Report identifies troubling trends in insurance company compliance with ACA’s breastfeeding benefits

A recent report from the National Women’s Law Center (NWLC) has identified several troubling trends in insurance company compliance with the Patient Protection and Affordable Care Act’s (ACA) breastfeeding benefits. NWLC found violations such as limiting coverage of breast pump purchases and failing to have in-network lactation counselors.

Breastfeeding benefits. The ACA’s breastfeeding benefits are part of the law’s preventive health services coverage provision. This provision requires health insurance plans to provide coverage for certain preventive services without out-of-pocket costs, including a new set of preventive services for women. The ACA requires health plans to cover breastfeeding support and supplies without copayments, deductibles, or coinsurance, for the duration of breastfeeding. The ACA requires this coverage for most employer health insurance plans, individual health coverage purchased on insurance Marketplaces operating in each state, and Medicaid enrollees who are newly eligible as part of a state’s decision to adopt the ACA’s Medicaid expansion.

NWLC report. The report, State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act, assessed the coverage of breastfeeding support and supplies by analyzing coverage offered on health insurance Marketplaces in 15 states during 2014 and 2015 and supplemented this review with evidence gathered through the NWLC’s CoverHer hotline.

The NWLC identified three major trends that prevent women from accessing breastfeeding benefits:

  • Some insurance companies impose restrictions and limitations on breastfeeding support and supplies, which explicitly violate the ACA or undermine the intent of the law;
  • Some insurance companies do not have a network of providers for women to get lactation counseling and are not following clear federal rules that allow women to obtain preventive services, including breastfeeding benefits, out-of-network, at no cost-sharing; and
  • Some insurance companies impose major administrative barriers or offer insufficient coverage that prevents women from obtaining timely breastfeeding support and adequate equipment, as envisioned by the ACA.

“Denying women certain breastfeeding benefits is a clear violation of the law, and women are experiencing the consequences every day,” said Gretchen Borchelt, NWLC Vice President for Health and Reproductive Rights. “The ACA has made dramatic improvements in women’s health coverage. If insurance companies fail to comply, they are illegally blocking further progress toward helping women breastfeed successfully. Everyone involved, from insurance companies to federal regulators, must work together to ensure that breastfeeding coverage fulfills the promise of the ACA.”

Based on these findings, NWLC is calling on insurance companies to come into compliance with the law and state and federal regulators to provide better oversight and enforcement. NWLC is also calling on federal regulators to consult with stakeholders—breastfeeding experts, the medical community, advocates, and insurance companies—to further develop and enforce federal standards for breastfeeding coverage that take into account the best evidence on helping women establish and maintain breastfeeding.

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