Discussions with Decision Makers: Senator Linda Coleman-Madison

Senator Linda Coleman-Madison (D- Birmingham) currently serves on the Senate Healthcare Committee for the Alabama State Senate.  Supported by ALAPAC, she assumed her current office in 2006 and previously was a member of the Alabama House of Representatives.  She also served as a member of the Birmingham City Council from 1985 to 1997. 

What first prompted you to consider running office?

I have always been involved with community from early childhood; this was instilled in me to give back. Starting as a neighborhood officer and trying to help improve the community I lived in, I began to realize that the need was greater than the boundaries of my community. 

 How does your background help serve you on the Health Committee and also the Legislature?

I have worked mostly in the public sector where the focus was on addressing human needs.  My experience in working to help people has been a base to build and helps my perspective on how I perceive issues that come before the legislature and the Health Committee.

What are some of your legislative priorities next session?

Healthcare should be a greater focus and the expansion of Medicaid, so one of my priorities will be utilizing some of the next appropriations of ARPA funds towards this end.  Overall, Alabama has done a poor job of filling the gaps relative to providing access to needed resources to address women’s healthcare, postpartum issues, and infant mortality.

What are some health-related issues important to your district and your constituents?

Diabetes, obesity, and food deserts (several communities do not have access to full grocery store where they can purchase healthy foods and fresh fruits and vegetables).

What can be done to alleviate the unnecessary and growing administrative and regulatory burdens and laws being placed on the medical community by insurers and government payers like Medicare and Medicaid?

A lot of this administrative regulations are stressors for those seeking medical care.  Doctors must comply, but the added time, and cost does impact service delivery to the patient.  Technology has helped to relieve some of the burden but not all.  When a patient goes for medical assistance and worry whether they will be helped because they may not meet a criterion, is added stress. I am not a medical professional, but I would start with evidence-based research with proven benefits as a start to alleviating the bureaucracy in this area.

What do you think people understand the least about our health care system?

What they are eligible for.

If you could change anything about our state’s health care system, what would it be?

Expand Medicaid and make it accessible statewide through current county health centers located in most counties.

Do you have a position on the expansion of Medicaid?

Yes, Alabama should expand Medicaid. Fallowed incentives enabled many states that took advantage of this and expanded access to healthcare for its residents.  There is nothing more important than the state of healthcare of the citizens of Alabama.  Our economy is only as healthy as the health status of our residents. Even the recruitment of jobs and industry takes backseat, because the goal is providing job opportunities for our residents who must be in good health to take advantage of the jobs.

How can the Medical Association – and physicians statewide – help you address Alabama’s health challenges?

The Medical Association and physicians have the knowledge and connections to address many issues. The state spent millions trying to address healthcare disparities with trying to establish “Regional Health Centers.” We need to involve those in the field of medicine more, because they have access to statistics, studies, cutting edge trends and evidence -based programs that work. Also, we cannot be limited by practices just in our country. There are many best practices we can learn from medical professionals in other countries. Gov. Ivey said we must find Alabama solutions to Alabama’s problems. I agree, but we can also learn and borrow from the successes of others. We may end up with a hybrid that fits Alabama’s needs. 

What is the one thing you would like to say to physicians in your district?

We need your help. As legislators, we are not the professional in the medical arena.  We try to respond to citizens who contact us for help, but we don’t always understand the process of service delivery and what that involves.

Preventing Home-Birth VBACs Attended by Non-Nurse Midwives

For the third installment of an in-depth look into each of the Association’s “Top 10 Highlights” from the 2022 Legislative Session, we will look at the Medical Association’s opposition to home-birth VBACs and support for high national standards that ensure the safety of pregnant woman and their children.

In 2017 Lawmakers passed legislation that allows a non-nurse midwife to legally deliver babies in Alabama.  The Association fought against this legislation for over a decade because the practice of non-nurse midwifery has led to more home births that can put the mother and her child in a dangerous situation if a medical emergency does occur.  Nonetheless, the Association was able to remove language from the legislation that would have allowed non-nurse midwives to perform a VBAC (Vaginal Birth After Cesarean Delivery) outside of a hospital setting.

Fast forward to the 2022 legislative session, a bill was filed that would do what the Medical Association negotiated to have removed from the 2017 law—allow non-nurse midwives to be able to perform a VBAC in a home setting. In response to the bill being filed, the Association partnered with physicians from the Alabama Chapter of the American College of Obstetricians and Gynecologists to educate lawmakers on what a VBAC is and the dangers it poses to both the mother and child. 

The Association and its partners voiced concern to lawmakers that although a VBAC is commonly performed, it is always done in a hospital setting with a medical team readily available because there are only minutes to spare if an emergency occurs. Due to the risks associated with VBACs, and specifically considering that uterine rupture and other complications may be unpredictable, the Association maintained that a VBAC be undertaken only by a physician-led healthcare team in a hospital, where an emergency cesarean delivery is possible within a time interval that best incorporates maternal and fetal risks and benefits with the provision of emergency care. Lawmakers agreed with these realities and chose to maintain current law that appropriately prevents non-nurse midwives from assisting a mother’s delivery of a baby in the home setting if the mother has had a previous C-section. 

The Association would like to thank the physicians who volunteered their time through zoom calls or gave their expert opinion to lawmakers at public hearings in order to maintain the critical patient-safety protection present in the existing law that was negotiated into the non-nurse midwife licensing bill before it became law in 2017.  The Medical Association fully expects to see this bill filed again in future legislative sessions and will continue to educate lawmakers on the dangers that this legislation presents to both the mother and child during birth.