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
Dr. Jill Finkelstein Took the Path Less Traveled to Arrive in Medicine
Dr. Jill Finkelstein can recommend better ways of becoming a physician than the route she took. Especially the year she spent studying for the MCATs as a post-baccalaureate student. “It was not a fun way to spend a year,” she admits. But it did test her commitment to medicine.
Halfway through college, Dr. Finkelstein still wasn’t sure what her future career would be. “I’m not sure what my track was, but I know it wasn’t medicine.” She needed a science credit and took biology. “I found the section on human physiology, the subtle ticking of the human body, very interesting.” A seed was planted.
Her roommate at the time was premed and the seed took root. “I knew I wasn’t going to accomplish what I needed to get done before the end of college, so I enrolled in a post-baccalaureate program at Bryn Mawr that is specifically for students looking to get into med school. Most of my classmates were switching careers. I was the youngest one in the program and got asked why I didn’t just pursue medicine from the beginning a lot,” she recalled.
For the next year she focused solely on getting into medical school. “It was a very challenging time. My roommates had all graduated from school and were working with regular 9 – 5 jobs. At the end of the day, they were done, meanwhile, at the end of my day, I had to study. I studied harder than I ever had before,” she said.
She scored high enough on her MCATS to be accepted at Robert Wood Johnson Medical School, now part of Rutgers University, and did her residency at George Washington University School of Medicine. “I needed to select a specialty and kept going back and forth between Emergency Medicine and Obstetrics and Gynecology – which aren’t exactly similar,” she said.
The more exposure to Emergency Medicine made her realize that would not be a good fit. “The fast-paced nature and adrenaline moments definitely had their appeal. “But I found that Labor and Delivery is full of fast-paced moments and adrenaline rushes too.”
Five years into practicing, she is happy with her decision. “I really enjoy the surgery that is involved with gynecology. It’s more than I was expecting there to be. My schedule is also very varied. I have hospital days, surgery days, and office days. There isn’t a lot of monotony.”
An OBGYN is the one doctor visit that is generally a happy one. “Pregnancy is a special time, and one of few happy reasons to have to go to the doctor. I like being a part of those special moments with patients,” she said.
Obstetrics and gynecology also give Dr. Finkelstein and regular schedule which she needs as she raises two young sons, ages five and two, with her husband, Jason.
“My husband and I used to like to explore new and trendy DC restaurant,” said Dr. Finkelstein. “Now that we have young kids, we can only go to places that have macaroni and cheese on the menu and where you won’t have to wait more than 5 minutes for food to be ready. My favorite DC restaurant was Komi which served many courses of amazing Mediterranean gastronomic creations, but they closed during the pandemic. Other restaurants I love are The Red Hen and Fiola Mare. Oh, and Jeni’s Ice Cream!” she added.
She and Jason get out every now when her in-laws watch the boys. They are looking forward to finding their new favorite restaurant.
She has been a member of MSDC since she began working at Kaiser Permanente several years ago. “It’s nice to have a group that is advocating for physicians. I look forward to becoming more involved as my boys get a little older.”
Do you know a physician who should be profiled in the MSDC Spotlight Series? Submit a nomination to Robert Hay, hay@msdc.org, for a future story. MSDC membership is encouraged for featured physicians.
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