NatioNal WomeN’s laW CeNter
12 STATE OF BREASTFEEDING COVERAGE: HEALTH PLAN VIOLATIONS OF THE AFFORDABLE CARE ACT
1 TheAffordableCareActdenes“cost-sharing”toinclude“deductibles,coinsurance,copayments,orsimilarcharges.”
(42U.S.C.§18022(c)(3)(A)(i).)
2 Thisreportusestheterm“insurancecompanies”throughouttorefertobothgroupandindividualhealthplans.
3 Theanalysisencompassesmorethan100publiclyavailablecerticatesofcoverageforQualiedHealthPlansofferedin2014
and/or2015fromAlabama,California,Colorado,Connecticut,Florida,Maine,Maryland,Minnesota,Nevada,Ohio,Rhode
Island,SouthDakota,Tennessee,Washington,andWisconsin.
4 U.S.Dep’tofHealthandHumanSrvcs.,HealthRes.andSrvcs.Admin.,Women’s Preventive Services Guidelines(Aug.1,2011),
Accessedathttp://www.hrsa.gov/womensguidelines/
5 IpS,ChungM,RamanG,ChewP,MagulaN,DeVineD,TrikalinosT,LauJ.BreastfeedingandMaternalandInfantHealth
OutcomesinDevelopedCountries.EvidenceReport/TechnologyAssessmentNo.153(PreparedbyTufts-NewEnglandMedical
CenterEvidence-basedPracticeCenter,underContractNo.290-02-0022).AHRQPublicationNo.07-E007.Rockville,MD:
AgencyforHealthcareResearchandQuality.April2007.
6 Ibid.
7 InstituteofMedicine,“ClinicalPreventiveServicesforWomen:ClosingtheGaps,”(2011),theNationalAcademiesPress.
8 CDCNationalImmunizationSurveys2012and2013,Data,2011births.Accessedathttp://www.cdc.gov/breastfeeding/data/
NIS_data/index.htm.
9 TheSurgeonGeneral’sCalltoActiontoSupportBreastfeeding.OfceoftheSurgeonGeneral(US);CentersforDiseaseControl
andPrevention(US);OfceonWomen’sHealth(US).Rockville(MD):OfceoftheSurgeonGeneral(US);2011.
10 OfceoftheSurgeonGeneral(US);CentersforDiseaseControlandPrevention(US);OfceonWomen’sHealth(US).Rockville
(MD):OfceoftheSurgeonGeneral(US);2011.Accessedathttp://www.ncbi.nlm.nih.gov/books/NBK52688/.
11 TheACA’spreventiveservicesbenets,includingbreastfeedingsupportandsupplies,areimplementedthroughregulationsat
45CFR147.130andfederalguidancefromtheUnitedStatesDepartmentofHealthandHumanServices,DepartmentofLabor,
andTreasuryDepartmentFAQsaboutAffordableCareActImplementation(PartXII).Theserulesapplytomostemployerplans
andtowomennewlyeligibleforMedicaid.
12 WhiletraditionalMedicaidprogramscoverawiderangeofpreventiveservicesforMedicaidenrolleeswithnominalorno
co-payments,theyarenotrequiredtoprovidethisbenetundertheACA.ThismeansthattraditionalMedicaidprograms,
includingpregnancy-relatedcoverage,arenotrequiredtoprovidebreastfeedingsupportandsuppliesbutmanystateschooseto
providethesebenets.Basedona2012surveywith44statesresponding,25statescoveredbreastfeedingeducationservices,
15statescoveredindividuallactationconsultations,and31statescoveredequipmentrentals.
13 UnitedStatesDepartmentofLabor,“FAQsAboutAffordableCareActImplementation(PartXII),”(February20,2013)
Accessedathttp://www.dol.gov/ebsa/faqs/faq-aca12.html.
14 Ibid.
15 45C.F.R.147.130(2014).
16 UnitedStatesDepartmentofHealthandHumanServices,BreastPumpsandInsuranceCoverage:WhatYouNeedToKnow,
updatedSeptember2014.Accessedathttp://www.hhs.gov/healthcare/prevention/breast-pumps/index.html.
17 TheCenterhastalkedtoalactationconsultantinVirginiawhohasaclientwithsignicantarthritisinherhandswhois
unabletooperateamanualbreastpump.
18 KaiserPermanente,offeredinColorado(2014&2015);BlueCrossBlueShieldofMN,offeredinMinnesota(2014).
19 KaiserPermanente,offeredinOhio(2014);HealthSpan,offeredinOhio(2015).
20 UnitedHealthcare,offeredinConnecticut(2015);UnitedHealthcare,offeredinOhio(2015).
21 Aetna,offeredinOhio(2015).
22 UnitedStatesDepartmentofLabor,“FAQsAboutAffordableCareActImplementation(PartXII),”(February20,2013)
accessedathttp://www.dol.gov/ebsa/faqs/faq-aca12.html.
23 InstituteofMedicine,“ClinicalPreventiveServicesforWomen:ClosingtheGaps,”(2011),theNationalAcademiesPress.
24 AnthemBlueCrossBlueShieldofConnecticutandAnthemBlueCrossBlueShieldMulti-StatePlan,offeredinConnecticut(2014
&2015);HealthyCT,offeredinConnecticut(2014&2015);HealthyCTMulti-StatePlan,offeredinConnecticut(2015).
25 AnthemBlueCrossBlueShieldandAnthemBlueCrossBlueShieldMulti-StatePlan,offerinConnecticut(2014&2015).
26 BlueCrossBlueShieldofTennesseeofferedinTennessee(2014).
27 BlueCrossBlueShieldofAlabama,offeredinAlabama(2015).
28 UnitedStatesDepartmentofLabor,“FAQsAboutAffordableCareActImplementation(PartXII),”(February20,2013)
Accessedathttp://www.dol.gov/ebsa/faqs/faq-aca12.html.
Endnotes