Executive Summary

Professional lactation support can help mothers initiate and continue breastfeeding, yet a new report shows that at least 20 insurance companies are not offering the Affordable Care Act’s (ACA) breastfeeding benefits.

• In 2011, 79% of U.S. newborn infants started to breastfeed. However, breastfeeding did not continue for as long as recommended. Data indicate that of infants born in 2011, 49% were breastfeeding at six months, and 27% were breastfeeding at 12 months.
• The new report, prepared by the National Women’s Law Center, identifies at least 20 insurance companies that are not offering ACA breastfeeding benefits. It highlights troubling trends in insurance company compliance that are likely to be systemic nationwide, such as limiting coverage of breast pump purchases and failing to have lactation counselors in network.

Breastfeeding rates continue to rise. In 2011, 79% of U.S. newborn infants started to breastfeed, according to the Centers for Disease Control and Prevention.¹ However, breastfeeding did not continue for as long as recommended. Data indicate that of infants born in 2011, 49% were breastfeeding at six months, and 27% were breastfeeding at 12 months.¹ Professional lactation support can help mothers initiate and continue breastfeeding, yet a new report shows that at least 20 insurance companies are not offering the Affordable Care Act’s (ACA) breastfeeding benefits.²

The report was prepared by the Washington, DC-based National Women’s Law Center (NWLC). It highlights troubling trends in insurance company compliance that are likely to be systemic nationwide, such as limiting coverage of breast pump purchases and failing to have lactation counselors in network.

Denying women certain breastfeeding benefits is a clear violation of the law, and women are experiencing the consequences every day, stated Gretchen Borchelt, NWLC vice president for health and reproductive rights.

“The Affordable Care Act has made dramatic improvements in women’s health coverage,” noted Borchelt. “If insurance companies fail to comply, they are illegally blocking further progress toward helping women breastfeed successfully.”

What the law covers

According to a breastfeeding toolkit developed by the Center, the ACA calls for new health plans to cover breastfeeding equipment and supplies without cost-sharing “for the duration of breastfeeding.” Plans may not apply any co-payment, co-insurance, or deductible to the benefits. (You can download the toolkit and other resources at the web site http://bit.ly/1pw9hMw.)

The terminology “breastfeeding equipment and supplies” most commonly refers to a breast pump and related accessories. Breast pumps often are used to express milk that can be stored after mothers have returned to work, are traveling, or have to be away from their breastfeeding child. Employers are required to provide a clean, private place for women to pump while on the job.

According to the NWLC, while a health insurer must cover breastfeeding equipment and supplies, it can impose some requirements on this coverage, such as requiring a purchase, rather than rental, of a breast pump.

What the report found

In its new report, the NWLC assessed coverage of breastfeeding support and supplies by analyzing coverage offered on health insurance marketplaces during 2014 and 2015 in 15 states (Alabama, California, Colorado, Connecticut, Florida, Maine, Maryland, Minnesota, Nevada, Ohio, Rhode Island, South Dakota, Tennessee, Washington, and Wisconsin). It supplemented its review with real-life situations reported through the Center’s CoverHer nationwide hotline [(866) 745-5487 or prevention@nwlc.org].

Analysts found that some insurance plans put unallowable limits on coverage, such as:

• allowing women to get lactation services only within two months of delivery;
• not covering a breast pump until after the baby is born;
• not allowing women to obtain breastfeeding services out-of-network without out-of-pocket costs when in-network services are not available.

The information from the NWLC CoverHer hotline was “crucial” in terms of understanding problems women are facing in obtaining coverage for breastfeeding benefits, says Anna Benyo, NWLC senior health policy analyst.

“Women report spending hours trying to get clear answers from their insurance companies or preparing an appeal,” says Benyo, who served as lead author of the current report. “Our research found ACA violation in the plan documents themselves, and then women who contact our hotline verify that they encounter the same problems when they try to use their coverage. This on-the-ground information has been very helpful in documenting the state of breastfeeding coverage and in our advocacy efforts at the state and federal levels.”

According to Benyo, the Center is working with government regulators who oversee insurance plans to ensure that they comply with the ACA legislation. “We want to make sure that insurance companies remove unallowable limits on coverage and create a network for women to access breastfeeding benefits at no cost-sharing, as required by law,” states Benyo. “At the same time, we know federal guidance detailing breastfeeding coverage falls short of what women need to breastfeed successfully. At the federal level, we are advocating for better coverage standards.”

REFERENCES

1. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Breastfeeding Report Card. United States/2014. Web: http://1.usa.gov/UNKkRy.
2. National Women’s Law Center. State of breastfeeding coverage: Health plan violations of the Affordable Care Act. Web: http://bit.ly/1AyZqPv.