Tagged Insurers

Insurer Slashes Breast Pump Payments, Stoking Fears Fewer Moms Will Breastfeed

A sharp cut in breast pump payments by the nation’s second-largest health insurer has prompted a strong reaction from breastfeeding advocates, who warn that some new moms will not get the pumps they need and fewer babies will be breastfed.

Starting last month, Anthem Inc. slashed the rate it reimburses medical suppliers for breast pumps by 44 percent — from $169.15 to $95. The move means some breast pumps that used to be free under a provision of the Affordable Care Act will now entail a cost to consumers, according to the advocacy group MomsRising. More complex pumps, which have always required an out-of-pocket payment, will now be more expensive. It’s unclear how many women will be affected.

“It’s going to have a bigger impact on lower-income moms who can’t afford the increased out-of-pocket expense,” said Ruth Martin, vice president of Workplace Justice Campaigns for MomsRising. “Some moms will just stop breastfeeding.”

The lower payment rate applies to all commercial health plans sold by Anthem, which provides medical coverage for 40 million — or about 1 in 8 — people in the United States. The rate will not affect Anthem-run Medicaid plans, company spokesman Eric Lail said.

Anthem says that a variety of high-quality breast pumps will still be available to nursing moms at no cost, as required by the ACA.

But the lower reimbursement appears to be limiting the number of free pumps available to Anthem enrollees as medical suppliers charge them for the shortfall on models that the old Anthem rate used to fully cover.

Bob Achermann, executive director of the California Association of Medical Product Suppliers, acknowledged that lower reimbursement rates for medical equipment in general have forced suppliers to make tough decisions, including limiting customer choices.

The cost of a breast pump can vary widely, depending on the model and whether it is purchased directly from a retailer or with insurance through a medical equipment supplier. Retail prices range from as little as $12 for the most basic pumps to $400 for the higher-end ones. Some hospital-grade pumps, which can cost several thousand dollars, are typically rented by moms for roughly $80 a month.

But the amount insured consumers pay, if anything, is based on the prices their health plan negotiates with suppliers, which can be lower than retail.

Anthem declined to reveal any prices on the range of pumps it offers but listed a handful of “popular” pumps its enrollees can get for free.

“Anthem recognizes the positive health benefits that breastfeeding can have on mothers and their newborns,” the company told California Healthline in an emailed statement. “The recent [rate] adjustment … will not impact the ability of any new mother to access a high-quality, standard double electric breast pump from our contracted medical suppliers.”

To comply with the ACA’s free breast pump mandate, commercial insurers have offered certain models at no cost. That has saved families hundreds of dollars, since breast pumps often were not covered at all before the ACA. Some state Medicaid programs, including Medi-Cal, also provide this coverage.

But the no-cost pumps do not work for all mothers, experts say. Breast pumps vary from manually operated ones to electric ones to the much stronger hospital-grade variety. The design or capacity of one pump may fit the needs — or bodies — of some women but not others.

Some mothers, for example, need to pump more milk because their babies have medical conditions that make it difficult for them to drink directly from the breast. Other mothers, returning to work after maternity leave, may need to express milk for daytime feedings by caregivers — or, if they are pumping at their workplace, to minimize break time.

Women who need more complex pumps — ones that have always required coinsurance payments — now must shell out more money as a result of Anthem’s decision, breastfeeding advocates say. That, in turn, raises a key question: Will more mothers simply settle for lower-end pumps that medical experts say might frustrate them and induce them to give up breastfeeding?

Karissa Soma of Orangevale, Calif., holding her 5-month-old son, Cotton, says the cost of having a baby is hard enough on families without the extra expense of a breast pump. (Courtesy of Karissa Soma)

Breast pumps “are not cheap,” said Karissa Soma, an Orangevale, Calif., mom who took a half-year off work to care for her 5-month-old son. “I paid almost $5,000 in hospital bills, and you add the expense to stay home. It’s already so much.”

Critics of Anthem’s decision believe it cuts against the spirit of the ACA breast pump rule, which was intended to remove barriers to breastfeeding. Research shows the health law provision, which was implemented in 2012, has induced more new moms to breastfeed their babies and to continue doing so longer than before.

“It is clear that this [Anthem] decision would have far-reaching and deleterious effects on a mother’s ability to reach their breastfeeding goals,” the United States Breastfeeding Committee and dozens of other breastfeeding advocates wrote in an April 25 letter to Anthem President and CEO Gail Boudreaux.

Given the well-known benefits of breast milk, the American Academy of Pediatrics recommends that new moms breastfeed for at least a year. But that’s not always easy. Breastfeeding can be hard for a new mom — and for the baby.

When 31-year-old Bakersfield, Calif., resident Megan Eskew, an Anthem enrollee, gave birth in April 2017, she needed a pump to feed her milk to her baby boy, Reid, who spent the first six days of his life in the intensive care unit and could drink only from a bottle.

The hospital-grade pump delivered the breast milk that Eskew, a first-time mom, believed was critical for Reid. When Reid left the hospital, he still needed to drink from a bottle, so Eskew selected a high-end pump that required a coinsurance payment of roughly $100 under the terms of her health plan. That was a year before Anthem cut its reimbursement.

“I’m lucky I had the financial resources to buy a pump,” Eskew said, “but not all moms have those options.”

KHN’s coverage of these topics is supported by
California Health Care Foundation
The David and Lucile Packard Foundation
Heising-Simons Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Best Reads Of The Week With Brianna Labuskes

From nursing home bullies to do-it-yourself gene editing in teenagers’ garages, this week was a wild — or should we say “royal” in anticipation of a certain big event across the Atlantic — ride in health news. So, buckle up, here’s what you might have missed.

This is the story that you’ll get sick of reading over the next six months, but it’s important because you can bet that the rising health law premiums will play a big role in the midterms. The only question is: Who’s going to win the blame game? As the first glimpse of sky-high rate hikes come out, Democrats are eager to point fingers, but Republicans say their liberal colleagues should “look in the mirror” when it comes to assigning responsibility.

• The Hill: Premium Hikes Reignite the ObamaCare Wars

In a decision that was expected, the Trump administration is resurrecting a Reagan-era policy that would add abortion restrictions to federally funded family planning programs. Abortion advocates say the policy — which they call a domestic “gag order — puts government into the middle of the doctor-patient relationship. But the other side sees it as another victory from an administration that is living up to its campaign promises.

• The Associated Press: Trump to Deny Funds to Clinics That Discuss Abortion

Pharma remained in the spotlight this week after all the attention from President Donald Trump’s plan to curb high drug costs, announced last Friday. While HHS Secretary Alex Azar is busy adamantly defending that blueprint, the Food and Drug Administration is naming names of companies accused of hindering generics development, in hopes that public shaming can get some bad actors to “end their shenanigans.” Celgene is one of those drugmakers in the hot seat.

• The Associated Press: FDA Names Drugmakers Accused of Blocking Cheaper Generics

• NPR: Celgene’s Patent Fortress Protects Revlimid, Thalomid

And you know how Viagra was a happy accident? Well, researchers want fewer oopsie successes and more that are deliberately planned.

 • The Washington Post: Viagra and Many Other Drugs Were Discovered by Chance. Now Science Is Hoping to Change That.

It was a good week to keep an eye on the states. Up in Vermont, the governor signed legislation that could allow the state to import drugs from Canada. HHS still has to approve the policy, though, and since Azar has called the tactic “a gimmick,” there’s no sure bet that it will move forward. The health world’s eyes are also on the state because its experimental plan to control costs is going to come within 1 percent of its financial target. An “impressive” feat, experts say.

• Politico: Vermont Becomes First State to Permit Drug Imports From Canada

• The Associated Press: Eyes Turn to Vermont As It Sees Success With Health System

And Maryland remains on the forefront of innovative thinking to control costs with the approval of its unique all-payer model.

• The Associated Press: Maryland Announces Agreement on All-Payer Health Model

“It’s one of the big demographic mysteries of recent times,” fertility experts say of the nation’s record-low birth rate for the second year in a row. Researchers aren’t sure why the numbers haven’t increased along with the improved economy as would be expected. But some suspect that younger women are putting off having babies as they focus on their careers.

• The New York Times: U.S. Fertility Rate Fell to a Record Low, for a Second Straight Year

And this doctor is pushing the boundaries of what is considered possible in fertility research with “three-parent babies” — sparking talk of sci-fi dystopian worlds. But critics worry there’s no oversight to stop the slide down the slippery slope of tinkering with human life.

• The Washington Post: Fertility Doctor John Zhang Pushes Boundaries in Human Reproduction

In the miscellaneous gotta-read files: An in-depth investigation reveals just how far a center once renowned for its heart transplant program has fallen; a tragic suicide sparks debate over whether colleges should tell parents when students are struggling; what the president’s proposed border wall means for a community burdened by extremely poor health; and a keyless ignition jaw-dropper. People are leaving their cars in the garage — not realizing the motors are still running — and suffering fatal consequences.

• ProPublica: At St. Luke’s in Houston, Patients Suffer As a Renowned Heart Transplant Program Loses Its Luster

• The New York Times: His College Knew of His Despair. His Parents Didn’t, Until It Was Too Late.

• The Wall Street Journal: Youth Suicidal Behavior Is on the Rise, Especially Among Girls

• US News & World Report: A Battle for Community Health in Texas’ Rio Grande Valley

• The New York Times: Deadly Convenience: Keyless Cars and Their Carbon Monoxide Toll

Have a great weekend!