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Monday, June 6, 2016

How Obamacare Got Me a “Free” Breast Pump – that I Never Use

Milking Obamacare for All Its Worth

Months before I gave birth to my daughter, I owned a breast pump. Before I purchased a single pacifier, baby outfit, or diaper, this durable good was shipped to me via a medical distributor, and I didn’t pay a single cent out of pocket.

From a personal perspective, I’m not going to complain about free stuff. But from a social perspective, “free” breast pumps for many new mothers is an inefficient mistake. Breast pumps are ordinary consumer purchases, not insurable medical expenses. Getting insurance involved hides their true costs and puts the wrong pumps in the wrong hands.

Obamacare’s Breast Pump Provision

The Affordable Care Act (a.k.a. Obamacare) included broad provisions requiring insurers to cover breast pumps. This sounded like an obviously good deal to many women who had been previously using old or underpowered pumps, or who could now simply enjoy never having to buy one themselves in the first place.

More babies getting fed more naturally, on the insurance companies’ dime — what’s not to like?

Implementation Problems

Even if you approve of these breastfeeding-related Obamacare provisions, they were predictably implemented unevenly. First of all, insurance companies got to decide which pumps to provide. Consumers often have few if any choices in insurance carrier (as when receiving insurance through an employer), and switching insurance is too difficult to do very often. This means that insurers went to varying lengths to comply with the spirit of Obamacare and expected their customers just to deal with it. Some began providing just a single (one breast at a time) manual pump, which would be wholly unsuitable for full-time pumping at work.

Additionally, some insurance plans in existence prior to Obamacare’s effective date were “grandfathered,” meaning that they are not required to comply with Obamacare in some ways (this is the “if you like your plan, you can keep it” bit). Patients on these plans may not even realize it, until they attempt to cash in on one of Obamacare’s promises — like a free breast pump — and are sorely disappointed.

And though the breastfeeding provisions were discussed excitedly in the mainstream media, women often had difficulty figuring out how actually to claim their pumps as a practical matter. Technically having “coverage” is no good without genuine accessibility in practice.

Indirect Effects

Obamacare’s breast pump provisions have more impact on the overall state of breast pumps than just getting some types of pumps into some mothers’ hands. These provisions have warped the personal breast pump market, a fairly new one at only about 25 years old, likely to consumers’ detriment  (if not now, then in the future).

Insurers and, by extension, the suppliers they hire now have the power to pick winners in the breast pump market. The two apparently most popular brands, Medela and Ameda, are common insurer-offered choices. They may well represent the best of breast pumps today, so women receiving them are pretty happy.

But in San Francisco, some group of startup-employees-turned-new-moms could well be cooking up a design for some amazing new app-powered breast pump the likes of which the world has never seen before (personally, I’d really like to see a dripless model so I don’t end up looking like I got in a fight with a milkshake). Breaking into new markets is hard enough already when customers aren’t channeled through centralized purchasing authorities. Now, it will be next to impossible. If some company does manage to get their product offered through the biggest insurance companies and their suppliers, they’ll just become the stagnant new incumbent in the future.

Additionally, insurers understandably want to confirm women’s pregnancy status before they pay for pumps. So now the suppliers they use are surely flooding physicians’ offices with requests for pregnancy documentation. This is hardly a good use of physicians’ administrators’ time, considering all the customer service and paperwork burdens they already face.

To top it all off, anecdotally, some mothers who received pumps resell them towards purchasing a different model that insurance didn’t offer, or just resell and pocket the cash if they didn’t need the pump in the first place. What a mess.

There Is A Better Way

There was always a better way to ensure that women genuinely in need of breast pumps receive them, by including their provisioning in a widespread means-tested program for mothers instead of within insurance coverage generally. In fact, this was already happening. Through Medicaid plans and the Women, Infant, and Children (WIC) program, low-income women already had access to breast pumps.

As far as government welfare programs go, WIC is sort of successful. Since the early 1970s, WIC has provided nutritional support for relatively low-income pregnant women and small children (it’s implemented at the state level, but mostly using federal funding).

WIC is not a perfect program. Its hazy criteria for judging applicants’ level of “nutritional risk” have led to a burgeoning participant base over time — hovering around half of pregnant and postpartum women (plus their eligible children) in America. This large participation rate warps the general market for infant formula, and the relative value of WIC benefits for breastfeeding versus non-breastfeeding postpartum women has fluctuated over the years. But at least WIC’s breast pump programs generally make sense.

The National WIC Association (NWA) has published guidelines for state WIC programs regarding breast pumps. The recommendations include assessing mothers’ needs to help determine which pump is right for them, triaging those interested in a pump (for instance by prioritizing those who work full-time outside the home), and refusing to provide pumps willy-nilly to all pregnant women prenatally.

These policies cause WIC breastfeeding support dollars to help more women more equitably. Insurers providing breast pumps in accordance with Obamacare do not seem to be following suit, guaranteeing that insurance consumers (who bear these costs via their premiums) as a whole are not getting much bang for their breastfeeding buck. On the other hand, attempting to verify which insured women were really working outside of the home and which could do with simple manual pumps would be a bureaucratic nightmare.

Perhaps making these choices isn’t really the place of health insurance at all — maybe that’s why it had to be mandated instead of emerging from consumer demand.

Let the Market Keep on Flowing

Of course, feeding babies is a popular goal — who would want to go on record against it? — and so is including women in the workforce, which breast pump availability seems to promote. But it makes very little sense to filter an ordinary consumer goods purchase (even one of vaguely medical character) through the insurance system, by legislative fiat.

A brand-new, consumer-grade breast pump generally costs $25-200. This expense is well within the reach of American mothers who are not receiving WIC. For those few mothers with special medical circumstances (like preemies or multiples) requiring a hospital grade pump, it is appropriate to consider the event and resulting breast pump insurable, if prescribed. Everyone else should just pony up for her own pump and let the market do what it does best — provide a wide variety of options of increasing quality at decreasing cost.

As for my Obamacare pump, it sits at the back of my closet alongside the diaper bag it came with. The insurance company’s supplier offered this bonus as an inducement to pick the cheaper brand of pump, but neither fit my needs by the time I actually gave birth.

After I had learned a thing or two about breastfeeding, I read the Amazon reviews for myself and ordered myself a popular $30 manual pump instead — as I should have had to do in the first place. 

  • Pamela J. Hobart studied philosophy and education at the doctoral level at Columbia University’s Teachers College, and she holds a B.A. magna cum laude in philosophy from Georgia State University.