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California Lactation Consultation Coverage Vetoed
In October 2009, Arnold Schwarzenegger, Governor of California failed mothers and children with the veto of two breastfeeding advocacy bills. After passage of both bills, by both houses of the California legislature (by comfortable majorities on all four votes), he still chose to go out of his way to deny nursing mothers support towards breastfeeding their babies.
California Assembly Bill AB513 – Coverage of Lactation Services and Pumps by Health Insurers
AB 513 essentially provides that health insurance providers that cover maternity care also must pay for lactation consultation by an International Board Certified Lactation Consultant (IBCLC) and in many cases the purchase of a personal breast pump or the rental of a hospital-grade pump.
In his October 11 veto, Gov. Schwarzenegger states that "the addition of a new mandate, no matter how small, will only serve to increase the overall cost of health care. This, like other mandates, only increases cost in an environment in which health coverage is increasingly expensive."
However, even without going outside of official government documentation on this bill, in the analysis of the health committee of the assembly, they state under purpose of this bill that "The author notes that exclusive breast-feeding for three months has been shown to reduce health care costs for infants in the first year of life alone by up to $475, compared to non-breast-fed infants and later that "the American College of Obstetricians and Gynecologists adds that the minimal costs associated with these services should be more than offset by the reduction of medical conditions in infants needing medical treatment."
The bill had the support of 31 organizations ranging from ACOG (above), American Academy of Pediatrics (AAP), several state breastfeeding task forces/coalitions, multiple agencies representing medical professionals (like the California Medical Assn. and California Nurses Assn.). It was opposed by only 6 indentified organizations, 3 of which were insurance companies, and health insurer associations (one of which said they oppose ALL state mandates to health coverage out of hand). So I suppose one could call this a victory for the insurance companies, except for it they had paid attention, they might have found it would actually save them money in the short and long run.
In the interest of full disclosure, there was documentation in the bill analysis citing the California Health Benefits Review Program (CHBRP) an independent analysis task force associated with several private and public California universities. Their opinion was that there would not be increased use of IBCLCs or breast pumps as a result of this bill, only shifting of the cost from out of pocket to insurers, and therefore no health care savings would result. They stated this was because consultation wasn't that expensive and so everyone who wants it was already using it, regardless of coverage, or finding less costly or free alternatives.
To support this they cite several "assumptions" and opinions of unnamed clinicians and experts. Given that they estimate the cost of an IBCLC visit at $95-$120, about the same as a sick visit to a pediatrician, one wonders if they would think a mandate for those visits would be not recommended as well, because parents would just take their kids anyway. I found this to be a ridiculous notion, not well supported in their otherwise extremely thorough study. Of course, this is the part of the 77 page report that was picked up in the legislative analysis.
Their statement that it "is possible that persons who may have delayed or
limited their use of outpatient lactation consultation or breast pump rental may increase
their utilization with coverage for these services" was not reported. I believe that others such as myself who understand the culture of breastfeeding and breastfeeding consultation, would find their assumptions as to why a mother might or might not seek support, and the type of support they might choose to be seriously flawed. (For details, see pages 39-40 of their report, linked below.)
As a California resident and breastfeeding mother, I could not be more disappointed in our Governor. How much more cover from the insurance lobby could be possibly need than both houses of his legislature and more than 30 health and government groups? Bad call, Arnie. But don't worry...we'll be back.
For details on also-vetoed California Senate Bill SB257 regarding notification of lactation accommodations at the workplace, see my related article, linked below.
Interested in learning more about the intersection of breastfeeding with politics and economics? You might find these two books useful:
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