Under the Affordable Care Act, insurance plans are required to give new mothers equipment and services to enable them to breast feed. What that means in practical terms for most moms is that insurers have to cover the cost of a breast pump – either a rental or a new one.
What the law doesn't say, however, is what kind of pump has to be provided. It is left to the insurance companies, following doctors’ recommendations, to decide whether to cover the cost of an electric or a manual pump.
Megan Lopez works full-time as a customer service representative at the OnPoint Credit Union in Portland, Ore.. She has a nine-month old baby whom she hopes to nurse for at least a year. She had been using a borrowed electric pump, but she had to return that when her friend had another child.
So she was pleased recently to learn about the breastfeeding support in the health law.
"I was excited. Because I said this is perfect. I can get a new breast pump and I need one, because I have to give mine back," Lopez said.
But when she contacted her insurer, Kaiser Permanente, her initial enthusiasm was quickly tempered. (Kaiser Health News is not affiliated with the insurer Kaiser Permanente.)
The Kaiser representative told her that the plan would provide a manual pump. “And I said: 'Really?' Because that's not even possible if you're working full-time,” Lopez recalls. “So I just said: 'Okay, whatever, I'm not going to get that, because it's not really going to work for me.' So I was pretty bummed out."
She says electric pumps are high powered and supposed to simulate a nursing child, whereas she finds manual pumps weak and clumsy.
But, she says, the main problem is the time it takes at work to express milk for her baby.
"It already takes my whole break to pump as it is with an electric pump on both breasts,” Lopez says. “So to do a hand pump and do it on each side, I couldn't even imagine. It'd be inconvenient."
A high-end, electric double-breast pump can cost $300, whereas an inexpensive manual one can be as little as $35.
Dr. Kim Luft, a pediatrician with Kaiser Permanente, says manual pumps meet the basic needs of most moms, but the insurer would cover an electric pump if it were a medical necessity. She also suggested that Lopez and others can work with their employers to find time to use the manual pump.
"If she's having an issue of not having enough time at work, then seeing if she could talk to her employer about the Oregon law that allows time for breast feeding, so she could get the time she needed," Luft says.
Lopez has no problem with her employer, OnPoint.
But Lopez says she doesn't want to take extra time and leave her work for others.
OnPoint issued a statement affirming its support for nursing mothers and noting that it is committed to making it easy and comfortable to pump during the work day. For example, OnPoint says it provides a private dedicated break room and up to 30-minute breaks for nursing mothers -- which it says is consistent with wage and hour laws.
Luft says essentially it comes down to money.
"We have limited resources and we have to be good stewards with those resources so that people's premiums … don't go high,” she explains. “But we're still giving everyone the basic medical care that they need, and it's a balancing act. And it's hard."
Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center, says the problem is that the law isn’t specific about what insurers need to cover.
"We are looking to the agency to clarify what it actually means so that women will be able to get the kinds of equipment that they actually need and will work for them," she says.
Mayra Alvarez is the director of public health policy at Office of Health Reform in the Department of Health and Human Services. She said the health law allows plans “reasonable strategies to manage their costs” for breast pumps, but doctors have the final say about what equipment new mothers should get.
"Health plans must cover what doctors find to be medically appropriate for his or her patient," she says.
This story is part of a collaboration that includes Oregon Public Broadcasting, NPR and Kaiser Health News.