Democratic Congresswomen Ask HHS for Answers on Breastfeeding Coverage
Washington, DC,
June 10, 2015
For women who choose to breastfeed, this landmark legislation requires insurance companies to provide access to critical coverage of breastfeeding equipment, support, and counseling at no cost. Sadly, recent reports demonstrate a failure by some insurers to comply with ACA requirements. Needless to say, this is deeply troubling and simply unacceptable.
Washington, D.C. – Congresswomen Gwen Moore (WI-04), Suzanne Bonamici (OR-01), and Debbie Wasserman Schultz (FL-23) sent a letter to Department of Health and Human Services Secretary Sylvia Burwell asking for clarification regarding insurance coverage of breastfeeding services. Recent reports find some insurance companies are not complying with the Affordable Care Act (ACA), which requires health insurance companies to provide full coverage for breastfeeding services and supplies. “Thanks to the Affordable Care Act, more American mothers are able to secure improved health outcomes for themselves and their newborn children. For women who choose to breastfeed, this landmark legislation requires insurance companies to provide access to critical coverage of breastfeeding equipment, support, and counseling at no cost. Sadly, recent reports demonstrate a failure by some insurers to comply with ACA requirements. Needless to say, this is deeply troubling and simply unacceptable. We ask that the Department of Health and Human Services ensure that health plans are fully compliant with the ACA in regards to breastfeeding services so that insurance companies can join us as partners in ensuring that our nation’s families are afforded every chance to live happy, healthy lives,” Congresswoman Gwen Moore said. “Breastfeeding is one of the most effective preventive health measures for mothers and children,” Congresswoman Bonamici said. “The benefits to both the child and mother are well-documented, but without easy access to a breast pump or to breastfeeding consultation some mothers cannot continue to nurse. For working or low-income mothers the cost hurdle can be especially difficult. In this letter my colleagues and I urge Secretary Burwell to enforce the ACA so that no woman has to forgo breastfeeding because she cannot afford a breast pump or the counseling services.” “As a mother who has nursed three children, I know the importance of breastfeeding as well as the challenges. All women deserve access to the services and support they need to breastfeed, if they decide to do so. By mandating comprehensive coverage for women’s health needs including breastfeeding, the Affordable Care Act was a monumental step toward providing this access. I am proud to stand with my colleagues to encourage and support HHS in ensuring compliance with a coverage provision so significant to the health of women and babies,” Congresswoman Debbie Wasserman Shultz said. The letter is below. Honorable Sylvia Mathews Burwell Secretary Department of Health and Human Services 200 Independence Ave SW Washington DC 20201 Re: Provide Guidance on ACA Mandate for Coverage of Lactation Services and Supplies Dear Secretary Burwell: As Members of Congress passionate about the health of women and children, we appreciate your leadership on this issue and in implementing the Affordable Care Act (ACA). As you well know, the ACA mandates that insurance providers cover lactation services and supplies for new mothers without cost-sharing. This mandate is an important step forward in ensuring all mothers have services and equipment they need to care for new babies. However, as highlighted in recent reports, insurance companies are not uniformly providing coverage for these services, thereby, making it difficult for millions of women to access this important care. To ensure that these benefits are made available to women as the ACA requires, we respectfully request the Department of Health and Human Services (HHS) immediately issue guidance to clarify that these services be covered by insurance plans. The ACA made dramatic improvements to women’s health care by ending discriminatory health insurance practices and making health coverage more affordable and easier to obtain. The ACA’s coverage of breastfeeding equipment, support, and counseling is an important new insurance benefit that has the potential to increase access to breast pumps and lactation counseling for women who choose to breastfeed. Research documents the significant health benefits of breastfeeding. According to the U.S. Surgeon General, breastfeeding protects babies from infections, illnesses, asthma, and reduces the risk of sudden infant death syndrome. Although many new mothers plan to breastfeed, they often encounter complications that prevent them from breastfeeding for as long as they planned. After reviewing the clinical evidence, the Institute of Medicine recommended that women receive comprehensive lactation support, counseling, and access to breastfeeding equipment as part of the ACA’s coverage of a range of preventive services. Unfortunately, recent reports indicate that insurance companies are not complying with the ACA’s requirements to provide coverage of breastfeeding support and supplies with no cost-sharing. Two reports by the National Women’s Law Center, the State of Women’s Coverage: Health Plan Violations of the Affordable Care Act, and a companion report, the State of Breastfeeding Coverage, document troubling trends based on an analysis of coverage documents and stories from women trying to access the breastfeeding benefits that they are entitled under the ACA. It is especially concerning that inadequate access to lactation counseling adversely affects low-income women and infants, and, in many cases, makes it exceedingly difficult for them to gain the health benefits of breastfeeding. It is clear from these reports, and from constituents who contact our offices, that some insurance companies either fail to comply with the ACA’s breastfeeding coverage requirements or do not have guidance from HHS that clarifies the requirement to cover lactation services and supplies. At the same time, recent materials from HHS show that coverage standards fall short of what women need. These coverage gaps could be remedied with clear federal guidance explaining the scope of the ACA’s breastfeeding coverage provisions. Accordingly, we request that you: • Ensure that Qualified Health Plans in states that use federal certification are fully compliant with the lactation services and supplies requirement; • Encourage states to enforce the ACA’s lactation services and supplies requirement; • Educate insurers about their obligation to make breastfeeding supports available without cost-sharing, including through out-of-network providers when the plan has not established a network of lactation providers; • Engage with key stakeholders to reexamine coverage standards, such as the public facing materials that allow plans to provide coverage for a manual breast pump, and develop new guidance that ensures the benefit actually meets women’s needs; and • Increase consumer education and awareness about the benefits of the ACA, including breastfeeding coverage, so more women can access these important benefits and can appeal insurance company decisions if their plan does not comply with the law. We applaud the steps HHS has already taken to implement the ACA, and we encourage the Department to take whatever further action may be necessary to ensure that women receive the breastfeeding benefits guaranteed by law. We look forward to collaborating with you on behalf of all women who need access to these crucial healthcare services. ### |
