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

• The 25 House districts that shifted the most from 2022 to 2024
• Getting back to the Senate: Defeated Senators who've returned to office
• Tell Congress it's finally time to Fix Medicare Now
• From the exam room to campaign trail: Physicians learn how to run for office 

The 25 House districts that shifted the most from 2022 to 2024 
By Nathan Gonzalez for Roll Call

New district-level analysis confirms what Republicans have been bragging about for months: 2024 was a good year for the GOP. 

On the surface, Republicans won the White House, took over the Senate and held the House. But a deeper dive into the results in individual House districts gives more texture to the underlying partisan shifts and geographic success that contributed to President Donald Trump's edge over Democrat Kamala Harris in the national popular vote. 

Using Inside Elections' Baseline metric as a guide, 24 of the 25 House districts that shifted the most from 2022 to 2024 did so in Republicans' favor. Unlike the 10 most evenly divided seats at the core of the current House battleground, very few of the seats that shifted the most are particularly competitive, and some of them are among the most partisan in the country.

Inside Elections' Baseline metric captures a congressional district's (or state's) political performance by combining all federal and state election results over the past four election cycles into a single score. This index aims to approximate what share of the vote a "typical" Democrat or Republican might receive in any given district by including elections beyond presidential contests. 

Overall, 254 House districts saw a shift in partisan performance toward Republicans, while 166 saw Baseline movement toward Democrats. 

The two districts that shifted the most might be the least interesting, but both provide insight into how the Baseline score works. 

West Virginia's 1st and 2nd districts shifted toward Republicans by 16.5 points and 10.3 points respectively. Both are GOP- held: Rep. Carol Miller's 1st District went from R+17.5 in 2022 to R+34 in 2024; Rep. Riley Moore's 2nd went from R+23.1 in 2022 to R+33.4 in 2024. 

Those shifts were driven by the dropping of the 2016 results, which included then-Democrat Jim Justice's 7-point win for governor and Democratic wins for state auditor and treasurer, and the addition of the 2024 results. Those 2016 results were the last statewide victories by Democrats not named Joe Manchin. 

But many of the other districts that saw large shifts help tell the story of the 2024 elections, and potentially beyond. 

Nine of the 24 districts that shifted toward Republicans are in New York, though most of them remain very Democratic. Rep. Alexandria Ocasio-Cortez's 14th District shifted toward the GOP by 8.3 points, according to the Inside Elections Baseline, but Democrats still have more than a 50-point advantage there.

It was a similar trend in other very Democratic seats in the Empire State. Grace Meng's 6th District saw a shift of 8 points toward Republicans, along with Ritchie Torres' 15th (7.3 points), Gregory W. Meeks' 5th (6.9 points), Nydia M. Velázquez' 7th (5.6 points), Yvette D. Clarke's 9th (5.4 points), Adriano Espaillat's 13th (5 points) and Minority Leader Hakeem Jeffries' 8th (4.9 points). Republicans also improved by 6.9 points in GOP Rep. Nicole Malliotakis' 11th District. Continue reading 

Getting back to the Senate: Defeated Senators who've returned to office 
By J. Miles Coleman for Sabato's Crystal Ball 

Over the summer, Politico checked in with former Sen. Jon Tester (D-MT). After losing his bid for a fourth term last year in one of that cycle's most high-profile races, the former senator, who now has more time to dedicate to his farm, appears to be living his best life. From what we can gather, Tester's experience seems common for senators who've exited the pressure cooker of electoral politics. At a 2019 Center for Politics event, former Sen. Claire McCaskill (D-MO), who had just lost her seat the year before, put it most succinctly, "I actually thought I was going to be miserable when I left office. I'm really, really happy!"

While Tester made it known that he wasn't eager to return to electoral politics—Sen. Steve Daines (R-MT) is up this cycle, and national Democrats would probably have welcomed another Tester run—he also knocked his party for having, as he put it, a tendency to "recycle" candidates. In Ohio, former Sen. Sherrod Brown (D), who entered and exited the chamber with Tester, is trying to win his state's other Senate seat, which is up next year as a special election. Meanwhile national Democrats recruited former Gov. Roy Cooper in North Carolina, and Senate Minority Leader Chuck Schumer is reportedly encouraging Maine Gov. Janet Mills (D) to run for Senate—while neither might be "recycled" Senate candidates, both are well known and may help illustrate the national party's preference for "tried and true" names.

To be fair to Democrats, this type of "recycling" has not been limited to their side. In New Hampshire, former Sen. Scott Brown (R-MA) is also trying to return to the Senate after losing his Massachusetts seat in 2012 and mounting an unsuccessful run against the now-outgoing Sen. Jeanne Shaheen (D-NH) in 2014. We may also note that, in that same state, former Sen. John Sununu (R), who lost his seat to Shaheen in 2008, is also openly considering a 2026 comeback run.

With former senators as potential nominees in at least a couple of 2026 Senate races, we looked back at what former senators have done after being voted out.

Based on our research, from 1946 to 2024, there have been about 220 instances of sitting senators losing reelection bids. For the sake of completeness, our tally included both appointed senators who were running for office in their own right and senators who were defeated in primaries. Despite, or perhaps, because of, the differing political environments that were included within that 78-year span, there was an almost eerie partisan symmetry, with each party owning about 110 defeats apiece. One caveat here is that for at least the first couple of decades since 1946, there was not true two-party competition throughout much of the Old Confederacy. So the Democratic tally is probably a little inflated because, during the earlier postwar election cycles, turnover in the South was mostly driven by Democratic senators losing primaries to other Democrats.

Over the years, it seems evident that most former senators have found themselves in agreement with the sentiments that McCaskill expressed above. Former senators often stay involved in politics by taking appointed roles or serving in some civic, media, or government-facing capacity—since leaving office, for instance, McCaskill herself has been a regular contributor to MSNBC. But the overwhelming majority of former senators have not tried to re-enter electoral politics at either the congressional or statewide level: this has been the case for about 175 defeated senators since 1946, or about 80% of our sample size.

About 20 other defeated senators went on to launch runs for Congress or governor. In 2024, then-former Sen. Kelly Ayotte (R-NH) became a successful example of this, winning her state's open governorship. Other recent, and less successful, examples include former Sens. Mark Begich (D-AK), David Perdue (R-GA) and Dean Heller (R-NV).

Another notable name was Massachusetts's Henry Cabot Lodge Jr., a Republican who lost his seat to then-Rep. John F. Kennedy (D) in 1952. Lodge would later serve in several ambassadorial jobs, which is not a rare post-Senate assignment for defeated members. But Lodge was also the GOP's vice-presidential nominee against the Kennedy/Johnson ticket in 1960. Continue reading

Tell Congress it’s finally 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. 

From exam room to campaign trail: Physicians learn to run for office

A tight race in a swing district was once again the backdrop for AMPAC's annual Campaign School on Sept. 11-14 at the AMA offices in Washington, DC. Twenty-two participants from across the country worked on the congressional "campaigns" of either the Democratic or Republican candidate in a simulated campaign. The participants included physicians, physician spouses, residents, medical students and state medical society staff.  

Over the course of the program, participants heard from political experts on both sides of the aisle on topics including campaign strategy, vote targeting, social media, paid advertising, public speaking and more. Taking what they learned in these sessions, participants then applied what they learned in real-life breakout exercises where they had to work together as a team to create radio ads, respond to a simulated campaign crisis and write and deliver a speech in support of their candidate.

Participants in this year's AMPAC Campaign School at the AMA offices in Washington, D.C.

Participants also heard from U.S. Senator, and AMPAC Campaign School alumnus, John Barrasso, MD (R-WY) about his path to public service; what impact running for office may have on you, your family and practice; and why it is so important to have more physicians engaged in the political process. He reminded participants that campaigns require careful planning and a willingness to take advantage of opportunities when they arise, while noting that plenty of candidates with great campaign plans still lose elections, but no candidate ever got elected without a great plan.   

The Campaign School is one of AMPAC's two annual programs, along with the Candidate Workshop, and is open to AMA member physicians, residents, students, spouses and state medical society staff who are interested in becoming more involved in the political process—whether that means a run for office themselves or wanting to learn the skills to be a valuable asset to the campaign of a champion of medicine.  

Dates for the 2026 Candidate Workshop and Campaign School have not been finalized, but please visit www.ampaconline.org to learn more about these programs. 

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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