Breast-feeding moms get help in health-care plan
Breast-feeding babies has many health advantages, but few mothers know they can get help — and equipment — to help them adopt the practice through the Affordable Care Act and their insurance companies.
Special to The Seattle Times
Beginning in August 2012, the Affordable Care Act required new insurance plans to cover the cost of breast-feeding equipment and counseling by a trained provider. For many plans, the rule went into effect when they were renewed in January 2013.
The law’s language is vague, so experts advise mothers to call their insurance provider to get the names of companies and lactation counselors covered by their plan. Purchases of a breast pump from a retailer like Amazon.com or Target, for example, might not qualify for reimbursement.
In addition, in March 2010 the act began requiring many employers to provide unpaid breaks and a private space — not a bathroom — for women to pump while on the job.
• U.S. Department of Health and Human Services on women’s preventive health benefits: http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html
• National Women’s Law Center on breast-feeding benefits: http://www.nwlc.org/tags/breastfeeding
• Nurturing Expressions in West Seattle: www.nurturingexpressions.com/
New moms crave information, whether it’s car-seat safety ratings, the pros and cons of pacifiers or how best to sooth a colicky infant.
So it’s a little surprising — and potentially troubling to health-care overhaul advocates — that moms aren’t up to speed on how the Affordable Care Act benefits them. The new law has specific requirements targeting moms, including coverage for breast pumps and consultants to help breast-feeding mothers.
But local breast-feeding advocates and new moms alike say that word of these perks has been slow to get out.
“So many moms don’t know about the benefit,” said Cary Seely, director of provider relations at Pumping Essentials, a California-based company selling supplies and services to assist in breast-feeding.
While many of the changes mandated by the Affordable Care Act will benefit low-income Americans by expanding access to health insurance, the Obama administration has tried to build support among a wide swath of the public.
Officials routinely tout reforms included in the new law that are designed to help the middle class.
Among them are provisions that mandate insurance coverage regardless of pre-existing conditions; allow adult kids to stay on their parents’ insurance plans until they’re 26; require free preventive services such as mammograms, colonoscopies and flu shots — and institute the breast-feeding provisions.
But in a recent poll, only 36 percent of Americans surveyed said the law “will make things better” for the middle class, while 49 percent responding said it “will make things worse.”
Still, the news of benefits is trickling out.
When Whitney Courson, of Seattle, was pregnant earlier this year with her first son, a friend advised her that her insurance might pay for a breast pump, which generally costs $200 to $400 for an electric model.
She forgot about the tip, even putting the pump on her baby-gift registry, hoping someone would buy it for her. Then another parent mentioned the benefit at a childbirth class.
This time, Courson called a representative at Premera Blue Cross, her insurance provider through her husband’s job at Amazon.com, and learned it would cover the cost of a breast pump. She bought one and had her baby, Nicholas, in July.
She loves the ability to pump and store milk so that she can bottle-feed her son when she needs to, or so that someone else can feed him in her absence.
“Now I’m telling everybody I know, ‘Call your insurance, this is amazing,’ ” she said.
Breast milk provides so many health benefits to babies that when medical authorities tout the benefits of breast-feeding, it practically sounds like promos for a fictitious miracle drug.
A 2011 report from the U.S. Surgeon General states that breast-feeding boosts an infant’s immune system and is associated with much lower risks of ear infections, eczema, diarrhea and vomiting, Type 2 diabetes, obesity, asthma, two types of leukemia and even sudden infant death syndrome or SIDS. Babies who are not breast-fed are 257 percent more likely to be hospitalized for lower respiratory tract diseases.
And those are just the perks for the babies. Studies suggest that mothers who breast-feed their children appear to have a lower risk of ovarian and breast cancers and postpartum depression.
Based on the landslide of pro-breast-milk evidence, numerous prominent health advocates and organizations have recommended that public policy encourage breast-feeding, ideally until a child is a year old.
And many women say they plan to breast-feed but find it difficult to follow through. Research from 2007 showed that 75 percent of mothers breast-fed their newborns, but only 43 percent were able to stick with it by six months. By one year, only 22 percent were breast-feeding. And these numbers include babies who may have received formula or other food in addition to breast milk.
“We have to get everybody access to really good breast-feeding support, whatever socioeconomic status or race,” said Tracy Corey, a board-certified lactation consultant and owner of West Seattle’s Nurturing Expressions, which provides breast-feeding equipment. “We are falling short.”
“A business case”
Breast-feeding advocates argue that there could be significant economic savings with an increase in the practice. A 2010 study concluded that if 80 percent of U.S. moms exclusively breast-fed their children until they were 6 months old, the nation would save more than $10 billion per year in pediatric medical costs.
Add to that what businesses and families save when parents don’t have to stay home to take care of sick kids.
“There is a business case for breast-feeding for sure,” said Seely, of Pumping Essentials. “Companies have a vested interest in this as well.”
While breast-feeding is associated with lower risks of disease and hospitalization — which should save insurance companies money over time — it will take a while for those savings to be realized.
There is also a possibility that the breast-pump benefit could drive up the devices’ cost, though insurance companies will try to lock in the best prices that they can. And there is the waste stream that likely will be created by all of the used, unwanted pumps once a mother is finished nursing.
To cover the cost of the benefits now, insurers may choose to nudge premiums higher. The real question is whether the savings from fewer sick moms and babies would eventually be passed on to consumers.
“Whether good public-health preventative practices actually lower costs in the long run is a debatable point,” said Aaron Katz, a principal lecturer at the University of Washington’s School of Public Health.
“They’re the right thing to do,” he said, because they improve people’s lives. But whether preventive programs can be linked to reduced health-care costs to consumers and insurers, “it’s hard to make that connection.”
The Affordable Care Act provision supporting breast-feeding went into effect for new health-insurance plans a year ago, but many plans didn’t incorporate the benefit until January 2013, when they were renewed.
One hurdle to more widespread use of the provision is the vague language used to describe it, leaving insurance companies to come up with their own interpretations of what it means.
Many plans require women to purchase their supplies from an approved medical-device provider, while other others will allow a mom to get reimbursed for a purchase made anywhere. Some will pay only for a handheld, nonelectric device, while others cover more premium pumps. The rule is even more unclear on the lactation-support provision, with no definition of who is qualified to assist a woman trying to breast-feed.
Generally speaking, Premera’s plans will pay for the purchase of a standard, electric pump or a yearlong rental of a hospital-grade pump if each comes from an in-network provider. The company also covers lactation counseling from licensed, approved practitioners.
Subscribers “are pleased when they hear they get this coverage and there is no expense on their part,” said Nicola King, spokeswoman with Premera Blue Cross.
As many moms do, Courson initially found breast-feeding difficult. She again turned to her insurance provider.
“I was so concerned about doing everything perfectly and not doing anything wrong,” she said. “I had so many questions and concerns. I wanted to see a lactation consultant so I called insurance just to see.”
Courson learned that she had coverage for counseling, and found a provider who would visit her home. Now more than a month after delivering Nicholas, breast-feeding is going well.
“Knowing this kind of care is available and covered ... that is huge,” Courson said. “Everybody should know about it.”
Lisa Stiffler, a Seattle freelance writer, can be reached at email@example.com. This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation, a health-policy research and communication organization that is not affiliated with Kaiser Permanente.