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
Physician Foundation Survey: The State of Physician Wellbeing Remains Low
The Physicians Foundation released part two of its 2022 Survey of America’s Physicians, aimed at understanding the state of physicians’ wellbeing and assessing solutions to address it. With National Physician Suicide Awareness Day just days away, on September 17, the results are concerning. There is a persistent decrease in overall physician wellbeing that is made worse by structural barriers and stigma in the physician community.
More than two years into pandemic and amid draining workplace challenges, the state of physician wellbeing remains low.
- Six in 10 physicians often have feelings of burnout, compared to four in 10 before the pandemic in 2018.
- One-third have felt hopeless or that they have no purpose.
- Half report withdrawing from family/friends/co-workers.
- More than one-third of physicians have checked in with a colleague who they suspected was experiencing mental health distress.
Physicians feel disconnected from the resources and people they should be able to rely on. Regrettably, significantly fewer physicians rate their colleagues, medical practices and hospital/health system as helpful to their mental health and wellbeing than they did a year ago. Half of physicians or more shared that their workplace rarely or never takes action on eight of the 12 evidence-based wellbeing actions identified to support physicians. These barriers and lack of support can and have led to tragic outcomes. More than half of physicians know of a physician who has ever considered, attempted or died by suicide.
Physicians need and deserve better. The survey identified what supports their mental health and wellbeing most.
- More than eight in 10 physicians shared their family and friends as most helpful to their mental health and wellbeing
- A higher proportion of black physicians than white and Hispanic physicians rated their family (92% vs. 85% and 87%, respectively) as very or somewhat helpful in the past year
- Confidential therapy, counseling or support phone lines were rated as the most helpful resource among physicians who had experience with it, followed by peer-to-peer support groups.
- 65% found confidential therapy, counseling or support phone lines to be helpful.
- 57% found peer-to-peer support groups to be helpful.
Clearly, physicians desire social connection and, at times, professional counseling to support their wellbeing. The Healthy Physician Foundation offers confidential counseling and career coaching at no cost to its members, plus a suite of online easily accessible resources. To facilitate critical social bonds, MSDC offers physician communities centered on common interests and goals, as well as an array of physician-oriented events. The Physicians Foundation lists “checking in with a physician” as one of six action steps to support wellbeing.
The study identified solutions to address physician wellbeing that are important to heed. Physicians in the survey highlighted the need to reduce low-level work and increase physician leadership.
- 89% found removing low-value work, including reducing EHR clicks and minimizing inbox notifications, helpful.
- 87% found giving physicians more flexibility and autonomy to adjust quality and patient experience goals helpful.
- 85% found eliminating insurance approvals such as pre-authorization helpful.
It is important to remedy the stigma, structural barriers, and excessive low-level work which exacerbate burnout. Physicians need and deserve better when it comes to their wellbeing and mental health. See healthyphysician.org for resources and ideas to heal our nation’s healers.