IRS Fears Women May “Abuse” Tax Credits for Breastfeeding Supplies


In the United States, we have a false love affair with motherhood. Indeed we also have a false love affair with fetal life, not backed up by any commitment to children once they are born.

We love to exalt motherhood, women as mothers, women with 19 children, women who “choose life,” whatever that means.  We just don’t want much to do with the “life after birth” part.

The most recent example of our hypocrisy is the fact that the new health reform bill will not cover breast pumps or the supplies often needed by breastfeeding mothers.  For those who may not be aware, new mothers who breastfeed often need breast pumps.  It may be because they are working outside the home and need to keep up their supply of stored milk so partners or caregivers can feed a baby breast milk even when mom is not there. Perhaps because the new mom is desperate for more sleep, so she pumps and stores milk so that her partner can feed the baby at night.  Perhaps she has other children to tend, so pumping helps ensure she can better juggle everyone’s needs.  Perhaps she is having problems with milk production and therefore needs a pump to increase her supply to adequately nourish her child (something with which I contended with my first baby).  And maybe our societal neurosis about nursing in public leaves some women feeling more comfortable toting breast milk in bottles when out on errands rather than dealing with people who can’t deal with a nursing mom.

No matter the reason, breast pumps are certainly as much a part of “medical care” as are adhesives used by denture wearers to keep false teeth in place.

Except that denture adhesive is covered as a basic medical expense under the new health care bill, and breast pumps are not.

According to an article in the New York Times yesterday, “Denture wearers will get a tax break on the cost of adhesives to keep their false teeth in place. So will acne sufferers who buy pimple creams.”

And:

People whose children have severe allergies might even be allowed the break for replacing grass with artificial turf since it could be considered a medical expense.

But, notes the Times,nursing mothers will not be allowed to use their tax-sheltered health care accounts to pay for breast pumps and other supplies.”

Why? Because the Internal Revenue Service has ruled that breast-feeding does not have enough health benefits to quality as a form of medical care.  But astro-turf does.

Get this:

Despite a growing body of research indicating that the antibodies passed from mother to child in breast milk could reduce disease among infants — including one recent study that found it could prevent the premature death of 900 babies a year — the I.R.S. has denied a request from the American Academy of Pediatrics to reclassify breast-feeding costs as a medical care expense. [emphasis mine]

Seriously?  Does the IRS now take contributions from Nestles?

Feeding a new infant entails much more than at what hour and how many times you wake up at night. It also intersects with the productivity of women as they work in and outside the home.

In fact, the medical and public health communities in the United States have been trying for decades to reverse the decline in and stigmatization of breastfeeding, with great success in increasing breast feeding rates for at least the first six months of a baby’s life. “According to a survey by the Centers for Disease Control and Prevention,” reports the Times, “about 75 percent of the 4.3 million mothers who gave birth in 2007 started breast-feeding. By the time the baby was 6 months old, the portion dropped to 43 percent, and on the child’s first birthday, to 22 percent.”

Breastfeeding is a commitment that is affected by and affects women’s ability to earn income and work outside the home, which is another reason the intersection of health and economics is so great.  And pumps can make the difference.

To continue breast-feeding once they return to work, many mothers need to use pumps to extract milk, which can be chilled and bottle-fed to the child later. The cost of buying or renting a breast pump and the various accessories needed to store milk runs about $500 to $1,000 for most mothers over the course of a year, according to the United States Breastfeeding Committee, a nonprofit advocacy group.

Lactation consultants, who can cost several hundred dollars, also would not be an eligible expense.  

While breastfeeding equipment and supplies weren’t covered before health reform, one of the main purposes of health reform (please help me out here if I missed the “purpose” of reform) was to improve upon and eliminate disparities in health care, including those disparities based on sex and gender.

And another major goal of the health care overhaul was to control medical costs by encouraging preventive approaches to health. This underscores the nonsensical nature of excluding supplies and support for breastfeeding, one of the most effective preventive “interventions” you can find.  Astro-turf might ameliorate severe allergic reactions, but it does not prevent allergies.

A study released this year by Harvard Medical School concluded that if 90 percent of mothers followed the standard medical advice of feeding infants only breast milk for their first six months, the United States could save $13 billion a year in health care costs and prevent the premature deaths of 900 infants each year from respiratory illness and other infections.

“The old adage that breast-feeding is a child’s first immunization really is true,” said Dr. Robert W. Block, president-elect of the American Academy of Pediatrics. “So we need to do everything we can to remove the barriers that make it difficult.”

Many mothers’ groups and medical experts say that breast milk provides nutrition and natural supplements that prevent disease, and would like to see its use expanded. Hospital accreditation groups have been prodding maternity wards to encourage parents to feed only breast milk until a child is 6 months old.

Let me underscore that figure: the United States could save $13 billion a year by supporting a low-cost preventive intervention: breastfeeding.

Let me also underscore that we spend untold sums of money trying to encourage breastfeeding in developing countries, for example, through international aid for the very reasons articulated above.  But here? It’s not healthy enough.  Somehow the IRS has decided its credentials as a government medical and public health authority supersedes those of AAP and countless other organizations that promote breastfeeding whenever feasible.

The Times suggests two reasons the IRS in all its public health expertise and wisdom has rejected coverage for breastfeeding.

One: It’s considered “natural.”

I.R.S. officials say they consider breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. But because the I.R.S. code considers nutrition a necessity rather than a medical condition, the agency’s analysts view the cost of breast pumps, bottles and pads as no more deserving of a tax break than an orange juicer.

Hmmmm.  I would think teeth would be considered “natural,” and a “necessity,” but when you lose them you get your dental work and your denture adhesive covered.  I would think breathing is considered a “necessity” and not a medical condition, but we cover breathing tubes in the hospital when breathing is compromised.

Yet under health reform American women intending to bear a child, who set aside part of their pretax earnings in flexible spending accounts to pay for un-reimbursed medical expenses will not be using them to pay for breast pumps.  No, no, no.  The men can get Viagra to make the babies.  The women can’t get reimbursed for feeding them.

Two, and here is my favorite “don’t-cover-the-pumps” reason: the IRS is concerned that if it allows coverage of breastfeeding equipment and supplies, women may abuse the privilege.

Yep. You heard it right.  We now have the advent of the breastfeeding-flexible-spending queen to replace the welfare queen. 

Roy Ramthun, a former Treasury Department official, said that tax officials’ reluctance to classify those costs as medical expenses stemmed from a fear that the program might be abused.

“They get very uneasy about anything that smacks of food because they fear it will open up all sorts of exceptions,” said Mr. Ramthun, who runs a consulting company that specializes in health savings accounts. “It’s a matter of cost and of protecting the integrity of the tax code.”

Yes, I can see it now.  Women using their flexible spending accounts to purchase breast pumps in different colors and sizes.  Women buying designer nursing pads to cover their leaking nipples at work.  Women who are not even mothers buying breast pumps to encourage their own milk production and creating a black market in breast milk on eBay. 

I wonder how I missed this opportunity to cheat the system when I nursed both my kids. If the IRS reverses this decision, I’m seeing a scandal bigger than Madoff.

What this reveals is that misogyny and discrimination in this country is so deeply engrained in our psyche we don’t even know it when we see it.  We create ridiculous barriers for women because they are women and we don’t even realize how ridiculous–indeed unethical, unhealthy and uneconomical–those barriers are.  Or how unjust.

The lack of coverage is not for lack of trying by advocates:

“Everyone says they support breast-feeding, but getting businesses and Congress to act on it has been surprisingly difficult,” said Barbara Emanuel, executive director of the breast-feeding advocacy group La Leche League International. “We get resistance from the formula companies and cultural resistance, so it can be hard to get nursing mothers the support that everyone agrees they deserve.”

Well, when you’ve got Senators like John Kyl telling us he doesn’t want insurance to have to cover maternity care because “he doesn’t need it,” and you’ve got “leading” media analysts like Joe Klein scoffing at the idea that businesses be made to ensure their lactating female workers have a private space to pump, you can imagine why it might be this difficult.

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  • robin-marty

    So I learned that you aren’t supposed to “reuse” a breast pump, only purchase new. I’m not sure if it’s real or not, since the only people who say it are the pump suppliers, but allegedly the milk and leak back into the pump apparatus itself, and cause I bio hazard. I got my THREE HUNDRED DOLLAR PUMP back from a friend I gave mine to after Vi was born, and am getting new tubes and sterilizing all of the outside filters, etc. but am concerned that it’s not enough and I don’t want to go purchase another THREE HUNDRED DOLLAR PUMP, especially when I was unsuccessful with breast feeding last time.

    Did I mention a high quality, “professional” double pump is THREE HUNDRED DOLLARS?

  • jodi-jacobson

    You don’t have to buy a new one.

     

    You do need to sterilize the tubing and you can buy new suction cups for your own use, if you so desire.

     

    A “bio-hazard?”  is this nuclear waste?  Jesus, these people really try to put us all over a barrel at any chance, don’t they.

     

    just sterilize the tubes.

  • jodi-jacobson

    I am fairly certain that the industrial sized and strength pump i rented from the hospital when Jenna was born was not new and not thrown away after i used it.

     

    That is why it was a rental.  If the hospitals rent them, you know that the issue of biohazard is a crock.

  • robin-marty

    I’m getting brand new tubing from a med supply store for $10. Good thing it’s so cheap since I can’t use my HSA…

  • gina-crosleycorcoran

    Every day, it’s becoming more and more embarassing to be a mother in America.  This country’s government lines their pockets with lobbyist money, and families suffer for it.

  • amie-newman

    For God’s sake, the FEDERAL government has a Healthy People 2020 (changed from 2010) initiative which seeks to promote breastfeeding! Some of the ways it recommends encouraging breastfeeding for the extended period of time that the WORLD HEALTH ORGANIZATION recommends for optimal health is to:

    # Increase the percentage of employers who have worksite lactation programs

    # Decrease the percentage of breast-fed newborns who receive formula supplementation within the first 2 days of life.

    # Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies.

    So the federal government says we should increase the % of employers who have worksite lactation programs, the World Health Organization and most major medical associations in this country say women SHOULD breastfeed/babies should receive only breastmilk for at least 6 months but optimally for one year after birth, mothers are increasingly forced to head back to work as early after birth as possible as sole or co-breadwinners in the family, we don’t provide any paid famiy leave, women are told that NOT breastfeeding is harmful to our babies and yet we are told now that a breastpump is not “medically necessary” so go find a way to do this all yourselves?!

    I’m incensed, truly. Thanks for writing about this, Jodi.

  • squirrely-girl

    Because the Internal Revenue Service has ruled that breast-feeding does not have enough health benefits to quality as a form of medical care.

    I love when accountants pretend to be doctors :/

  • donenaturally

    Ladies, I share your concern with the IRS, very infuriating! I also want to clear up a lot of confusion out there about “used” breastpumps, so that you may understand, and can pass it along to your friends, family and colleagues.

    Let me introduce myself first. My name is Summer Hill. I am a Infant Nutrition and Lactation Educator at University of Kansas Hospital, working throughout the hospital, but mainly on Mother/Baby and the breastfeeding mother babies helping them with their goals. I am a La Leche League Leader here in Prairie Village, KS, a Certified Breastfeeding Educator, a Certitifed Childbirth Educator with The Bradley Method of Natural Childbirth, and I just sat for my International Board Exam for Lactation Consulting in July 2010, and am awaiting my results (will receive those 10/29/2010!!!) that I will now have the official credential of IBCLC next to my name.

     

    So big debate, can you use a “used” breastpump. First to clarify, there are two kinds of breastpumps out there. There are closed motor pumps meant for multiple users and then open motor pumps meant for personal use, or single users.

    Closed motor pumps are the type they use in the hospital, and some rent, like Medela Symphony or Medela Lactina and have a motor life that lasts a very, very long life and cost in the $1000s of dollars. A closed motor means there is absolutely no way transfer of live fluid (human milk) could enter the motor, because of the way the motor and system are configured, provided we always use new, sterile tubing and kit with each user.

     

    Open motor pumps are personal use pumps, like the the Medela Pump N Style, or Medela Freestyle, Medela Swing, Avent Isis, and so forth. An open motor pump means there is a way that live fluid can enter the motor, even with changing of tubing and kit, milk can get trapped inside the actual motor. Granted it is remote and more like a hypothetical risk, but still a risk, and not one a hospital or other authority could assume. But a mother could assume this risk, provided she knows the mother who is offering her pump to her, her health history and such, or even a mother who would value the benefit of this pump along with the risk of transmission, over the very real risk of formula use.

     

    Now here is the main reason I caution women not to use “used” breastpumps that are personal use pumps. These personal use pumps have a motor life and are much more affordable for women to buy than the above mentioned multiple user pumps. The motor on personal use pumps is designed and built to last about 500 hours. 500 hours of pumping is used in about 1 year of pumping, 3-4X a day for about 5 out of the 7 days of the week. When that pump has neared that end of life, it will no longer vaccum or suction appropriately, and not express well. It will appear to be sounding like it does still work, when indeed it is ‘dead’. And a women who begins using this pump at the end of its life, will of course, think her milk supply has suddenly dried up and it is her fault, when it is actually the fault of the motor. If we catch it in time, we can recover her milk supply, but if not, women may go on to completely involute (dry up), and lose their entire milk supply, thinking they spontaneously dried up, and never think it could be the pump.

     

    Even mothers of multiple children, who have used their own pump for 500 hours, should purchase a new pump with subsequent children, so they may keep up their milk supply. Yes it is costly. Usually about $300 or more. But very cheap and reasonable when compared to the cost of formula that would be needed to purchase should this pump reach its end of life (500 hours) during your breastfeeding experience and risk losing your milk supply.

    So when thinking about using a  ‘used’ breastpump, be informed. Assume the risk of the transmission of life fluid, that can carry viruses, diseases and such, know the history, and most importantly in my opinion, find out how long the the prior user pumped, how often each day, for how many weeks/months and then make your informed decision.

     

    There is also something called a pump gauge you could ask someone to test your pump. Many IBCLCs have them. We have one we use on our hospital Lactation team. This gauge can test a pump to see how much suction and vaccum is operating at now. It won’t tell you how much life is left, and that can happen quickly, losing vaccum fast. But it will tell you at that testing, what the pumping pressure and vacuum are, and combined with the knowledge of the last user’s pumping experience, can give a woman a good idea of how much life it actually left in that pump.

     

    It is very well meaning that people do offer their pumps to other women, or even sell them at a lower cost, but if we don’t know the life of the motor, it is best to just buy a newly purchased one, with a new 500 hour life in it, and get the volume of milk you and your baby deserve.

     

    I hope  this helps many out there avoid any future problems with their precious milk supply.

     

    Summer Hill

     

  • jodi-jacobson

    thank you!

  • donenaturally

    You are very welcome.

     

    :)

  • darcie

    I completely agree that lactation consultants and breast pumps should be covered under HSAs and all other health insurance coverage.  It should be done because it helps babies get FED. 

    If the rationalization for covering breast pumps is because they are needed due to supply issues or needing them because women need to return back to work then, what about when a mother needs formula because she can’t breastfeed or needs to supplement (because of going back to work of supply issues, etc.)? This is when the slippery slope begins. 

    If it should be covered becasue it’s a public health issue then there aren’t strong arguments for that either.

    As far as the costs of breastfeeding w/r/t the Pediatrics article:

    http://www.sciencebasedmedicine.org/?p=4678

    http://stats.org/stories/breast_feed_nyt_jun_20_06.htm

    In addition – breastfeeding and immunity building:

    http://www.slate.com/id/2138629

    I fully agree that the support for families in this country is lacking; longer leave time should be supported because it’s important for the healthy development of families (not just breastfeeding).  Supporting equal treatment for moms also includes non-breastfeeding moms.

  • jodi-jacobson

    WIC covers formula for those who qualify.

     

    I am not debating that there are many people in this country—too many–that either fall through the “qualify” cracks or who “make too much” (ostensibly) to qualify even though they are barely getting by if at all.

    Breastfeeding is a public health issue.  It provides a number of preventive health enefits to infants and babies.  It is far cheaper than formula.  We should be encouraging breastfeeding to the extent possible without stigmatizing those who do not or can not breastfeed.

    and I speak as someone who had incredible difficulty breastfeeding and have two healthy, smart children ages 14 and 11 who recieved both breast milk and formula.  The issue really is where is the best cost investment up front?

     

  • darcie

    Jodi,

    WIC does cover formula and breast pumps and lactation consultants (at least in my state).  If we are promoting the coverage of breast pumps and lactation consultants under private insurance then we should be covering formula too.

    I also repectfully disagree on breastfeeding as a public health issue.  I am so tired of people mis-interpreting studies and not understanding the difference between correlation and causation. 

    Breast feednig is cheaper?  Add up visits to lactation conusltants, $400 pumps, breastpads, nipple shileds etc. not exactly cheap. 

    I also am a mom who breast fed and formula fed. I honestly do support breastfeeding. What I don’t support is misleading women.

  • fturley80x

    You don’t need to buy a new pump everytime, just sterilize it properly and its good.

     

    Bio-Hazard? Nah. Just take the common hygiene precautions.. and it’ll be fine.

  • jodi-jacobson

    Hi Darcie,

    I respectfully disagree as your contentions are not supported by evidence.  In fact quite the opposite.

    Breastfeeding provides extensive public health and cost saving benefits across the population.

    From womenshealth.gov:

    In fact, breast milk has disease-fighting antibodies that can help protect infants from several types of illnesses. And mothers who breastfeed have a lower risk of some health problems, including breast cancer and type 2 diabetes.

    From the Centers for Disease Control:

    Breastfeeding: Ideal for Infants
    Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. Research indicates that women who breastfeed may have lower rates of certain breast and ovarian cancers.

    From the USDA Economic Research Service:

    A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent). This figure is likely an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis. This report reviews breastfeeding trends and previous studies that assessed the economic benefits of breastfeeding.

    These same conclusions are supported by the World Health Organization and the American Academy of Pediatrics.  The evidence is just clear.

    At the individual level, formula feeding is estimated by Consumer Reports to cost roughly $1500.00 per year.  I don’t know what share of women need to visit lactation consultants, but in my case, even with a first baby that had all sorts of problems latching, eating enough, etc at first, i only needed two visits to get things going.  And I didn’t need any of it with my second.  If you buy formula only, you have to buy formula, period.

    The fact is this: If women can breastfeed (and I mean “can” on all levels, i.e. they have the support necessary) then breastfeeding provides both individual and population-level social, economic and health benefits that can not be rivaled by formula feeding at least for the first year to six months.  The public health and economic benefits are so great that doing what we can to support breastfeeding is a slam dunk.

    That is not the same as saying that mothers who can not breastfeed, or who choose to formula feed should be stigmatized or otherwise criticized, as I also see happening when things like this get ideological.

    and in the interest of “not misleading women” i rely on the cumulative evidence of the data and the experts.

     

    best wishes,

     

    Jodi

  • robin-marty

    I know her, and I’m not worried about contamination. But she was an extended breast feeder, so that makes me think my pump’s been hard used.

    Boo…

  • darcie

    If you take a look at these studies directly, the evidence is not so clear.  The problem is these studies are not publicly accessible unless you pay for them or have access to research databases (like I do).  Many people have to rely on the interpretation of these studies by “experts” and media who have other agendas.  I am not saying that BF is bad for babies or it’s not designed to be for babies.  I am saying that it’s not the magic elixir that many promote it to be.  It’s not a public health issue as much as it is a politicized issue.  It goes back to correlation vs. causation and words like “may” don’t hold much water.  More important numbers are the numbers needed to treat (NNT) or the number of people needed to be treated to see one person benefit.  If you do research on this and breastfeeding those numbers are pretty high.  So, if the economists are relying on these numbers and using some percentage to estimate the costs on the healthcare system I am not sure I would call it a slam dunk.

    from stats.org

    “One of the most common errors we find in the press is the confusion between correlation and causation in scientific and health-related studies. In theory, these are easy to distinguish — an action or occurrence can cause another (such as smoking causes lung cancer), or it can correlate with another (such as smoking is correlated with alcoholism). If one action causes another, then they are most certainly correlated. But just because two things occur together does not mean that one caused the other, even if it seems to make sense.

    In many cases, it seems obvious that one action causes another. However, there are also many cases when it is not so clear (except perhaps to the already-convinced observer).

    Typically, one can only establish correlation unless the effects are extremely notable and there is no reasonable explanation that challenges causality.

    When the stakes are high, people are much more likely to jump to causal conclusions. “

    http://stats.org/stories/2009/lack_stats_affects_media_oct8_09.html

    For example, the study issued on Type 2 Diabetes by the American Journal of Medicine and discussed on Web MD simply states “the risk of type 2 diabetes increases when followed by <1 month of lactation.”  The study also states the limitations of the study: “It was based on recall and reporting bias, … which could attenuate estimates.  Studies have linked obesity and insulin resistance to difficulties with breastfeeding. It is also possible that pregnancy complications such as pre-term birth and pre-eclampsia…are associated with risk for glucose intolerance and cardiovascular mortality later in life.  Data on women’s level of obesity or insulin resistance were not collected from participants.”

    They are definitely correlated, but is it because women with insulin issues to begin with end up formula feeding, or is it because BF reduces the risk of diabetes? 

    The AHRQ review of BF studies reveal many confounding factors and flaws in those studies as well.

    Reading WHO studies are an eye opener too…exclusive breastfeeding instead of feeding a 6 month old tea, juice or contaminated water – I totally support and agree with that, who wouldn’t?

    This is a quote from the WHO about current studies on BF:

    “Published studies of the effects of breastfeeding on child and maternal health have several methodological flaws. Use of a standard definition of breastfeeding, controlling for a variety of potentially confounding variables, and making efforts to control for reverse causality by excluding deaths near birth could make future studies more reliable.

    For outcomes for which data are currently lacking, well-conducted randomized controlled trials are needed, except for ‘infant mortality’ because it would be very difficult to design ethically acceptable studies that include infant mortality as an outcome.”

    Perhaps this physician can better explain my point:

    http://mainstreamparenting.com/2008/01/16/breastfeeding-advocacy-vs-lactofanaticism/

    This is what I mean by misleading women. Mothers need to educate themselves about the real risks and costs involved.  I get upset when educated women just regurgitate “statistics” when they don’t take the time to understand what they really mean.

    I completely support educating women about BF and supporting women who want to and can. Please don’t add to the promotion of weak statistics. I am relying on cumulative, accurate data.