Health Equity
Medicaid Enrollment Touches 39% of the Residents of The District of Columbia; DC’s 70/30 FMAP is Vital for the Maintenance of Health & Human Services
A reduction in the District’s FMAP would not lead to long-term government savings and would have a ripple effect throughout the entire health system in the DMV, crippling access to care for not only Medicaid beneficiaries but also all those who live, work, and visit the District of Columbia, including members of Congress and their staffs.
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Why does DC receive an Enhanced FMAP Rate?
The DC FMAP rate of 70% established by the Revitalization Act resulted from bipartisan analysis, discussion, and negotiation by Congressional leadership aiming to balance fairness with the District’s restricted ability to generate revenue. Congress recognized that the District of Columbia faces unique financial challenges due to its non-state status and the significant amount of federally-owned land within its boundaries. The District is unable to tax non-residents’ earnings, so these workers pay no taxes to support the infrastructure and services, such as roads, public safety and emergency services that they benefit from in the District. The District is also unable to tax up to 40% of the real property within its borders due to statutory restrictions.
Why are we concerned about DC's FMAP now?
Members of Congress have proposed reducing the DC FMAP to the statutory minimum for all other states, which is currently 50% (but could be reduced even more). Such a change would impact every physician and every practice, regardless of type, location, and payers contracted. Even practices who take no insurance will not be able to send patients for specialist care, hospital admissions, or other types of care.
What can MSDC members do?
- If you know a member of Congress or staffer, reach out to them and share how DC cuts will hurt your patients.
- Share your relationships and outreach with hay@msdc.org so we can help coordinate advocacy efforts.
- Email hay@msdc.org if you would like to be paired with a physician member of Congress office and trained by MSDC staff on how to reach out.
Resources
- DC FMAP cut fact sheet
- California Medical Association fact sheet on Medicaid cuts
- MSDC and healthcare association letter to Congress arguing against DC FMAP changes.
- MSDC original story on Medicaid changes.
News, Statements, and Testimony on Health Equity Issues
Study: Pre-Vaccine Pandemic Expanded Moral Injury to All Healthcare Workers
We know moral injury was on the rise prior to the COVID-19 pandemic and the pandemic has been a traumatic event. In case there was any doubt that it has compounded moral injury in the healthcare workforce, a new study confirms what we have all experienced.
Publish last week in the JAMA Network Open, the study surveyed professionals during two time periods ("phases") before a COVID vaccine became available: April 24-May 30, 2020 and October 24-November 30, 2020. The survey captured over 1,800 individual responses from the physician, nursing, advanced practice practitioner, and chaplain professions. The authors concluded from the data that moral injury came not from one event but from continued exposure and morally injurious environments.
Studying responses showed the following:
- Moral injury in the first phase of questions came from fear of the virus and infection, but in the second phase moral injury came from the routinization of treating people infected with the virus.
- Lack of PPE was a major driver in moral injury in phase 1 but decreased substantially as more PPE was available on phase 2.
- Over both phases respondents reported increased isolation due to fear of being infected or assuming people were infected and hiding their symptoms. The increased distance - physical and emotion - was a self-reported cause of much moral injury.
- Over both phases, healthcare practitioners felt burned out due to a physical distance from patients, due to COVID protocols and reliance on telemedicine.
- Many practitioners felt betrayed by employers in phase 1 due to PPE shortages and requirements. One respondent wrote, "I felt our lives were more disposable than our PPE was".
The study concludes that the workplace bears a large responsibility to address to moral injury the last two years has caused. Urging employers to move beyond slogans like, "heroes work here", the authors propose proactive treatments such as:
- Providing adequate PPE
- Available PTO
- Support for childcare needs
- Nearby lodging for individuals on rapid-cycle shifts
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