March 9, 2015 — While many women are benefiting from Affordable Care Act (PL 111-148) provisions that improve breastfeeding-related health coverage and support workers who breastfeed, some women still struggle to access such benefits for a variety of reasons, Politico Pro reports.
U.S. breastfeeding rates have increased steadily since 2002, and about 79% of babies born in 2011 were initially breastfed, according to CDC data. However, only about 25% of women continued breastfeeding their infants for a full 12 months, as recommended by the American Academy of Pediatrics (Mershon, Politico Pro, 3/8).
Breastfeeding Provisions in the ACA
The ACA's preventive services provision, which took effect in 2012, requires insurers to cover a range of services, including comprehensive coverage of breastfeeding equipment and support, without copayments or deductibles (Women's Health Policy Report, 8/1/12).
Further, under the ACA, certain employers are required to provide time and space for women to express breast milk until their child's first birthday. The ACA also stipulates that employers must give women a "reasonable amount of time" to pump or breastfeed; allow them to do so as often as necessary; and provide a private, clean room that is not a restroom.
In addition, if employers compensate other employees for break times, they also are required to compensate women who use their break time to breastfeed or pump. Further, women who work while they express milk must be paid normally, according to the ACA.
However, employers with fewer than 50 workers can qualify for an exemption from the law's breastfeeding requirements if the rules pose an "undue hardship" for the employer (Women's Health Policy Report, 8/7/14).
Some Health Plans Lack In-Network Lactation Consultants
Despite the ACA requirements, many women are still not receiving access to breastfeeding services. According to Politico Pro, one issue is that many health plans do not have lactation counselors or consultants who are in-network (Politico Pro, 3/8).
HHS has told insurers they must cover out-of-network lactation consultants if they do not have a trained provider in their normal network (Women's Health Policy Report, 10/2/13).
However, the National Breastfeeding Center's 2014 scorecard gave only 20 out of more than 100 insurers an "A-" grade or better for the breastfeeding support offered by their plans. According to Politico Pro, many insurers improved the services they offered from the previous year, but 26 insurers scored still received no better than a "D" grade.
Breastfeeding USA Director Genevieve Colvin said, "There's no clear guidance on what good coverage looks like." She added that insurers also do not have an incentive to improve "since they're not required to measure their performance."
National Breastfeeding Center Executive Director Beverly Curtis said that while there had been "quite a bit of progress," there still is "a ways to go." She said, "We need to move forward and get some of these policies a little more evidence-based and more specifically tailored to the needs of mothers."
Curtis added that advocates had made "huge" steps in the past few years and that if there is the same level of progress made in the next three to four years, advocates "should see quite a bit of change, especially with insurers."
Lack of Lactation Consultants, Physician Training
Clare Krusing, an America's Health Insurance Plans spokesperson, said that while insurers are required to comply with the ACA, part of the issue with breastfeeding-related services is that there is a shortage of lactation consultants.
Politico Pro reports that the U.S. has fewer than 15,000 licensed lactation consultants and that some states have fewer than 50 consultants.
In addition, Krusing noted that many physicians -- including obstetricians, gynecologists and pediatricians -- have not received sufficient training related to breastfeeding services.
For example, about one-third of obstetrics and gynecology residents surveyed in a 2014 poll said that they thought they received adequate breastfeeding training. According to Stephanie Mass, who represents gynecologists on the U.S. Breastfeeding Committee, many doctors are attempting to educate themselves about such services.
Some Employers Not Offering Services
Meanwhile, while "[m]any, many employers are doing the right thing" and providing the required services, "all too often ... workers in a range of industries ... are not being accommodated despite the very clear requirements in the ACA to provide that break time," according to Liz Watson, director of the workplace justice program at the National Women's Law Center.
In addition, some employers are imposing "ridiculous" hurdles for women to access such services, she said.
Further, the law's requirements on having access to time and a place to pump at work only apply to hourly workers, according to Politico Pro. Sen. Jeff Merkley (D-Ore.) and Rep. Carolyn Maloney (D-N.Y.) this year plan to reintroduce the Supporting Working Moms Act, which they first proposed in 2013, to expand the rules to apply to salaried employees.
Some Women Not Aware of Breastfeeding Benefits
Meanwhile, many women might not be aware of the ACA's breastfeeding benefits or how to access such services, according to Politico Pro.
Maloney said, "Far too many women are still unaware of their rights. We can and should do more to make sure women know their rights when they return to work and what their health insurance covers as it relates to lactation."
Overall, Curtis said that it would take a collaborative effort. She said, "Everyone can make breastfeeding easier, from the insurer to the doctor to the health care facility and the community. In a sense, it does take an entire village to help a mother breastfeed" (Politico Pro, 3/8).