Breastfeeding Promotion and the Patient Protection and Affordable Care Act
1. Promotion of Breastfeeding
and the
Patient Protection and
Affordable Care Act
Karen DeCocker-Geist MSN, CNM
Frontier Nursing University
2. 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
3. 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)
4. “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
5. 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)
6. The Act requires health plans to cover
preventive services for women with no
cost sharing, including breastfeeding
support, supplies, and counseling.
Healthcare.gov (2012)
7. “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
8. The Surgeon General and the
Institute of Medicine both identify
the important role of breastfeeding in
prevention and reducing
health care spending.
(USBFTF, 2012)
9. 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)
10. 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”
11. What Should Plans do to Provide Real
Evidenced Based Lactation Care?
• Breastfeeding Support
• Supplies
• Counseling
12. Comprehensive Lactation Support Should Be
Provided by a specialist specifically trained in
lactation medicine and support services
▫ During pregnancy
AND
▫ Postpartum
(USBFTF, 2012)
13. 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)
14. 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)
15. 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)
16. 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)
17. 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)
18. 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
19. 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.
20. 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
