• Subject: VIP Insider: August 2025
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Welcome to this month's edition of the AMA's Very Influential Physician (VIP) Insider. Read on for details about these topics:

  • Tell Congress it's time to Fix Medicare Now
  • The stakes are high; the battlefield small
  • Breaking down the 2026 Senate map
  • The Gavinmader: how we would rate the new California democratic map
 

Tell Congress it's time to Fix Medicare Now 

As you are no doubt painfully aware, the Medicare physician payment system is hopelessly broken. When adjusted for inflation, Medicare payments to physicians have plummeted by 33% since 2001. In the past five years alone, Congressional inaction has led to repeated payment cuts, compounding the financial pressure on physician practices.

 

Contact your legislators today and urge them to pass long-term physician payment reform! 

 

While Congress recently passed its reconciliation package – the "One Big Beautiful Bill Act" – which includes a temporary 2.5% physician payment increase in 2026, it fails to address the root problem: the lack of a long-term, sustainable solution.  

 

Unlike other health care providers, physicians are the only group who do not receive automatic, annual inflationary updates tied to the Medicare Economic Index (MEI). As costs rise and the number of Medicare patients grows, physician payments continue to fall behind – forcing many practices to operate at a loss or close altogether.

 

America's physicians and patients deserve better – The current path of temporary one-year "fixes" is simply not sustainable – many physician practices are hanging on by a thread and without meaningful reform - many struggling practices will be forced to make the hard decision of operating at a loss or closing their doors forever – like so many of their colleagues have already done.

 

It's time for Congress to act! Please contact your legislators today and urge them to move beyond the yearly short-term "fixes" and work together to advance legislation permanently tying physician payment to the MEI to help stabilize physician practices and protect patient access to care.

 

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

 

The stakes are high; the battlefield small 

By Charlie Cook of the National Journal 

 

In next year's elections, don't expect much outside of the seven swing states.

 

Gerrymandering has never been more effective and insidious than now. Few voters defect from their party anymore; 90 percent of voters are effectively locked-in. Combine that with far more audacious parties armed with sophisticated databases and software packages, and a shift in district lines can have pretty predictable results.

 

What's more, the stakes over redistricting are now far greater than they ever could have been in the days of 60-, 80-, or even 135-seat House majorities, which the Democrats enjoyed during LBJ's first full Congress as president.

 

Now the House is split between 219 Republicans and 212 Democrats, with four vacancies—three in Democratic districts, one in a Republican.

 

With almost 40 percent of all congressional seats in states that could see a redrawing of district lines, little can be definitively said. Not every single one of the 170 districts in Texas, California, Florida, Indiana, Kansas, Maryland, Missouri, Ohio, and Wisconsin will see dramatically changed lines; there are an infinite number of possible outcomes. Remember also that while New York cannot redraw its lines in time for 2026, it could in time for the presidential election year in 2028.

 

Those old days did produce some grandmasters in the dark arts of redistricting. Phillip Burton and his brother and fellow House Democrat, John Burton, teamed up with then-California State Assembly Speaker Willie Brown in the 1980s to draw maps that, at least to Republicans, were diabolical. One district was purported to have 385 sides, which Phillip Burton referred to as "my contribution to modern art."

 

A bit later, House Majority Leader Tom DeLay of Texas oversaw an equally barbaric redistricting in his state in favor of Republicans.

 

In the Senate, the two most important variables at this point are the decision by Gov. Janet Mills as to whether she will challenge Republican Susan Collins in Maine and what happens in Texas's March 3 primary between GOP incumbent John Cornyn and state Attorney General Ken Paxton.

 

Six years ago, Collins was badly outspent yet defeated state House Speaker Sara Gideon by 8.6 percentage points, 51 to 42 percent, a margin of 70,422 votes. That same night, Joe Biden carried the state by 9.1 percentage points, 53.1 to 44 percent, a margin of 74,302. Running 7 percentage points and more than 140,000 votes ahead of the top of the ticket is something that rarely happens anymore.

 

But Trump's presidency has made life much tougher for Collins, who has the distinction of being the only member of the Senate to represent a state of the opposite partisan hue. With Sherrod Brown, Joe Manchin, and Jon Tester gone, no Democrats remain from red states. Collins is the only Republican left from a blue state. The line she has to walk is far narrower than it was for past moderate Republicans from New England; Trump makes it almost impossibly thin. No surprise that her job approval rating has fallen from six years ago.

 

But what Collins has going her way this time is that she now chairs the Senate Appropriations Committee, which may not sound like a big deal to a lot of people, but in lightly populated and not particularly wealthy states, it is a very big deal. Ask West Virginians about the Robert Byrd era or Alaskans about when Sen. Ted Stevens held the committee's gavel.

 

Maine Democrats do not have a deep bench. Rep. Jared Golden is seeking re-election in the tough 2nd District, but as a fairly conservative Democrat, he would have a hard time winning the statewide Democratic Senate primary. All of the other potentially plausible Democratic candidates are running for the open governorship; a general election for governor should be a lot easier for a Democrat than dislodging Collins. It seems about 50-50 on whether Mills runs. If she does, she might have an edge over Collins. But without Mills, it will be a long shot for Democrats.

 

Just as Democrats are on the edge of their seats about Mills's decision in Maine, national GOP strategists have to be as nervous as a long-tailed cat in a room full of rocking chairs over the Texas Senate primary. While the state may not be quite as Republican as it was a few years ago, the GOP does have a real advantage, meaning that the non-controversial Cornyn should be a cinch in a general election. But is the state red enough to cover some of Paxton's personal, ethical, and political liabilities? Maybe yes, maybe no.

 

It is more than a little ironic that with the stakes in American politics so high these days, the battlefield is smaller than ever. Competitive races for the Senate, the presidency, and, to a lesser extent, governorships are now mostly confined to the seven purple swing states of Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania, and Wisconsin.

 

The 24 solidly red and 19 solidly blue states are mostly bystanders. That's part of what makes the Senate arithmetic so challenging for Democrats. With Maine the only Republican-held seat up in a blue state, and the open GOP-held seat North Carolina the only purple state up in 2026, that means Democrats have to defend their own purple seats in Georgia and Michigan, knock off Collins, win North Carolina, and still beat two Republicans in red states to score a four-seat net gain and a majority next year.

 

When was the last time an incumbent Republican lost a general election in one of those 24 states we now list as red? In 2008, Sen. Ted Stevens from Alaska was under indictment. He lost the general election to Mark Begich, even though the indictment was subsequently reversed due to gross prosecutorial misconduct. The last Democratic incumbent senator to lose a general election in a blue state was in 2014, when Mark Udall lost to Cory Gardner in Colorado.

 

The reality for Democrats is that their best chance of winning a Senate majority is to prevail in North Carolina and Maine this year, while defending Georgia and Michigan, then look to 2028, when they'll try to win at least two out of these three: Sen. Ted Budd's seat in North Carolina, Sen. Ron Johnson's Wisconsin seat, and the White House.

 

 

Breaking down the 2026 Senate map 

By Max Cohen, Andrew Desiderio, Ally Mutnick and John Bresnahan of Punchbowl News 

 

Fifteen months out from the midterms, Republicans remain the heavy favorites to retain control of the chamber thanks to a good map, despite some high-profile setbacks. Senate Democrats still need to net four seats to reclaim the majority, a huge hurdle.

 

Recent political shifts have moved several key races in Democrats' favor, giving the minority party an outside chance to pull off a shocker. GOP Gov. Brian Kemp isn't running in Georgia, former Democratic Gov. Roy Cooper jumped in the North Carolina race and Republican infighting in Texas could prove disastrous.

 

The Big Four:

 

Georgia: Sen. Jon Ossoff (Ga.), the cycle's most endangered Democrat, is raising loads of money. Kemp is throwing his weight behind former college football coach Derek Dooley, an untested political novice locked in a messy primary with Georgia GOP Reps. Mike Collins and Buddy Carter.

 

Trump's team isn't happy with Kemp for boosting Dooley. Ossoff could squeak out a general election win, but it won't be easy in a state that went for Trump last November.

 

Michigan: The Wolverine State is almost the mirror image of Georgia. Republicans lined up behind former Rep. Mike Rogers, who narrowly lost to Sen. Elissa Slotkin (D-Mich.) in 2024. Meanwhile, Democrats have a messy primary to replace retiring Sen. Gary Peters (D-Mich.) with no clear favorite.

 

Rep. Haley Stevens (D-Mich.) hasn't cleared the field like Slotkin did last cycle. Stevens is battling against state Sen. Mallory McMorrow and progressive darling Abdul El-Sayed in a primary that won't be settled until August 2026. Republicans haven't won a Senate seat in Michigan since 1994, but Trump carried the state in 2024.

 

North Carolina: The general election will likely be Cooper against RNC Chair Michael Whatley. Democrats feel great about nabbing a top-tier recruit in Cooper, the popular two-term former governor. Republicans are relieved they've all coalesced quickly around Whatley and averted a primary.

 

Cooper's impressive electoral track record statewide could make him the favorite, especially because Whatley is so unknown. But Republicans note that North Carolina backed Trump three times in a row. The question is how Whatley — the ultimate political insider — will fare in a statewide race.

 

Maine: There are tons of unresolved issues in the Pine Tree State, mainly whether Democratic Gov. Janet Mills will run. Mills, 77, is a well-liked executive in a state that has a long history of electing Democrats statewide — except when they're running against Sen. Susan Collins (R-Maine).

 

Collins, 72, has said she intends to run. And she's raising money. But at a time when the White House is thumbing its nose at Congress and the Appropriations Committee that Collins chairs, this isn't a guarantee.

 

Senate GOP leaders believe Collins is the only Republican who can win in Maine. So they're willing to let Collins freelance when she needs to — like voting against the reconciliation bill and the rescissions package. Continue Reading 

 

The Gavinmander: how we would rate the new California democratic map 

By Kyle Kondik and J. Miles Coleman from Sabato's Crystal Ball

 

A proposed Democratic gerrymander of California finally emerged late Friday. There is a long and difficult path toward it actually being enacted. This week, Democrats in the California state legislature will have to vote to present the proposal to voters this November as a constitutional amendment. Voters would then decide whether they will want to replace the work of the state's independent redistricting commission, which voters gave the power to handle redistricting in advance of the 2010 census, with this Democratic gerrymander.

 

While its passage is hardly guaranteed, Gov. Gavin Newsom (D-CA) is trying to nationalize the issue as a way to strike back against Republicans, who are on their way toward passing a new gerrymander of Texas that could allow them to win up to five additional seats in that state. Texas state House Democrats broke quorum to delay the map but that effort seems to be petering out. We also wonder if Texas Republicans may try to go even further on their map proposal, although they have not as of this writing. A second special session of the Texas legislature started Friday, and the map was reintroduced with only very minor changes, so our previous assessment of that map remains unchanged.

 

The proposed California map could allow Democrats to win up to five more seats in 2026. However, not all of those gains are guaranteed, and voters will get their say, unlike in Texas, where there are not state-specific constraints on partisan redistricting.

 

Republicans will fight the map's passage—former Speaker Kevin McCarthy (R), who held a House seat in California, has set a goal of raising $100 million to defeat it. Swing voters (and even some hardcore Democrats) may be cross-pressured between the good government impulses undergirding the independent redistricting commission and a partisan desire to get back at President Trump and Republicans for the Texas map (and other new Republican gerrymanders that are likely coming elsewhere).

 

The redistricting commission is popular: A Politico/Citrin Center/Possibility Lab survey found that just 36% supported returning line-drawing authority to the state legislature. This helps explain why Newsom's proposal only applies to the rest of the decade and would only go into effect if Texas or another Republican state redraws. Politico also reported on internal Democratic polling showing the issue getting a little over 50% if framed in such a way, with support then growing with partisan Democratic messaging. An Emerson College poll showed that 33% of those surveyed supported redrawing the map with 25% opposed, and 42% were undecided. A general rule of thumb is that the "yes" side of a ballot issue usually wants to be polling around or higher than 60% to feel good about passage. That is not present in the polling discussed here, but this is also an emerging issue that will be hotly contested in a campaign, and Newsom and Democrats may very well be able to get Democratic voters in a Democratic state to "put their jerseys on" and back them in a partisan, national fight. We don't really see a favorite yet on the ballot issue. 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. 

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