The XX Factor

Sure It Takes a Village. But Does the Village Have To Buy Breast Pumps?

Kate, I can totally see why people think it’s a great idea to force insurance companies to buy breast pumps. And for the record, I’m entirely on board with making insurance companies pay for birth control, since it will cut down on unintended pregnancies and abortion. It’s mind-boggling that they’ve held out for so long (frankly, I’m surprised all the complaints that insurers cover Viagra but not birth control have not encouraged them to stop covering Viagra).

Supporting free birth control—whether it’s paid for by insurers or the government itself—is one way I differ from many of my fellow conservatives. But when it comes to requiring insurers to pay for breast-pump rental, I’m gonna go full Bachmann. It’s ridiculous.

I say this as someone who breast-fed each of my three sons for a whole year and who got a bruise on my forehead from beating it against the wall after a young single-mother-to-be I knew told me she wouldn’t even try breast-feeding “because WIC will pay for formula.” I loved breast-feeding. When I went back to work after my oldest was born, I loved my breast pump (and yes, I broke the new-mommy rule and BORROWED one from a family member). If insurers want to pay for breast pumps, I’m all for it. I’m glad that least some women on WIC can get breast pumps.

But I can’t get behind requiring a private insurer to provide a device that is rarely medically necessary, to engage in a practice that has dubious claims of health benefits. It’s not just the creeping nanny-state-ism, though that’s admittedly part of it. It’s that it opens the door for so much else. If you can make the case for breast pumps, why not car seats? I mean, by law, every kid needs a car seat. Why not require insurers to buy everyone a Britax? And you can’t just let them sleep on the floor. How about making Aetna send you a voucher for a crib from Pottery Barn?

No, maybe kids don’t need the top-of-the-line car seat or cribs. But according to what I’ve read, insurers aren’t required to just provide any old breast pump. No, they have to cover “renting” breast-feeding supplies. Let’s do this math: The cost to rent a hospital-grade pump is, as you say, anywhere from $1 to $3 a day. Let’s go with $2 a day. That’s close to $750 for a year, and what if the woman has two or three kids? That could be a cost to the insurer of up to $2,200. You can BUY a good electric pump for $250—the Medela Pump In Style that I had worked just as well as the hospital-grade machine I rented for a few weeks—and have it for all your kids. Why the emphasis on the rental? If a new mom breast-feeds for four months—and 70 percent of women DO breast-feed in the early postpartum phase—it’s more cost-effective to buy a pump or at least subsidize it than to pay for a rental. I realize the math makes sense to an administration whose stimulus package cost at least $185,000 per job created, but probably not to many others.

It’s important to focus on the cost, because the insurance companies will. Preventative exams like pap smears and mammograms make sense to insurance companies, not because they mean better care for the patients, though they do, but because they can save the companies money when they don’t have to cover treatment expenses for breast cancer or cervical cancer. But there is no upside to the insurance companies for this, no cost savings elsewhere. Which means that either premiums are going to go up, or other services will be cut. I’m guessing that premiums go up.

I am curious to see how insurance companies respond. Can they offer to buy consumer-grade pumps instead? Can they cut a deal with Medela (does any other company even make breast pumps?) or with hospitals, and require that women who want to have their pumps covered at least get them from the hospital?

It’s always nice to think of things as “free”: free birth control, free health care, free breast pumps. But, of course, nothing is ever free.