Alabama SB 26: Just Say No to Healthy Babies and Brains

I notice several bills introduced this session in Alabama have to do with drugs.  This one, SB 26, probably has less to do with drugs and more with money—but it will fail to solve either our drug problem or our budget crisis. 

This wrong-headed bill, which seems to be modeled on one that didn’t pass in Kentucky, would require any adult applying for state-subsidized health care benefits to first pass a drug test.  Current recipients would have to pass a test yearly to keep their benefits.  Whoever fails the drug test gets kicked off Medicaid and has to wait a full year to try again.  I guess they are hoping that this will cut down Medicaid expenses in 2014, when we start adding more adults.

The only exceptions are people who are in nursing homes (that’s right, Grandma and Grandpa can keep sneaking out back to get high) or other institutional facilities.  No exception for two extremely important groups—pregnant women and those disabled by serious mental illness who live in the community.

In Alabama, a woman who is poor and who becomes pregnant can qualify for Medicaid to get prenatal care through a program called Best Start.  She will be covered throughout pregnancy, and then the newborn will be covered.  This really makes a huge difference!  Just a couple of days ago, I heard a visiting neonatologist lecture about why Alabama babies die at higher than the national average.  It turns out that the newborn of a mother with no insurance is TWO TIMES as likely to die, usually related to prematurity or other birth conditions, as the newborn of a mother with Medicaid.

If this bill passes, mothers who are using drugs will not be able to get medical care during pregnancy, and the babies will be twice as likely to die.

I guess this doesn’t matter, since most of them will at least get out of the uterus.  For some reason, personhood after being born doesn’t seem to be as important in this legislative session.  (Yes, I’m working on that bill—it turns out there are 300 references to a “person” in the Alabama Code that would be affected).  But even if you believe only that first breath counts, I don’t know how on earth this will save money.  For every baby that dies and doesn’t need public funds, several more will survive with expensive, life-long disability.

Persons with serious mental illness and addicted to drugs (called “dual diagnosis”) will no longer be able to get medication and therapy.  They will have to be psychotic for a full year before they can try and fail again.  Maybe they can be committed to a long-term facility, so they can get treated.  When they are better, they can be discharged home and will still have to wait a year to re-apply for care.  During that time, how many will quickly relapse and have to be committed again?  Or wind up in prison, where many of our state’s mentally ill persons live?  How much money will that cost?  And how many people will suffer permanent damage to their brains?  The longer psychosis goes untreated, the less likely a person is to get better.

Guess who will be able to pass the screens and get Medicaid?  The casual, “recreational” drug users, who are not addicted.  That’s right, the ones who are breaking the law just because they want to.  They can wait however many days it takes for the drug to clear their systems, and then use again until their next scheduled test month.  They’ll be able to continue getting public money—only those with true addictions (a medical condition) will not be able to get help. 

I am told it isn’t getting that much traction yet.  One reason might be that similar legislation in other states is under legal challenge as form of unconstitutional search and seizure.  You might take a moment and notify your legislators to vote against it, just in case.



Filed under Alabama legislative session 2012

4 responses to “Alabama SB 26: Just Say No to Healthy Babies and Brains

  1. Barbara Power

    Wow. This blog is a perfect example enormous of medical-social complexity. First off, I completely agree with the author’s sentiments. Second, I have realized after countless calls and letters to my 2 senators how futile it is to engage them on issues like this. I have mostly received responses of rather extreme anger when I raise any of these topics (in the context of healthcare, equity, justice). In NH, the legislature cut $200 million annually from fed/state funds which hospitals receive (it is claimed that this hits hospitals in the financial category of uncompensated care). The justification from legislators is murky and illogical–the default is to blame Obamacare.

    The following events immediately took place: all of the high-volume hospitals in the state started laying off personnel; all of the same institutions eliminated (or the equivalent) their access to those with acute mental health problems; some have made the newspapers by literally closing their doors to anyone on Medicaid. One fallout (which is now becoming commonplace in the USA) is that cops on-the-beat have become the front-line “providers” for those with mental health exacerbation and jail is now the “care” these patients receive. Another is the vast empty statistical “hole” that others affected by these decisions disappear into. If the doors are closed, then where does a pregnant woman go to have her child (not to mention prenatal care). Following that, with no means of payment as a result of no medicaid funding, both mother and child have no access for basic postpartum care, pedi care, immunizations, well-baby checks, assessment of problems, treatment of routine pedi-infections…. This whole picture displays a scary new definition of “Diversion.”

    The state motto in NH is “live free or die.” Not being a native of this state, the motto has always embarrassed me. Now it has progressed to outright shame.

  2. I agree with everything you said except I just want to point out that yes, those babies will have a higher chance of death if she has no insurance, but wont they have a higher chance of death anyway because of efects from the drugs that she is taking? Maybe instead of taking her insurance there should be mandatory Rehab or something like that to try to get her off of the drugs.

    • Right now, some of the Medicaid and some of the uninsured(as well as the privately insured) babies are exposed to drugs before birth. So even with drugs, Medicaid helps. Might be because the women have assistance from the social worker and other nonmedical help. They can use the Medicaid to get treatment at the mental health center. I agree with you that the combination of drugs AND no Medicaid could be much worse.

      As for whether they should be forced into mandatory rehab, I think it would violate their civil rights unless all of us, pregnant or not, or at least without respect to insurance status, had to undergo testing and rehab the same way. And I think most people would see that as a 4th amendment violation. So I doubt if a law like that would stick.

      Let’s pretend we did that though. Let’s say we put everyone who tests positive for drugs in rehab tomorrow. We don’t have nearly the number of rehab beds we need even for those who want to go now. There are long waiting lists for Pearson Hall.

      Interestingly, the main substance I see fetuses and children exposed to that harms them severely is legal– cigarette smoke! The fact that no one is calling for locking up smoking moms to save their babies tells me it isn’t really about health.

  3. Barbara Power

    Another incredible statement of fact and experience. Quite right — the legal substance(s)…. and other elephants on the table. Your comment “it isn’t really about health,” is devastatingly true. It’s about discrimination, diversion of resources away from already marginalized people, and punishment of the vulnerable. All forms of deeply embedded structural violence in the USA.

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