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
Living in China as a High School Student established Laura Sander’s Healthcare Career Track
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Once her eyes were opened to the health disparities that existed in the world, a young Laura Sander was committed to addressing them.
Her medical journey began at age six when she informed her mother that she wanted to be a nurse. “My Mom responded that I could be a doctor if I wanted to. From then on, I was on a straight path towards medicine,” she said.
Her decision was reinforced when her family relocated from Philadelphia to China during her high school years. “My father is a chemical engineer and worked for a French oil company in China. I spent two years of high school at Hong Kong International School and the second two at the International School of Beijing,” she said.
The experience was a game changer for Sander. “When I came home, I saw these same disparities – on a different scale – in our cities in the U.S.,” she recalled. Among her observations were people living in shoddy homes and with limited access to food.
Dr. Sander recognized that it was chance that she was born in the United States, “In part because of my privilege, I feel a calling to narrow the health disparity gap to allow people to meet their full potential.”
She attended medical school in Philadelphia and considered educational opportunities through new eyes. “The social and structural determinants of health, such as lack of educational opportunities, unemployment, racist housing policies, and the lack of access to healthy food, compound over years and generations – and make people sick. In DC, for instance, there is a 21-year life expectancy gap between neighborhoods about 10 miles away,” she said.
Dr. Sander pushed up her sleeves and got to work.
“I began to affect change by building and leading a primary care practice in 2014 in Baltimore that cared for the sickest and costliest patients; those with complex care needs and only Medicaid patients,” she said. “In this partnership with the insurer, my multidisciplinary team addressed medical, behavioral and social needs,” she added.
Today she works at Johns Hopkins Sibley Memorial Hospital that offers Ward Infinity. The mission of the program is to partner with change agents to magnify and accelerate their capacity to radically improve the health and well-being of underinvested communities.
To accomplish this partnership, Sibley offers grants to residents in Washington D.C. Wards 7 and 8 for community-driven solutions that will reduce health disparities. Some grant recipients include an artist and his partner who want to create a documentary to educate young adults about sugar; a pediatrician that offers a program to support new mothers; and a new grocery store model that supports local businesses.
Dr. Sander developed and led Ward Infinity’s public health component. She also mentored the teams engaged in this work and served on the Advisory Council.
Her personal time is ideally spent where there are few distractions. “I was a competitive swimmer in high school. Swimming gave me strong discipline and dedication. I realized that to be my best, I needed to put time into training. This transferred over to my medical school studies,” she said.
When she can’t get in the pool, she enjoys running to keep her grounded. “I enjoy running in all seasons to keep physically active and to maintain my mental health. That time is critical for me to reset from a tough day or week.”
Dr. Sander became an MSDC member as part of Sibley’s institutional membership. She served on MSDC’s Wellbeing Committee as a representative of Sibley Memorial Hospital and provided input to the wellbeing programming.
The program is in response to the epidemic of burnout in healthcare professionals. MSDC remains dedicated to providing resources and support to District physicians in their struggle against burnout. The Wellbeing Program is a comprehensive program that provides resources and templates to address moral injury and burnout. The program includes a wide range of resources including coaching, counseling, networking, and best practice templates. It is open to all physicians and is supported by physician organizations, foundations, and health systems.
Do you know a physician who should be profiled in the MSDC Spotlight Series? Submit a nomination to hay@msdc.org for a future story. MSDC membership is encouraged for featured physicians.
Photo Caption: Laura Sander in Yushu City, China