rate.

Biden's own Gallup approval rating plummeted from 56 percent in June 2021 to 42 percent that October, never to rise above 45 percent again. His political viability had pretty much evaporated before his administration’s first birthday. This past January, during Biden's last month in office, CNN's pollsters asked whether his presidency had been a success or a failure. Only 38 percent said it was a success, while 61 percent called it a failure—even more dismal than their assessment of Trump's at that point four years earlier.

Democrats will need to reassure those swing voters that if put back into power, they’ll focus on restoring the services that so many people have relied upon.

The 2020 election was not about Biden but about Trump. Voters didn’t seek a president who would do things that were "historic" or "transformational." Back in the 2020 election campaign, a wired-in Republican strategist summed up the essence of the polling and focus group research he had conducted, telling me that voters "want to know who will make their lives normal again." Not an apt description of the past four years.

One of the things that has kept Trump's numbers from plummeting has been that a majority of Americans agree, at least in principle, with the general direction that he is headed. But they think he takes things to an extreme, and they don't like his approach. Most Americans do believe that previous presidents had not been sufficiently diligent about having some semblance of control over our Southern border, but they think he has gone too far. Most believe that previous presidents did too little to keep the federal government from getting bloated; they believe these cuts have gone too far and have been administered too recklessly. They believe we have not always negotiated the best trade deals and that some countries have taken advantage of us, but that doesn’t mean Americans support widespread tariffs they know will increase prices.

Is there a Democrat out there who can run like the Joe Biden of 2020, while convincing voters he won't govern like the Joe Biden of 2021?

It’s time to Fix Medicare Now - urge your Senators to support S. 1640
Due to Congressional inaction in 2024, physicians received yet another 2.83% payment cut starting January 1, 2025, 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%.

Please contact your Senators today and urge them to cosponsor the "Medicare Patient Access and Practice Stabilization Act" (S. 1640) today.

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 - Recently, Sen. Roger Marshall, MD (R-KS) introduced the "Medicare Patient Access and Practice Stabilization Act" (S. 1640), companion legislation to H.R. 879, which was introduced earlier this year by Reps. Greg Murphy, MD (R-NC) and Jimmy Panetta (D-CA).

This legislation, if passed, would temporarily reverse the damaging 2.83% cut and provide a much-needed 2% positive payment update, which is an increase equivalent to roughly half of the Medicare Economic Index (MEI) for 2025, helping to stabilize physician practices and protect patients' access to care.

Please join the thousands of physicians from across the country who have already taken action by contacting your Senators and urge them to cosponsor the "Medicare Patient Access and Practice Stabilization Act" (S. 1640) 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.

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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