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

• Hotline's updated 2026 House power rankings
• Roll Call's list of the most vulnerable Senators one year out
• AMA releases 2026 Medicare physician payment schedule final rule summary
• Physician advocacy in action 

Hotline's updated 2026 House power rankings
By James A. Downs and Kirk A. Bado

At this stage in the cycle, there's more uncertainty than certainty as the White House pushes Republicans to redraw maps and Democrats struggle to respond in kind.

At publication, only Texas and North Carolina have successfully passed new maps. California is currently counting ballots to respond to Texas. If passed, the state could add five new Democratic-leaning seats.

Hotline has opted to leave out a handful of seats that are all but guaranteed to flip and are deemed uncompetitive by campaign committees and super PACs. Two districts in Texas now skew heavily Republican and won't be contested by either party, while a third went to President Trump by about 10 points and could come online as the primaries develop.

Seats in Utah, Missouri, and Indiana all face potential changes, but with judicial and legislative challenges still pending, the final district makeups are not currently clear. Republicans could benefit in up to three seats in Missouri and Indiana, while two GOP-held seats in Utah could become battlegrounds.

The list is based on conversations with strategists, consultants, and campaigns in both parties.

1. Nebraska's 2nd: Open
This open seat remains atop the list, and it equally remains a must-win for Democrats in pursuit of the majority. The Omaha seat is just one of three Republican-held districts that former Vice President Kamala Harris won, due in large part to Rep. Don Bacon's crossover appeal. With his retirement at the end of the term, Republicans have massive shoes to fill. Omaha City Councilman Brinker Harding and former state Sen. Brett Lindstrom are duking it out for the GOP nomination, while the Democratic field is crowded and largely unsettled. Regardless, whoever emerges on the Left will start with a leg up in the Democratic-leaning seat.

2. Texas's 34th: Rep. Vicente Gonzalez (D) ↑
Redistricting did no favors for Gonzalez, whose district shifted 6 points to the right following the state's contentious special session this summer. Gonzalez won reelection last year despite President Trump carrying the Rio Grande Valley seat, but demographics are often destiny, and it may be hard for the congressman to survive this time around. What could help him, however, is a contentious Republican primary between Eric Flores, an Army veteran and former federal prosecutor, and former Rep. Mayra Flores, whom Gonzalez has twice defeated.

3. North Carolina's 1st: Rep. Don Davis (D) ↑
Davis is the other Democrat on this list who may fall victim to redistricting. Republicans in the General Assembly passed new lines, shifting the 1st District several points rightward—Trump would have won it by double digits—and effectively eliminating all swing districts in the Tar Heel State. Davis hasn't made his decision known yet—he's suggested he may run for reelection in the 1st or the 3rd against Republican Rep. Greg Murphy—but this instantly becomes a top opportunity for the GOP. There's little Democrats can do to stop the map: Republicans have a supermajority in both chambers, and congressional maps are not subject to gubernatorial veto. Three local elected officials are duking it out on the Right for the opportunity to take on Davis, if he decides to stand and fight. Continue reading 

Roll Call's list of the most vulnerable Senators one year out
By Daniela Altimari and Mary Ellen McIntire 

Democrats' hopes of securing control of the Senate next year begin with defending a freshman from a Southern swing state that Donald Trump narrowly carried in 2024. And Republican efforts to maintain their Senate majority center on a longtime incumbent who has managed to hang on despite representing a state that leans blue.

A year out from Election Day, Georgia's Jon Ossoff, a Democrat seeking his second term, and Maine's Susan Collins, a Republican seeking her sixth, top our list of the most vulnerable senators of 2026. 

Several other incumbents — including Republicans John Cornyn of Texas and Bill Cassidy of Louisiana and Democrat Edward J. Markey of Massachusetts — also make our list. But their biggest challenge is likely to come in the primary from a member of their own party.

The ranking is based on extensive conversations with campaign insiders, party officials and independent election analysts, as well as candidates' fundraising and race ratings by Inside Elections with Nathan L. Gonzales.

CQ Roll Call typically focuses on the 10 most endangered members in each chamber, but our latest Senate list features only six. 

Because our list focuses on incumbents, it doesn't take into account open-seat races, whose outcomes will also determine the balance of power in the Senate. Three Democratic incumbents from competitive states — Michigan's Gary Peters, New Hampshire's Jeanne Shaheen and Minnesota's Tina Smith — as well as Republicans Thom Tillis of North Carolina and Joni Ernst of Iowa all announced their retirements, leaving behind competitive seats.

Democrats need a net pickup of four seats to win control of the chamber next year. Speaking before Tuesday's off-year elections, Democratic National Committee Chair Ken Martin admitted that would be a “pretty steep” hill to climb. 

But sweeping Democratic wins across the country Tuesday injected some optimism into the minority party, with Senate Minority Leader Charles E. Schumer and Democratic Senatorial Campaign Committee Chair Kirsten Gillibrand, both of New York, saying the results “make clear that Republicans' Senate majority is at risk.”

Democrats harbor long-shot hopes of expanding their path to the Senate majority through red-state races that could become competitive under the right conditions. In Alaska, for instance, Democrats are already criticizing two-term Sen. Dan Sullivan for his votes in favor of legislation that included cuts to Medicaid. Former Rep. Mary Peltola, the last Democrat elected statewide, would be a strong opponent, but she has not yet announced her 2026 plans.

And Nebraska's Pete Ricketts is fighting off a challenge from independent Dan Osborn. In 2024, Osborn, a former labor leader, came within 7 points of defeating the state's senior senator, Republican Deb Fischer. But Ricketts, a popular former governor, is seen as a stronger contender against Osborn.

1. John Ossoff (D) - Georgia 
As the only Senate Democrat on this list from a state that Trump won in 2024, Ossoff has had to navigate the political complexities of a purple state. But this is his first test since his victory over former Sen. David Perdue in a runoff election in early 2021 helped hand Democrats control of the Senate. This year, Ossoff faces a fractured Republican field: Two congressmen, Mike Collins and Earl L. “Buddy” Carter, are running, along with former University of Tennessee football coach Derek Dooley, a political newcomer who has the backing of Gov. Brian Kemp. Despite the GOP divisions, Republicans are confident the party will coalesce behind the winner of the May primary. Ossoff, meanwhile, has a big fundraising advantage over his potential rivals. He raised $12.1 million between July and September and ended the third quarter with $21.4 million in the bank. Democrats were also encouraged by Tuesday's election results, which saw a pair of Democrats flip two seats on the state's Public Service Commission.

2. Susan Collins (R) – Maine 
Maine is unsurprisingly shaping up to host another marquee Senate race next year. Collins, the lone Republican senator representing a state won by Kamala Harris last year, has yet to officially announce her campaign for a sixth term. But the Democratic primary to take her on has heated up, with Gov. Janet Mills and oyster farmer Graham Platner locked in a battle that highlights the generational and ideological differences within the party. Platner, who raised $3.2 million in the first six weeks of his campaign, has been dogged by recent negative headlines over unsavory past social media posts and a problematic tattoo. But a University of New Hampshire survey from last month showed him with a double-digit lead over Mills. Also running is former congressional aide Jordan Wood, who's raised $3.1 million since joining the race in April. To hang on as New England's only Republican in the Senate, Collins will have to overcome low favorability ratings (which she's done before) and fend off Democratic attacks over health care costs and the fall of Roe v. Wade, which occurred after her last reelection. She ended September with $6.7 million banked.  

3. John Cornyn (R) – Texas  
For months, Cornyn has been fighting for his political future against firebrand primary challenger Ken Paxton, the state attorney general. Now, the senator faces a battle on a new front, with GOP Rep. Wesley Hunt joining the field. Cornyn has Senate GOP leaders behind him, and a pro-Cornyn super PAC is already running ads supporting his campaign. That spending has boosted Cornyn's poll numbers: An October survey by the University of Houston and Texas Southern University found him and Paxton effectively tied, with Hunt in third place. Cornyn reported raising $910,000 last quarter through his main reelection committee and about $2.4 million through his joint fundraising accounts. Paxton raised $1.3 million in that same span, while Hunt netted $366,000 for his House account. On the Democratic side, state Rep. James Talarico has proved to be a fundraising juggernaut, bringing in $6.2 million in his first three weeks. Former Rep. Colin Allred, who lost to Sen. Ted Cruz by 8 points last year, raised about $4.1 million for his second Senate bid. Continue reading

AMA releases 2026 Medicare physician payment schedule final rule summary
On Oct. 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Payment Policies under the Medicare Physician Payment Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies final rule, implementing significant payment policy changes that will take effect on Jan. 1, 2026.

To help physicians understand the impact of the final rule, the AMA developed a detailed summary and analysis (PDF), which explains how:

• All physicians will benefit from the positive conversion factor updates for 2026, including a 3.77% increase for advanced alternative payment model (APM) qualifying participants (QPs) and a 3.26% increase for all other physicians.
• For many physicians, the benefits of the positive update will be at least partially offset by the finalized practice expense and efficiency adjustment cuts, which are broken down in the summary.
• Physicians who treat hospital inpatients and nursing facility patients through telehealth, those who provide services requiring direct supervision, and teaching physicians who virtually supervise residents in the delivery of telehealth services will all benefit.
• Maintaining the Merit-based Incentive Payment System performance threshold to avoid a penalty at 75 points for the next three years introduces much-needed stability and predictability into a program that costs $12,800 per physician per year to comply.  

The analysis provides additional information about individual code changes and valuations, skin substitutes, geographic practice cost indices, the Medicare Diabetes Prevention Program, the Medicare Shared Savings Program, MIPS Value Pathways, and the Ambulatory Specialty Model, among others. The AMA has also developed a two-pager (PDF) to explain the problematic efficiency adjustment and practice expense payment policies. More context and background about Medicare physician payment is available on this AMA webpage. 

Physician advocacy in action
Members of the San Mateo County Medical Association recently took part in a health care roundtable with Representative Kevin Mullin (D-CA) to discuss the impact of the One Big Beautiful Bill Act on Medicaid recipients, the potential expiration of ACA tax credits at the end of the year, telehealth coverage, CMS Medicare physician reimbursement rates, lowering prescription drug costs and many other healthcare related issues. 

This is what physician advocacy looks like in action. If you would like to be featured in a future issue of the VIP Insider newsletter, please contact: politicaleducation@ama-assn.org  

Left to right: Dr. David Goldschmidt, Dr. Vincent Mason, Dr. William Tatomer, Rep Kevin Mullin, Dr. Connor Lundy, Mr. Keith Darby

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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