New parents understand that breastfeeding can be a struggle, but insurance companies often make the process even harder than it has to be by not offering quality breast pumps and making it hard to get a breast pump in a timely fashion. On their own, at anywhere from $80 to $2,500, breast pumps are not only very expensive but they can be uncomfortable to use, time-consuming, and inefficient at removing milk from the breast, unless you have a way to access disrupters like the Willow, which was designed by women, costs $479.99, and comes with 1:1 online coaching. As if economic and design limitations weren't enough, breast pumps just become even more difficult to obtain for those who cannot afford them. If you have certain brands of health insurance and need to purchase a breast pump in the coming months, you might be surprised to find the pump you need isn't free at all.

Insurance giant Anthem (known as Blue Cross, Blue Shield, or Empire Blue) quietly cut the reimbursement rates for breast pumps on April 1 by more than 44 percent, from $169.15 to $95.00. Breastfeeding advocates learned of this change when fee schedule HCPCS E0603 leaked in December after Dr. Jennifer Thomas received a letter sent to medical equipment suppliers informing them of the change and posted it on her Facebook page. When she contacted Anthem and asked them to reconsider their upcoming change, she received a response from Anthem’s vice president of provider solutions, Kathryn Norman, that read in part, “Quality, accessibility and affordability were important components in making this decision to ensure Anthem’s members will continue to receive high quality, affordable care. With that in mind and high confidence that quality affordable care remains intact, we respectfully decline the request that Anthem reverse the fee schedule reduction.”

The assumption was that Anthem expected medical equipment suppliers and manufacturers to absorb this cost change for customers, significantly reducing costs while allowing the insurance company to remain in compliance with federal regulations. This is standard operating procedure in a for-profit healthcare system. A spokesperson for Anthem told Romper, ahead of April 1, "Anthem has confirmed that many of our national DME providers will have available, at no cost to our members, a variety of quality brands of breast pumps."

This change prompted breastfeeding advocates, including Alyssa Milano, to sign a petition against the price hike. And it is just the latest example of insurers not understanding or respecting women’s medical needs in the pre- and postnatal periods. For too long, breast pumps have been perceived as a luxury or a perk, when in reality they are a highly specialized piece of medical equipment that insured women are lawfully entitled to.

The Affordable Care Act (ACA) requires insurers to cover the cost to customers of a breast pump, whether as a rental or through outright ownership, along with lactation counseling services and support. Medical suppliers often negotiate fee schedules with insurance companies to keep costs low, but the Affordable Care Act worked to ensure that corporate profit margins would never again get in the way of a woman's access to health care or medical equipment. Even so, there are many documented cases of women being denied coverage for medical procedures they need, like abortion or sterilization. Prior to the ACA, even well-insured women often had difficulty getting maternity coverage for what was classified as a "pre-existing condition," per Health.gov.

For people who are breastfeeding, breast pumps are often just as medically necessary as a pair of crutches for someone with a broken leg.

Breast pumps are not available to most pregnant women until their due date, which means those who want to kickstart lactation or happen to deliver early won’t have a pump to get acquainted with before the baby’s arrival. Further, women’s pump choices are limited by the arrangements their insurer has with equipment companies and their level of coverage. Not all pumps are alike; some are better than others, some cost substantially more, and some are better suited to women's anatomy than others.

Anthem’s move will make it harder for pregnant patients to find an affordable, effective solution among their already limited selection of covered breast pumps. When popular breast-pump vendors MommyXpress and Aeroflow provided me with a list of their current prices, I found there were no breast pumps available under the $95 threshold for Anthem customers. None. Both companies responded to the April 1 price adjustment by making their least expensive breast pumps available for free to Anthem customers, but customers who wish to purchase a higher quality, more popular breast pump like a Medela or a Spectra, should expect to pay between $100 and $275 out of pocket, according to representatives of MommyXpress and Aeroflow.

Anthem has tried this before, and that time, it didn't go well. In late 2016, the insurer lowered their breast pump reimbursement rate to $95 for insured patients in the state of Alabama, cutting the state's current breast pump reimbursement rates by more than 55 percent. When breastfeeding advocates and parents throughout the state caught wind of the change, they fought back and won.

For people who are breastfeeding, breast pumps are often just as medically necessary as a pair of crutches for someone with a broken leg. Our breast pumps allow us to make sure our babies are fed after we return to work, usually well before we feel ready. They allow us to increase or maintain our supply when we’re away from our babies or when we are sick and our supply drops, and can prevent breast infections from oversupply or poor milk removal. For parents of premature infants, breast pumps allow our babies to receive the benefits from breastmilk before they’re strong enough to eat on their own.

Dr. Ann Witt, a board-certified family medicine physician, certified lactation consultant, and fellow of breastfeeding medicine, is worried about the impact Anthem’s policy changes will have on patients. “As an insurance company, Anthem should want infants to breastfeed longer as it improves infant and maternal health outcomes and lowers health care costs,” she told Romper by email. “Already in the United States, breastfeeding duration is lower than recommended, moms are not meeting their goals, and studies show that lack of breastfeeding is a contributing factor in high infant mortality rates.”

As is the case with most barriers to healthcare, this change will hit those most vulnerable the hardest.

As is the case with most barriers to healthcare, this change will hit those most vulnerable the hardest, something Dr. Witt worries about. “With lower pump reimbursement, many mothers may only be able to obtain a pump that is not as effective in removing milk, which will result in decreased milk production and earlier weaning,” she says, noting that the groups that already have lower breastfeeding rates and higher infant mortality — low-income families, and people of color — will be most affected. “The decision by Anthem puts another barrier in place for moms returning to work and meeting their breastfeeding goals.”

The pressure to breastfeed starts prior to delivery, and compounds the difficulties women face when they cannot. My community in Northeast Ohio has infant mortality rates that are much higher than the national average, and local agencies have responded by incessantly reminding pregnant women that breastfeeding can prevent infant mortality. Breast pumps are a valuable tool for women struggling with lactation issues, and a necessity if public health agents insist on pushing breastfeeding.

At a time when a sharp focus is on infant and maternal mortality, making it more difficult for vulnerable families to maintain a breastfeeding relationship will hurt mothers and their babies.

But breast pumps aren’t one-size-fits-all and finding a pump that works for you can be difficult. I own three pumps: a Spectra S2, a Medela PISA, and a manual pump for traveling. There is a stark difference between my two electric pumps. My Spectra pump fits my body and matches my baby’s nursing style, while the Medela pump simply doesn’t work well for me. I wouldn’t be able to produce nearly enough breastmilk without my Spectra pump, and there’s no way I could have maintained breastfeeding this long without it. With Anthem’s new policy, some new mothers won’t be able to afford the pump that works best for them, making their breastfeeding journey even more difficult or impossible than it already is.

When I asked Anthem how their new rules would impact their customers who couldn’t afford to pay the difference for a quality breast pump, they directed me to their official statement, which denies any change to out-of-pocket costs:

Through our existing supplier relationships we are able to provide mothers with access to a variety of quality pumps at no cost to them including: Ameda Finesse, Evenflo Advanced, Lansinoh Signature Pro, Spectra S2 Plus and Medela Pump in Style.

The upcoming adjustment to the fee schedule for all durable medical equipment, including breast pumps, will not impact the ability of any new mother to access a high-quality, standard double electric breast pump from our nationally contracted medical suppliers. Additionally, when medically necessary, and when the consumer meets certain criteria, coverage for a hospital grade breast pump may also be provided.

Anthem will continue to actively work to achieve increased breastfeeding rates and support new mothers who choose to breastfeed.

Anthem subsequently did not directly respond to queries around the MommyXpress and Aeroflow price lists, which indicated that several of the breast pumps listed above would no longer be available through all of their suppliers to consumers at no cost, following the fee schedule change.

At a time when a sharp focus is on infant and maternal mortality, making it more difficult for vulnerable families to maintain a breastfeeding relationship will hurt mothers and their babies. While hospital-grade pumps should still be available to customers with a documented clinical “need” for them — such as an infant in the NICU — the idea that a breast pump is a discretionary item for new mothers, and that “access” to medical equipment is something an insurance company can toggle up or down to suit its bottom line, is dangerous.

Feeding your baby isn’t elective — it’s what keeps them alive. Only 13 percent of new mothers manage to breastfeed to six months, per a survey of over a thousand women by UC Davis Medical Center, and 92 percent of women said they were having trouble breastfeeding three days after birth. The WHO recommends babies be exclusively breastfed at least to six months of age, with breastfeeding continued after that alongside supplemental food to age 2. But if we want women to breastfeed, we will have to look at the support we offer women.

Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.