Methodology

The Machine Score

One number from 0 to 100 for every member of Congress: how independent the member is from the hospital lobby. Higher is better.

Draft rules, version 1, November 2026. No scores are published yet; every member shows a dash until the first scores are released under the rules in force then.

What it measures

A score of 100 means the member never sided with the hospital lobby on a scored action. A score of 0 means the member sided with the lobby every time.

It measures behavior, not party, ideology or intent. A Republican and a Democrat with the same record get the same score.

The anchor: what counts as the lobby’s side

Each action is judged against the published position of the American Hospital Association or the Federation of American Hospitals. The position is on that specific bill, amendment, rule or letter.

The position comes from the lobby’s own letters, key-vote alerts, testimony or press releases. We never decide what is pro-hospital; the AHA and FAH told everyone in writing.

If neither group took a public position on an action, that action is not scored.

Every scored action links to the vote, bill or letter and to the AHA or FAH document that states the lobby’s position.

What gets scored

Federal cost drivers only

Only actions on the cost drivers this site tracks. Certificate of need is left out for members of Congress because it is state law. It returns for state legislators.

Driver	Examples of scored actions
I. Physician-owned hospitals (Section 6001)	Bills to lift or keep the ban; letters to CMS on expansion exceptions
II. Price transparency	Enforcement bills; votes on penalties; letters opposing or supporting CMS rules
IV. Hospital subsidies	The 340B program reform; nonprofit tax exemption and charity care standards; DSH; tax-exempt bonds
V. CMS favoritism	Site-neutral payment bills and amendments; facility fee limits; sign-on letters to CMS
VI. Stark and Anti-Kickback	Bills that ease or tighten the rules that keep physicians from building competitors

How actions are weighted

Action	Weight
Floor vote	3
Committee vote or markup amendment	2
Sponsoring a bill	2
Cosponsoring a bill	1
Signing a letter to CMS, HHS or leadership	1
On-the-record public statement (hearing, release)	1

Recency. Actions from the last three Congresses, six years, count in full. Older actions count half.

Minimum record. A member needs at least five scored actions. Below that the member shows “Insufficient record,” not a number.

Money. Hospital-industry PAC and executive contributions from FEC filings sit beside the score on every member’s entry. They are not inside it. The score rests only on what the member did, judged against what the lobby asked for in writing.

The formula

Score = 100 × weighted actions against the lobby’s position ÷ all weighted scored actions.

Worked example, hypothetical

Actions	Count × weight	Scored	Against the lobby
Two floor votes with the lobby	2 × 3	6	0
One committee vote against the lobby	1 × 2	2	2
Cosponsored two lobby-backed bills	2 × 1	2	0
Score = 100 × 2 ÷ 10		10	2

Score: 20, in the band “Reliable ally of the lobby.”

The bands

The band label shows large, the number beside it

Score	Band
80 to 100	Reformer
60 to 79	Independent
40 to 59	Mixed
20 to 39	Reliable ally of the lobby
0 to 19	The Machine

Publication rules

Every action listed: Each scored action appears on the member’s entry with a link to the vote, bill or letter. It also links to the AHA or FAH document stating the lobby’s position.
Recalculated on each action: Scores are recalculated whenever a scored action happens. Every entry carries an as-of date.
Corrections: Any member’s office can submit a correction or a statement. Corrections are logged publicly.
Reproducible: The full list of scored actions is published as a download, so anyone can reproduce any score.

Still to be fixed before the first scores

Draft rules

The rules above are the draft. These points are open, and the first published scores will state how each was settled.

Anchor for state legislators Pending: Whether state hospital associations join the AHA and FAH as the anchor when state legislators are scored.
Committee weight Pending: Whether committee votes weigh more than the draft’s 2, since committees are where bills are written.
Money Pending: Beside the score, as drafted, or inside it at up to 15 percent as a percentile rank of hospital-industry receipts.
Name and bands Pending: Whether the score keeps its name now that 100 is the best score. And whether the 0 to 19 band keeps the label “The Machine.”
Lookback Pending: Six years at full weight, as drafted, or the current Congress only.
Start date Pending: Whether scoring begins with the 120th Congress in January 2027 or with current members’ existing records.

Shown on the Senate Finance scorecard. All methods · Report a correction