Insurance Companies Should Be Investing More, Not Less, in Breastfeeding

A woman holding a breast pump.
Photo illustration by Slate. Photos by Thinkstock.

Breastfeeding is hard enough. We live in the only industrialized nation that doesn’t offer a federal paid maternity leave policy. Even worse, about 25 percent of mothers in the United States return to work just 10 days after giving birth. That means millions of mamas turn to breast pumps to provide their infants with the optimal nutrition for their first year of life and to finish the job our society won’t allow us to complete with our bodies and babies alone.

That makes access to pumps a critical part of maternal and infant health. And a key factor in the nation’s public health landscape writ large. With so much at stake, why would Anthem, a health insurance company that covers more than 40 million people in 15 states, cut the reimbursement rate for breast pumps by 44 percent, just months after the CEO announced record-breaking profits?

On April 1, Anthem health insurance, which operates as Blue Cross Blue Shield in many states, slashed the amount durable medical providers will receive for the breast pumps they provide directly to mothers from $169 to $95. The pumps mothers can access via Anthem will be of a lower quality in terms of motor type, pump strength, filter, and other factors. Lesser quality pumps don’t extract as much milk from the breast or can become incredibly painful, which will inevitably decrease the mother’s milk supply while increasing frustration and disappointment and cutting short the breastfeeding relationship.

In response to my queries about the change, Anthem issued the following statement:

Anthem recognizes the positive health benefits that breastfeeding can have on mothers and their newborns, and we are committed to ensuring new mothers have the information, tools and support they need to successfully breastfeed their newborns. The recent adjustment to the fee schedule for all durable medical equipment, including breast pumps, will not impact the ability of any new mother to access a high-quality, standard double-electric breast pump from our contracted medical suppliers.

However, there was no further information on how Anthem is defining “high quality,” and there was no response to my specific question about whether a physician or medical director was consulted on the policy change.

“More than 85 percent of breastfeeding mothers express breast milk, most of them using a pump for an extended period of time. A lower reimbursement rate for common electric breast pumps could make it difficult, if not near impossible, for moms to have access to the breast pump most suited for their needs,” says Tina Sherman, campaign director at MomsRising, an advocacy organization that has a campaign to pressure Anthem to reverse its decision.

Why cut costs on the backs of helpless infants and mothers who are already struggling with the stresses of motherhood, work, school, and life challenges, and providing economically for their families?

Researchers at Indiana University, the University of Kansas, and the RAND Corp. found that since the Affordable Care Act passed in 2010 mandating that insurance companies provide breast pumps at no cost, 47,000 more infants were breastfed in just one year. The ACA requires large employers to provide reasonable break time and a private place for expressing breast milk as well as mandating coverage of lactation support services and equipment. But now this support has been cut to a minimum.

This how-low-can-you-go approach to breastfeeding support is the antithesis of what insurance companies are actually meant to support —health. Babies who are exclusively breastfed have stronger immune systems and need fewer doctor visits and prescriptions over time. Recent studies have shown if mothers could meet current medical recommendations for breastfeeding it would save the U.S. economy nearly $13 billion per year in pediatric health costs and premature deaths. And what of the health of mothers? Breastfeeding lowers a mother’s risk of breast and ovarian cancers.

Even policymakers recognize these benefits. Last year, U.S. Rep. Terri Sewell of Alabama, a member of the Ways and Means Health Subcommittee, testified to Congress that health care policy should prioritize breast milk and breastfeeding as the first choice for infant feeding strategy in the United States.

And it sets a dangerous precedent for a “race to the bottom” for what qualifies as meaningful support at a time when insurance companies, physicians, public health agencies, communities —pretty much everybody— should be doing more, not less, to support all mothers who want to breastfeed. Taking advantage of the loopholes of the Affordable Care Act versus doing all you can to support healthier infants sends a clear message about Anthem’s true priorities. And it continues a dangerous trend of constantly putting the burden of breastfeeding solely on mothers, financially, emotionally, and socially.

Meanwhile, Anthem’s move is surprisingly shortsighted even from a cost-benefit analysis, since moms without access to proper breastfeeding education, quality breastfeeding supplies, and meaningful breastfeeding support tend to have babies who are sick more often. This means higher health care costs for payers, including taxpayers.

It’s also bad news for Anthem’s policyholders and shareholders. Dr. Briana Jegier, a health economist and associate professor at D’Youville College in New York, estimated the potential impact of a 5 percent drop in Anthem’s breastfeeding rate due to this policy change on the total cost of health care for Anthem Blue Cross Blue Shield insurance policyholders. “We know that even small changes in breastfeeding rates, for example, increasing breastfeeding just 5 percent, can save over $40 million annually in medical costs in the U.S.,” she said. “Since Anthem represents 40 million people, or 12.5 percent of the U.S. population, if the cut to reimbursement for pumps reduces breastfeeding exclusivity and duration by that same small 5 percent, that’s like walking away from over $5 million dollars in cost savings.”

That coverage has also helped decrease the unacceptable racial disparities in breastfeeding that have persisted for more than 40 years. The IU report found that increases in breastfeeding were especially notable for black, less educated, and unmarried mothers who historically have been denied access to meaningful breastfeeding support. The study’s researchers say the increase is due to the ACA mandate. That means access to high-quality pumps is also a social justice issue and critical to reducing the high black infant mortality rate that continues to plague the U.S. “Many of the economic burdens, such as the costs of buying a breast pump, may be greater for less educated or unmarried mothers,” said lead researcher Lindsey Bullinger of Indiana University’s School of Public and Environmental Affairs.

Either way you look at this, Anthem’s so-called cost cutting against babies in the face of record profits is bad news for families. It’s a slap in the face to the millions of American mamas, 80 percent in fact, who start out breastfeeding their infants but don’t find the support, resources, or social capital to continue. It shows at best a glaring blind spot, at worst, a complete disregard for the role breast pumps play in contributing to more breastfed infants, at least until we achieve the needed policy changes that would actually level the playing field for all mothers. And it’s a clear clarion call about where Anthem stands on the health and vitality of infants. We hear you.