Under Obamacare, insurance companies provide more breast pumps

The 2010 Affordable Care Act (ACA) may have helped more women in the United States breastfeed as a result of its coverage of breast pumps, suggests a new study.

Among women in Maine with private insurance, the number of claims for breast pumps rose 11-fold after the law’s breastfeeding provisions took effect.

“Something that is a pretty small provision has really made a big impact,” said lead author Summer Hawkins, of the Boston College School of Social Work.

The ACA - better known as Obamacare - contains two breastfeeding provisions, Hawkins and colleagues write in the American Journal of Public Health. It requires employers to provide women with breastfeeding time and a space to pump, and it requires private insurance companies to completely cover the cost of lactation support counseling and equipment rental.

Breastfeeding coverage began to take effect as early as 2012 for some plans, they add.

“I was really intrigued that in early 2013 that there were these blog posts coming out about these national shortages of breast pumps due to the Affordable Care Act,” Hawkins told Reuters Health.

Pediatricians recommend that mothers exclusively breastfeed infants until at least 6 months of age because it is tied to reduced risk for babies of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.

Mothers may benefit too, with longer periods of breastfeeding linked to lower risks of depression, bone deterioration and certain cancers.

To see if there was a link between implementation of the ACA breastfeeding provisions and an increase in breastfeeding services, Hawkins’ team examined insurance claims data from Maine from 2012 through 2014.

Over the entire study period, the researchers found only 11 claims for breast pumps among women on Medicaid, the state and federal health insurance program for the poor. Medicaid does not cover the pumps.

Meanwhile, they found 70 claims for breast pumps among women with private insurance in the third quarter of 2012. That number rose to 629 a year later and to 803 in the third quarter of 2014.

“The next quarter this was offered, you saw an uptick,” said Hawkins of the claims for pumps. “Then the next quarter, you saw even more.”

There was no increase in claims for lactation services. Hawkins said that part of the regulations may not have been as clear for insurance companies.

The results are not surprising, said Diane Spatz, director of the Lactation Program and Mothers’ Milk Bank at the Children’s Hospital of Philadelphia.

“We certainly know that access to breast pumps improved for some people in some populations with the Affordable Care Act, but it’s not universal,” said Spatz, who is also affiliated with the University of Pennsylvania School of Nursing in Philadelphia.

Spatz, who wasn’t involved with the new study, pointed out that claims did not increase among women on Medicaid, who are already less likely to start breastfeeding.

Spatz told Reuters Health that the legislation doesn’t specify what type of pump must be covered by insurance. But Hawkins noted that the vast majority of claims have been for electric or hospital-grade devices, which are generally preferable to manual pumps.

The data from Maine don’t necessarily reflect what is happening in other states, Hawkins said. And her team can’t say whether more women were actually breastfeeding once they got their pumps.

If efforts to repeal the ACA are successful and breastfeeding coverage is lost, the claim rates won’t continue to increase, Hawkins predicts.

“I think it would sort of roll back to what it was,” she said.

SOURCE: American Journal of Public Health, online May 18, 2017.