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
JAMA Surgery - Female Surgeons Face Higher Risk of Infertility, Pregnancy Complications
A new study in JAMA Surgery and covered by The New York Times highlights the challenges female surgeons of reproductive age face in having children.
The study notes that currently 38% of surgery residents and 21% of practicing surgeons in the U.S. are women, with medical school graduate rates approaching sex parity. It also notes in the introduction that physicians face pressure to delay having children until after training, which for almost all surgeons is at "advanced maternal age". Other studies have shown that female surgeons are more likely to be childless, but there is little research on infertility and complications.
The study was led by Dr. Eugene Kim, who had a female surgeon colleague that suffered life-threatening pregnancy complications. The survey study included 850 surgeons (692 women and 158 men). The results showed female surgeons had twice the rate of pregnancy loss as the general population (42%). Compared to the male surgeons, female surgeons were more likely to delay having children due to their training, and had fewer children overall, and were more likely to use assisted reproductive technology.
The study also compared female surgeons with female partners of male surgeons to study if societal factors accounted for pregnancy and childbearing struggles. The results found female surgeons were more likely to suffer physical and behavioral setbacks during and after pregnancy than their non-surgeon counterparts. This led the authors to conclude that the physician lifestyle, and not solely societal factors universally impacting women, leads to female surgeons' childbearing struggles. Some of the factors highlighted include:
- Lack of paid leave or maternity leave during training
- Perceived damage to reputation due to absence
- 40+ hours of work weekly causing physical complications
- Prolonged standing with less water and food due to demands ofjob
- Reliance on IVT and ART to conceive
The authors propose three recommendations to address these issues:
1. Training programs should include clear, widely disseminated policies to support pregnant and expecting trainees
2. Institutions and practices should adopt supportive work plans for pregnant physicians and physicians on maternity leave
3. Trainees and physicians should be provided with resources, time, and space to meet their reproductive and childcare needs.
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