Highlight on Alabama: Public health officials fighting to balance access, safety, and costs

Alabama health news lately has focused on maintaining access to certain health care services, including abortion services and mental health. This priority, however, is coming up against concerns regarding safety and adequate funding, and the need to balance these issues extends to the expansion of the Medicaid program.

Abortion safety and access

Abortion clinics in Alabama must still involve a doctor who maintains hospital admitting privileges. The State Committee of Public Health just rejected a new rule suspending this requirement in an 8-5 vote. Currently abortion doctors must have local admitting privileges, although an alternative allows clinics to contract with an outside doctor with such privileges. The new rules would have provided an exception for some clinics to simply have doctors available for consultation with additional training for employees to handle abortion complications.

Those opposing the new exception state that it’s important to maintain uniformity in standards of care to ensure patient safety. Yet one doctor in support of the rule felt that it would protect patient safety by ensuring access to a medical procedure in a safe, controlled environment. The vote on the new rule stemmed from a temporary restraining order on enforcing the existing regulations sought by the West Alabama Women’s Center and its doctor, located in Tuscaloosa. The clinic claimed that the only local hospital was not willing to grant the doctor admitting privileges, and that no other doctor in the area wants to contract with the clinic. This issue arose only recently, as the Tuscaloosa clinic’s prior doctor (now retired) had maintained admitting privileges. The committee’s decision will not affect any of the state’s other clinics, which meet the requirements for admitting privileges, and the Tuscaloosa clinic will continue to operate under a waiver for most of 2016. What will happen when the waiver expires remains to be seen.

Mentally ready for change

The National Alliance for Mental Health (NAMI) released its third annual report on the state of mental health care across the country. A NAMI lobbyist pointed out that in the last five years, Alabama has seen a $40 million hit in general funding for mental health services and closed three mental health hospitals. Alabama has many opportunities for improvement in mental health treatment, and the prison system intends to do its part.

The Alabama Prison Reform Task Force initially focused on changing parole and probation, and saw its recommendations passed by state legislature in May. Now, the task force hopes to reduce the crime rate by providing better mental health treatment for inmates, including drug treatment. The Alabama Department of Corrections has diagnosed about 12 percent of current state inmates with a chronic mental illness and spends about $12 million each year on mental health treatment. Task force members think that providing better mental health treatment to inmates will lower costs in the long run and reduce the crime rate.

However, the issue extends outside the walls of prisons. Officers involved in parole, probation and community corrections say about 39 percent of offenders returning from prison are unable to find adequate mental health care upon release. Substance abuse services are also limited. One effort to reduce overcrowding and recidivism is mental health courts, which review cases involving some nonviolent felonies and provide treatment plans. The task force also intends to focus on referral processes for mental health services, including those for juvenile offenders.

More Medicaid would help, too

Providing affordable access to mental health care is a consideration in the argument for expanding Alabama’s Medicaid program. Another task force, this time the Alabama Health Care Improvement Task Force, recommended Medicaid expansion as soon as possible to close the “coverage gap.” Those in this gap are too poor for Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) coverage, but make too much to qualify for Medicaid as it currently operates. The task force pointed out that Alabama ranks at the bottom or extremely low on many health outcomes compared to the rest of the nation. It stressed the importance of improving opportunities to obtain primary care. The task force anticipated that expansion would cover 290,000 more Alabamans. Of these, 185,000 are part of the state’s workforce. Funding is an issue as always, but a tobacco tax hike to help cover expansion costs is on the table.