Obamacare and Your Breasts: Overcoming the Challenges- by Joy Kosak
August marks the one-year anniversary of the Affordable Care Act (a.k.a. Obamacare) provision that offers new moms breast-feeding support and supplies for free. Given that mothers are the fastest-growing segment of the U.S. workforce, with 56 percent having children younger than age 3, this impacts many women on a national scale. However, the Obamacare provision offers very little direction about breast-pump specifications or lactation support details, leaving open-ended questions for everyone involved, including insurance providers and new mothers.
As the manufacturers of a very popular hands-free pumping bra, my sisters and I were excited about the Affordable Care Act. The lightbulb went off when we realized there was an opportunity to give moms a complete tool kit to help drive their breast-feeding success. When considering all the pieces that will help a new mom, as this provision aims to do, it’s not a matter of simply handing her a breast pump with a book of instructions; it’s about providing a well-rounded package that will help both mothers and babies reap the benefits of breast-feeding. Mothers who breast-feed are at less of a risk for postpartum depression, several types of cancer, heart disease, and type 2 diabetes. Breast-fed babies tend to experience fewer ear, respiratory, and gastrointestinal infections. Not to mention, breast-feeding creates a special bond between the mother and her child.
As mothers ourselves, we were thrilled when the provision passed. However, entrenched in the industry, we were also able to anticipate the many challenges that exist in implementing this provision.
Challenges for Insurers
Although many insurance providers are doing their best to meet the demands of this new benefit for their members, there are some challenges. For example, due to the vague language in the Affordable Care Act around this benefit, insurance plans can interpret how they provide it in a number of ways. Some are choosing to offer only a manual breast pump to every mother regardless of her situation. To complicate matters, further many insurance plans do not recognize a certified lactation consultant (IBCLC) as a professional who can offer breast-feeding support services, as they do not have the credentials recognized to bill within the insurance ecosystem. These issues will get worked out eventually, but in the meantime, it creates a frustrating and cumbersome process for new moms.
Obstacles for New Moms
When a new mother wants to obtain a breast pump, she calls her insurance provider to learn what exactly she qualifies for. Many customer-facing representatives within insurance plans are unclear on this benefit, resulting in miscommunication to the mother. Does new mom pay out of pocket? Will the provider pay? Does the new mom submit the paperwork? With such undefined answers and confusion internally, a mother may call and hear one thing, only to call back and hear something completely different when she speaks to a different representative.
Many new moms who try to take advantage of the Obamacare provision are given a list of durable medical equipment providers (DMEs) to call and find a breast pump. This could be as long as 10 to 100 contacts that may or may not offer breast pumps. The inefficient and roundabout process of obtaining a free breast pump has left many new moms frustrated and discouraged.
Additionally, because a breast pump is just another SKU in the system for many durable medical equipment providers, there’s no guidance or continued support as the new mother learns to express, store, and utilize her milk, even though Affordable Care Act mandates “breast-feeding support.”
Bridging the Gap to Serve a Real Need
The Centers for Disease Control found that 75 percent of new moms initiate breast-feeding, but only 33 percent continue past 3 months, and by 6 months that number drops to 13 percent. The need here is tangible: obtaining a pump shouldn’t be such a hindrance, and there should be more support.
My sister and I launched Pumping Essentials to be the central point of contact for these moms so we can translate what they’re actually eligible for under the Affordable Care Act when looking at their specific health-insurance plan. We carefully considered how we could provide clarity at a time of confusion and maximize these benefits for new mothers at no additional cost.
Aiming to serve as the middle-man between new moms and their insurance provider, our mission is to help new moms obtain the best breast pump for their individual needs bundled with the value added accessory of a hands-free pumping bra, a key tool that provides the convenience of being able to multitask while pumping, which is so important to today’s busy mom.
Another key piece of implementing this provision is providing adequate breast-feeding education, which is exactly what Pumping Essentials is aiming to offer. What is the first step once you get the pump out of the box? How often should I pump? How do I communicate to my caregiver as I hand her a cooler filled with breast milk? These are a few of many questions that could come up for a breast-feeding mother. Through our partnership with Isis Parenting, new moms can access self-driven two-hour online educational class and weekly real-time support through an online webinar to ask questions of a breast-feeding professional and other mothers in a group setting. Isis has been a leader in newborn and breast-feeding education for the past 10 years. Our partnership will enable moms to obtain the knowledge they need to reach their breast-feeding goals.
In addition to helping moms obtain a breast pump and counseling, we provide a Simple Wishes hands-free pumping bra. A Facebook survey found that 100 percent of moms are more productive and less stressed after returning to work. Mothers responded saying that 68 percent would have given up on their breast-feeding goals without a hands-free bra to make the process easier.
In light of the fact that the provision does not define what type of pumps insurance providers must provide, and many insurance companies put margin before member need, some moms are ending up with less-than-satisfactory models that could result in degradation to their breast-milk supply. For example, a vast majority of lower-end breast pumps don’t offer multiple breast shield sizes. If the shield doesn’t fit, it can create blisters or other trauma to the breast tissue. A variety of shield sizes is just one key element of a good breast pump, and there are many others to consider. We’ve partnered with the leading breast pump manufacturers so that each mom gets the type of pump she needs, even if it means making a lower margin.
Coming from a family of nine breast-fed children, it was never a question for me whether I would breast-feed. But not everyone is as lucky to have the support and encouragement my sisters and I had. My personal mission and the mission of all women should be to be supportive of other women, not only of their success, but of the fact that they’re trying. This provision is a step in the right direction, and we hope that with our help more moms can achieve their personal breast-feeding goals.