In 2012, an Affordable Care Act policy went into effect that requires commercial and Medicaid expansion plans to cover breastfeeding support beginning in the time of pregnancy. It’s been 11 years and nothing has happened. No changes. Despite the White House announcing last year that the Department of Health and Human Services would begin enforcing the policy, we have yet to see any health plans held accountable.
As a third mom who is breastfeeding a 12-week-old baby, I respectfully ask that CMS enforce the legislation and policy established in 2012. As the Kaiser Family Foundation report on Medicaid coverage of pregnancy-related services points out, many states are currently not compliant to ACA requirements.
Right now, the United States is woefully behind our peers in all things maternal health. Our maternal mortality rates are worse than those of our parents’ generation, women’s and maternal health is understudied and underinvested in, and women’s pain during pregnancy and postpartum is continually ignored.
The failure of the US health care system to support women is incredibly short-sighted. Economists Henry Paulson and Timothy Geithner have published a report on economic uncertainty in the United States and one of their main recommendations is that the country needs population growth, even starting with new births. Some members of Congress are even calling on US women to focus on thriving families, but they don’t support investing in maternal and child health.
Today, most states do not allow breastfeeding support providers to enroll as Medicaid providers, which severely limits access. In some cases, it’s because there is no provider-type designation for lactation consultants. States may require credentials such as MD, NP, PA, or RN, as well as certification as an International Board Certified Lactation Consultant (IBCLC). Many states integrate breastfeeding support services into the overall maternity care payment rather than reimburse them separately, which creates a disincentive to providing care and is time-limited, while many parents require support beyond the postpartum care visit. The universal payment for maternity care is already too low, so there is no longer any room for breastfeeding and infant feeding support, which are a clinical specialty. However, as in the case of women’s health, these specialties are rejected and devalued, despite their enormous health benefits.
Breastfeeding the infant is deeply connected to the maternal health experience, including the physical and mental health of the mother and the health of the infant. Those first hours, days and months are critical to your baby’s well-being.
We know that breastfeeding support helps improve breastfeeding rates for those who choose to breastfeed (and it’s their choice!). Society does not support those who want to breastfeed despite the obvious public health benefits that come with it. Research shows that families in maternal health deserts lack access to support services, and this is especially true for Black women.
Support for breastfeeding initiated during pregnancy reaches patients before the baby is born to help address other maternal health issues. Early mental health screenings can detect the risks of postpartum depression and anxiety. Postpartum lactation support appointments are also a good way to remind patients to show up for the six-week postpartum visit, which historically has been attended by only 60 percent of patients. The six-week postpartum appointment is essential to check the mothers health, including blood pressure to prevent preeclampsia and control diabetes problems or anemia problems.
The ACA’s CMS Medicaid Breastfeeding Services coverage must apply. Women have been waiting for 11 years.
Andrea Ippolito is a health technology expert and founder of SimpliFed, a maternal health company that provides support for infant feeding and breastfeeding.
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