Hawkins Summer Sherburne, Horvath Krisztina, Noble Alice, Baum Christopher F
School of Social Work, Boston College, Chestnut Hill, Massachusetts.
Department of Economics, Boston College, Chestnut Hill, Massachusetts.
Womens Health Issues. 2022 Mar-Apr;32(2):114-121. doi: 10.1016/j.whi.2021.10.005. Epub 2021 Nov 19.
The Patient Protection and Affordable Care Act (ACA) required new private insurance plans to provide breast pumps with no cost sharing beginning August 2012, and in January 2014 expanded this requirement to Marketplace plans and expanded Medicaid coverage. We first examined the associations between the ACA reforms in 2012 and 2014 with rates of breast pump claims between Medicaid enrollees and those with private insurance. We next examined the associations between the monthly rate of breast pump claims with breastfeeding initiation and duration by insurance type.
Using 2011-2015 public and private health insurance claims in All-Payer Claims Databases from Massachusetts, Maine, and New Hampshire, we conducted a linear regression model to evaluate the associations between the 2012 and 2014 ACA health insurance reforms with rates of breast pump claims by health insurance status. We then linked the monthly rates of breast pump claims per 1,000 live births to the Pregnancy Risk Assessment Monitoring System with self-reported breastfeeding initiation and duration. We estimated probit regression models to examine the associations between monthly rates of breast pump claims per state, insurance type, age group, and breastfeeding outcomes.
For the 2012 ACA reform, breast pump claims increased by 183.4 (143.7-223.1) per 1,000 live births for women with private insurance, but decreased for Medicaid enrollees (-99.3 [-139.0 to -59.6]). For the 2014 ACA reforms, the opening of health insurance Marketplaces had no effect on breast pump claims for women with private insurance (8.3 [-43.6 to 60.2]), whereas Medicaid expansion increased claims by 119.4 (67.5-171.3) per 1,000 live births for Medicaid enrollees. Every additional 10 breast pump claims per 1,000 live births was associated with a 1.08 percentage point increase in breastfeeding initiation among women with private insurance (0.108 [0.018-0.198]), but not Medicaid enrollees (0.076 [-0.078 to 0.230]). In contrast, every additional 10 breast pump claims per 1,000 live births was associated with a 1.79 percentage point increase in breastfeeding for 4 or more weeks for women with private insurance (0.179 [0.063-0.294]) and a 2.05 percentage point increase among women with public insurance (0.205 [0.033-0.376]). Interaction analysis revealed no significant differences in associations by insurance type across breastfeeding outcomes.
The ACA breastfeeding coverage requirements fill a gap for women wanting to obtain a breast pump to support breastfeeding. The monthly rate of breast pump claims, as an indicator of access, translated into higher levels of breastfeeding for women with private and public insurance with the potential to reduce socioeconomic disparities.
《患者保护与平价医疗法案》（ACA）要求自2012年8月起，新的私人保险计划应免费提供吸奶器，2014年1月，该要求扩大至医保市场计划，并扩大了医疗补助覆盖范围。我们首先研究了2012年和2014年ACA改革与医疗补助参保者和私人保险参保者的吸奶器报销率之间的关联。接下来，我们按保险类型研究了吸奶器每月报销率与母乳喂养开始情况及持续时间之间的关联。
利用马萨诸塞州、缅因州和新罕布什尔州全支付方索赔数据库中的2011 - 2015年公共和私人医疗保险索赔数据，我们进行了线性回归模型，以评估2012年和2014年ACA医疗保险改革与按健康保险状况划分的吸奶器报销率之间的关联。然后，我们将每1000例活产的吸奶器每月报销率与妊娠风险评估监测系统中自我报告的母乳喂养开始情况及持续时间相联系。我们估计了概率单位回归模型，以研究各州、保险类型、年龄组和母乳喂养结果的吸奶器每月报销率之间的关联。
对于2012年的ACA改革，私人保险女性每1000例活产的吸奶器报销增加了183.4（143.7 - 223.1），但医疗补助参保者报销减少（-99.3 [-139.0至-59.6]）。对于2014年的ACA改革，医疗保险市场的开放对私人保险女性的吸奶器报销没有影响（8.3 [-43.6至60.2]），而医疗补助扩大使医疗补助参保者每1000例活产的报销增加了119.4（67.5 - 171.3）。每1000例活产中额外增加10次吸奶器报销与私人保险女性母乳喂养开始率增加1.08个百分点相关（0.108 [0.018 - 0.198]），但与医疗补助参保者无关（0.076 [-0.078至0.230]）。相比之下，每1000例活产中额外增加10次吸奶器报销与私人保险女性母乳喂养4周及以上的比例增加1.79个百分点相关（0.179 [0.063 - 0.294]），与公共保险女性增加2.05个百分点相关（0.205 [0.033 - 0.376]）。交互分析显示，不同保险类型在母乳喂养结果方面的关联无显著差异。
ACA的母乳喂养覆盖要求填补了希望获得吸奶器以支持母乳喂养的女性的空白。吸奶器每月报销率作为可及性指标，转化为私人保险和公共保险女性更高水平的母乳喂养，有可能减少社会经济差距。
