Promotion of Breastfeeding and the Patient Protection and Affordable Care Act

Karen DeCocker-Geist MSN, CNMFrontier Nursing University

Patient Protection and Affordable Care Act

On June 28, 2012

The U.S. Supreme Court issued its ruling to uphold

the Patient Protection

and Affordable Care Act

Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost

•Historic new guidelines that will ensure women receive preventive health services at no additional cost such as co-pay or deductibles

•Standards were developed by the independent group, Institute of Medicine (IOM)

Healthcare.gov (2012)

“These historic guidelines are based on science and existing literature and will help ensure

women get the preventive health benefits they need.”

Health and Human Services Secretary, Kathleen Sebelius

 

Eight new Prevention Services for Women Now Fully Covered

BEGINNING AUGUST 2012:

• Well-woman visits.• Gestational diabetes screening• Domestic and interpersonal violence screening and

counseling.• FDA-approved contraceptive methods, and contraceptive

education and counseling.• Breastfeeding support, supplies, and counseling.• HPV DNA testing, for women 30 or older.• Sexually transmitted infections counseling for sexually-active

women.• HIV screening and counseling for sexually-active women.

Countdowntocoverage.org(2012)

The Act requires health plans to cover preventive services for women with no cost sharing,

including breastfeeding support, supplies, and counseling.

Healthcare.gov (2012)

“Our Nation's public health leaders have come together to

call for real changes in the policies, systems, and

environments that impact breastfeeding families”

United States Breastfeeding Committee Chair, Jeanne Blankenship

The Surgeon General and the Institute of Medicine both

identify the important role of breastfeeding in prevention and

reducing health care spending.

(USBFTF, 2012)

Good News/Bad News• Good: New health plans will need to include these

services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012. 

• Undecided: The rules governing coverage of preventive services allow plans to “use reasonable medical management” to help define the nature of the covered service apply to women’s preventive services. 

• Bad: Plans will retain the “flexibility to control costs” and promote efficient delivery of care.Healthcare.gov (2012)

For Now, Individual Plans and Policies Can Decide How They Will Comply with The Act• The insurance industry has a poor track record

for fairly deciding what is “reasonable coverage”

• Undecided means each plan can determine what they will offer under these new rules

• What lactation experts will they consult before deciding?

• A plan is able to control their costs and meet their own criteria of “efficient delivery of care”

What Should Plans do to Provide Real Evidenced Based Lactation Care?

•Breastfeeding Support

•Supplies

•Counseling

Comprehensive Lactation Support Should Be

Provided by a specialist specifically trained in lactation medicine and support services

▫During pregnancy

AND

▫Postpartum (USBFTF, 2012)

Support During Pregnancy Prenatal visits include breast inspection and lactation history

Relevant and accurate education

Breastfeeding classes for women and their support people

(Childbirth Connection, 2012)

Lactation Consultation Postpartum

Visit at place of birth within 24 hours after delivery

Daily visits in first 3 days of life

As needed for maternal support or health of the baby for 8 weeks post-partum

If medical issues persist: Support visits until resolution or weaning of the infant

Duration of the first year (USBFTF, 2012)

Breastfeeding Supplies• In special cases such as a preterm, special needs or

seriously ill infant ▫ Rental cost of a hospital grade electric pump to use for

duration of illness or until weaning

• Accessories such as nipple shields when suggested by the Lactation Professional

• Prescription medications related to breast infection or breast trauma

• For any woman who desires a breast pump▫ A quality dual electric pump from a leading manufacturer

(USBFTF, 2012)

Why Be Involved if You are Not Breastfeeding?

•Lack of breastfeeding increases the risk of acute and chronic diseases in children adults

•Suboptimal breastfeeding duration: ▫Significantly contributes to our epidemic of

childhood obesity▫Increases maternal risks of breast and ovarian

cancers, cardiovascular disease, and diabetes (USBFTF, 2012)

In 2010, the United States incurred at least $13 billion per year in excess costs due to pediatric illness because of suboptimal breastfeeding rates.

(USBFTF, 2012)

What Can You Do?• Contact your healthcare plan and ask what

services they provide now for breastfeeding mothers

• If your policy does not offer quality coverage for lactation professionals and supplies ask why

• Write and ask for changes to be made based on evidence of better health outcomes

• Provide evidence that quality lactation support does save lives and money

The views or opinions expressed in this presentation are solely those of Karen DeCocker and do not necessarily reflect the views or opinions of Frontier Nursing University.

References• Childbirth Connection (2012). Transforming Maternity Care. Retrieved

from: http://transform.childbirthconnection.org/blueprint/• Edward Sharpe and the Magnetic Zeros(2012): Song title Mother from

the CD Every Mother Counts 2012.• US Breastfeeding Committee (2012). Professional lactation services

page. Retrieved from: http://www.usbreastfeeding.org/Portals/0/Letters- Comments/2011-03-07-Joint-Letter-BF-Approp.pdf

• U.S. Department of Health and Human Services, Office of Women’s Health, Prenatal Care Fact Sheet (March, 2009) Retrieved from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.pdf.

• Healthcare.gov (2012) Essential Health Benefits: HHS Informational Bulletin. Retrieved from: http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html