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Spokane, Washington  Est. May 19, 1883
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Breastfeeding boosted by Affordable Care Act

Amber Williams, with her daughter, Isabelle, prepares her breast milk to be stored in the freezer for later feedings. The Affordable Care Act now requires health care insurers to cover breastfeeding support, including supplies and counseling. (Colin Mulvany)
Amber Williams, with her daughter, Isabelle, prepares her breast milk to be stored in the freezer for later feedings. The Affordable Care Act now requires health care insurers to cover breastfeeding support, including supplies and counseling. (Colin Mulvany)

Amber Williams has joined the ranks of working moms.

Williams, whose daughter, Isabelle, is 4 months old, recently returned to her job as manager of a Spokane bank, where she takes short breaks throughout the workday to express breast milk for her daughter.

Many moms like her stand to benefit from a provision of the Affordable Care Act that requires insurers to cover the costs of renting or purchasing breastfeeding supplies, plus support and counseling.

Williams’ insurance covered her double electric pump, which would have cost hundreds of dollars out of pocket.

“It was huge,” she said. “It was a big relief and, of course, it freed up money to buy the other big things that insurance doesn’t pay for.”

She added: “Knowing that I had access to a good pump also encouraged me to breastfeed longer, rather than switching to formula when I went back to work.”

Following the passage of the law, medical equipment providers and manufacturers are scrambling to keep up with the demand for breast pumps. Meanwhile, insurers are working to figure out how to implement the rule.

“It’s a good thing,” said Colleen Dehle, nurse manager at the Birth Place and Women’s Outpatient Services at Providence Sacred Heart Medical Center. “Exclusive breastfeeding has so many benefits. This really aids in that.”

Sacred Heart reports an 18 percent increase in mothers seeking lactation consultation since the beginning of the year. The Care Shop, an on-site medical equipment provider, has seen an increase of 92 percent in retail breast pump purchases.

The sharp increase is likely because most insurance companies require their members to get pumps from a durable medical equipment provider, rather than a retailer such as Babies “R” Us or Target, said Julie Mowreader, operations manager for the Care Shop. Only about five medical equipment providers in the Spokane area offer breast pumps for sale or rent.

“We’re all in this evolving place where we’re trying to define those policies and work within it,” Mowreader said. “Overall I think the need is being met, but we are definitely having growing pains.”

The law took effect Jan. 1 for many plans, though those with grandfathered plans may not be eligible for the benefit. A double electric pump can cost $300. Less-efficient manual pumps can cost as little as $35 but don’t work for all women. The type of pump covered depends on the insurance plan.

Breastfeeding support is treated as preventive care under the law.

“It’s not enough for a doctor or nurse to say ‘breastfeed,’ ” said Dr. Alfred Berg, a professor of family medicine at the University of Washington and chairman of a national task force that made recommendations for the new law. “Breastfeeding really only happens if there’s enough support, education and training, and accessibility. The evidence is pretty clear. If you want to support breastfeeding, you have to do all these things.”

Although breastfeeding is the most natural option for babies, successful breastfeeding doesn’t always come easily and many women experience complex barriers. Breastfeeding rates sharply decline in the weeks and months after delivery.

That’s why it’s crucial for women to have access to support, said Lisa Mertens, assistant nurse manager of the Birth Place and Women’s Outpatient Services.

“There’s a learning curve for moms and babies,” Mertens said.

Williams wasn’t always sure she was going to breastfeed her baby, but a breastfeeding class her insurance paid for changed her mind.

“The class made all the difference,” she said. “I thought, ‘OK, this isn’t scary.’ ”

The new law also requires employers to provide time and space for nursing moms to express milk, but Washington already had a state law requiring companies to do so.

“Exactly where this will all go is a good question,” said Berg, the UW professor. “Breastfeeding has been a core part in what obstetricians and family doctors and pediatricians have been recommending for 30 years, but we’ve often run into problems because the workplace doesn’t support it, women can’t afford the breast pumps, a variety of things happen. If investing in breastfeeding in this way helps move the needle a little bit, that would be a good thing.”

The United States would save an estimated $13 billion a year if 90 percent of moms exclusively breastfed for six months, because breastfed infants typically need fewer sick care visits, prescriptions and hospitalizations, according to a 2010 study in the journal Pediatrics.

Medicaid expansion, another part of the Affordable Care Act, means more women will get coverage for breastfeeding supplies and counseling. Washington, along with 31 other states, already offered breast pump coverage through Medicaid.

“Most countries are way ahead of us on this topic,” Berg said. “The United States always does things in its own way and will implement this in its own way, and it will be interesting see what the consequences are.”

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