The writer was a 52nd District Court judge in Novi and assistant state attorney general. He's chief financial officer of the Justice Speakers Institute and a Deadline Detroit contributor.
By Brian MacKenzie
Have you ever seen or known of a baby that was born affected by opiates? Withdrawal can be just as traumatic as for an adult, except the baby has no prior experience which would help it cope with the symptoms.
Signs of Opioid-Induced Neonatal Abstinence Syndrome (NAS) include:
• Tremors
• Convulsions
• Fever
• Vomiting
• Diarrhea
• Dehydration
Although not all infants exposed to opiates exhibit these symptoms, many do shortly after birth, followed by a period of escalation which, in 70 percent of the cases, requires the use of methadone or morphine as a treatment.
These babies will lose weight due to appetite loss, have trouble going from sleep to awake states, exhibit a hyper-reaction to touch, sound, movement or visual stimuli resulting in over-stimulation, and suffer continual physical problems like gagging, vomiting/diarrhea, and fever.
If you haven’t encountered a baby with NAS here in Michigan or elsewhere, and the Senate’s proposed health care bill passes, it is more likely you will.
The reasons are twofold.
First, this bill makes very deep cuts to Medicaid. Currently, nearly half of all pregnancies are insured by Medicaid, a number that includes the nearly 5% women who are addicted to opiates at the time they give birth. The legislation eliminates prenatal and birth insurance for all of these women. But the cuts are not merely aimed at pregnant women; the bill also eliminates treatment for the nearly four million Americans who are receiving mental health and substance use disorder treatment though Medicaid.
Contrary to what Attorney General Jeff Sessions has argued, we cannot incarcerate our way out of the opioid crisis.
As the Pew Research Center’s study proves, locking up drug users has no impact on their subsequent drug use. Drug treatment on the other hand is effective in reducing drug use with resulting societal cost savings. The largest savings comes in the form of crime prevention, including reduced incarceration and victimization costs.
A large number of states, including Michigan, have addressed the opioid crisis by the use of Medication Assisted Treatment (MAT). According to the Substance Abuse and Mental Health Services Administration (SAMHSA) MAT is one of the most effective ways of treating opiate addiction. Medicaid not only pays for up to 50% of all MAT, it covers the costs for all of the millions of people currently receiving treatment for their substance use disorder.
Retired Judge Brian MacKenzie
Supporters of the Senate bill claim that it provides $2 billion in additional money for drug treatment in 2018. However, these funds are a one-year authorization with no certainty that additional moneys will be approved for 2019 or beyond.
And while $2 billion sounds like a lot of money, in one year, Ohio spent 657.3 million federal dollars on drug treatment which means one state spent more than one quarter of that line item. In order to replace Medicaid spending on drug treatment the legislation would have to authorize tens of billions of dollars. So, the only reason this money is in the bill is to provide political cover for Senators whose states have been hard hit by the opioid crisis. That cover is necessary as passage of this proposal will decimate effective drug treatment care in this country.
But there is second equally important change in the Senate bill affecting people with substance use disorders.
Before the current law, only one third of those who had private insurance had coverage for mental health or addiction disorders. When the Affordable Care Act was passed it required that all insurance plans provide drug treatment as an essential health benefit. This meant every middle class household had this coverage as part of their insurance.
However, the current draft of the Senate bill would end this mandate by allowing states to revoke benefits like mental health treatment, MAT, prescription drugs and maternity care. Thus, middle class families who bought private insurance would be left with no mental health or drug treatment coverage for themselves or their children.
A study in 2012 found that an NAS baby was born every 25 minutes in the United States. Hospital care for these babies costs an average of $66,700 per birth. Whether you personally know one of these infants or not, we all will bear the cost of their lack of prenatal treatment if the Senate passes this healthcare bill.
The best treatment for NAS is to help more mothers to become free of all drugs. You can help accomplish this by calling or emailing your Senators and telling them to vote for babies and against the Senate bill.
