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Wed March 20, 2013
Law Says Insurers Should Pay For Breast Pumps, But Which Ones?
Originally published on Wed March 27, 2013 7:30 am
Pediatricians and health officials are eager to encourage breast-feeding as one of the best and most economical ways to protect a baby's health.
To that end, the federal Affordable Care Act requires that health insurance plans provide new mothers with equipment and services to help make those feedings easier.
But the law doesn't specify what kind of breast pump must be provided, and that's causing problems for nursing mothers, critics say. The inexpensive manual pumps that some insurers offer aren't speedy, efficient or comfortable enough to be practical, according to many working moms.
Megan Lopez, for example, works full time as a customer service representative at the OnPoint Community Credit Union in Portland, Ore. She has a 9-month-old baby whom she hopes to nurse for at least a year.
Lopez at first used a borrowed electric pump, but had to return that when her friend had another child. A colleague mentioned the health law's requirements to Lopez, and said his wife's insurance company had given his wife an electric pump.
But when Lopez contacted her insurer, Kaiser Permanente, she got a different answer. The Kaiser representative told her that the plan would be authorizing reimbursement for a manual pump.
"And I said, 'Really? 'Cause that's not even possible if you're working full time," recalls Lopez, who says she gets only a short break at work to express milk for her baby. "I was pretty bummed out."
Lopez says using a hand pump would require twice as much time as an electric or battery-powered variety.
"It already takes my whole break to pump, as it is, with an electric pump on both breasts," she says. "So to use a hand pump and do it on each side — I couldn't even imagine it'd be convenient."
Dr. Kimberly Luft, a pediatrician with Kaiser Permanente, says the insurer would cover an electric pump if it were deemed a medical necessity. But manual pumps meet the basic needs of most moms, Luft says. She suggests women work with their employers to find enough time to use the devices.
OnPoint issued a statement affirming its support for nursing mothers, and said the company is committed to making it easy and comfortable for women to pump during the work day. Lopez says she has no problem with her employer, and doesn't want to take a longer break if that means forcing her colleagues to pick up the slack.
Luft says that for Kaiser Permanente, the decision of which pump to provide comes down to money and fairness to other patients in the same medical plan. High-end electric pumps can cost hundreds of dollars, while a manual version can be had for about $35.
"We have limited resources, and we have to be good stewards with those resources so that people's premiums don't go high," she explains. "But we're still giving everyone the basic medical care that they need." It's a balancing act, Luft says. "And it's hard."
But Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, says the law simply isn't specific enough. She wants the federal government to set sharper minimum guidelines that allow less wiggle room for insurance companies.
"We are looking to the agency to clarify what it actually means so that women will be able to get the kinds of equipment ... that will work for them," Waxman says.
Mayra Alvarez, director of public health policy in the Office of Health Reform at the Department of Health and Human Services, says the health law as written already allows plans "reasonable strategies to manage their costs" for breast pumps, but intends that doctors have the final say about what equipment new mothers get.
"Health plans must cover what a doctor finds to be medically appropriate for his or her patient," she says.
RENEE MONTAGNE, HOST:
As of this year, a new part of the Affordable Care Act went into effect. It requires most insurance plans to provide support for breast-feeding. In most cases, that the cost of a breast pump will be covered. But what the law does not say is what kind of pump - and that's leading to some confusion.
Kristian Foden-Vencil of Oregon Public Broadcasting, reports.
KRISTIAN FODEN-VENCI, BYLINE: Megan Lopez grew up in Portland and works at the OnPoint Credit Union. It's her job to take phone calls and help customers with their finances. She has a nine-month old and works full time, so she needs a breast pump. Since she wants to breast-feed for at least a year, she was pleased to learn about the new federal health care law.
MEGAN LOPEZ: I was excited because I said this is perfect. I can get a new breast pump and I need one.
FODEN-VENCI: A friend loaned her one, then promptly got pregnant and needed it back. Lopez learned about the free pump from a co-worker, whose wife has Providence Insurance.
LOPEZ: He said: Yeah, she's able to get an electric pump. No problem. They're paying for the whole thing. Like, that's awesome. So I called Kaiser, who I have, and they said: We're providing a manual pump. And I said, really?
LOPEZ: 'Cause that's not even possible if you're working full-time. So I just said, OK, whatever, I'm not going to get that. 'Cause it's not really going to work for me. So I was pretty bummed out.
FODEN-VENCI: She says electric pumps are high powered and supposed to simulate a nursing child, whereas, she finds manual pumps weak and clumsy.
LOPEZ: It already takes my whole break to pump as it is with an electric pump on both breasts. So it's - to do a hand pump and do it each side, I couldn't even imagine it'd be convenient.
FODEN-VENCI: A high-end electric-powered pump can cost $300, whereas a manual one can be $35. Different health plans are providing different pumps.
Dr. Kim Luft is a pediatrician with Kaiser Permanente. She says manual pumps meet the basic needs of moms, but...
DR. KIM LUFT: If there's any medical issues going on where a electric pump would be a medical necessity, then we would order it. And if she's having an issue of not having enough time at work, then seeing if she could talk with her employer about the Oregon law that allows time for breast-feeding, so she could get the time she needed.
FODEN-VENCI: Lopez has no problem with her employer, OnPoint. She says she doesn't want to take extra time and leave her workmates to cover for her.
OnPoint issued a statement saying it supports nursing mothers and is committed to making it easy and comfortable to pump during the work day - consistent with wage and hour laws.
Meanwhile, Kaiser says helping new mothers breast feed is one of its priorities, too. But its own literature says manual pumps don't increase milk supply for most women.
Kaiser pediatrician, Dr. Kim Luft, says essentially it comes down to money.
LUFT: We have limited resources and we have to be good stewards with those resources so that people's premiums or taxes don't go high. But we're still giving everyone the basic medical care that they need and it's a balancing act. And it's hard.
FODEN-VENCI: The confusion comes from the fact the law isn't specific about what insurers need to cover. Judy Waxman, of the National Women's Law Center, says the U.S. Department of Health and Human Services needs to step in.
JUDY WAXMAN: We are looking to the agency to clarify what it actually means, so that women will be able to get the kinds of equipment that they actually need and will actually work for them.
FODEN-VENCI: Myra Alvarez is with the U.S. Department of Health and Human Services. In a statement recorded by the agency in response to NPR's questions, she says the Affordable Care Act is helping take medical decisions out of the hands of insurance companies and putting them in the hands of women and their doctors.
MYRA ALVAREZ: The regulations give health plans the flexibility to decide whether to pay for women to purchase or simply rent a breast pump and plans are allowed to use reasonable strategies to manage their costs.
FODEN-VENCI: Meaning they can provide a manual pump instead of an electric one if it saves money. But, she says, it's doctors who have the final say.
ALVAREZ: Health plans must cover what doctors find to be medically appropriate for his or her patient.
FODEN-VENCI: The Department of Health and Human Services says breast-feeding is important since it helps reduce the risk of some illnesses, such as ear infections and asthma.
For NPR News, I'm Kristian Foden-Vencil in Portland.
MONTAGNE: And this story is part of a reporting partnership between NPR, Oregon Public Broadcasting, and Kaiser Health News. Transcript provided by NPR, Copyright NPR.