BILL ANALYSIS
AB 513
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Date of Hearing: May 20, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 513 (De Leon) - As Amended: May 5, 2009
Policy Committee: Health Vote:12-3
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and health insurers that provide
maternity benefits to cover the rental of breast pumps and
lactation consultation with an international board certified
lactation consultant (IBCLC).
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), increased annual costs of $178,000 (60% GF) to
CalPERS. No increased costs to Medi-Cal or the Healthy
Families Program. The impact on public payers is relatively
minor because of high coverage levels provided under current
law for both consultation and breast pump rental.
2)Annual increased premium costs across the private insurance
market of $3 million. These costs reflect premiums for group
insurance and for premiums in the individual health insurance
market. About $2 million of increased premium costs are due to
a reduction in out-of-pocket costs incurred by women and their
families prior to the mandate established by this bill.
COMMENTS
1)Rationale . This bill is sponsored by the California Women,
Infants, and Children (WIC) Association and is supported by a
broad array of providers and health advocates. According to
the author, breast feeding has been long-established as a low
cost method of improving maternal and child health. According
to the sponsor of this bill, exclusive breastfeeding for three
months has been shown to reduce health care costs by up to
$475 during a baby's first year of life.
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This bill increases the number of women who are able to continue
breast feeding after leaving the hospital by increasing access
to breast pumps and lactation support by certified
professionals. IBCLCs are specialized health care
professionals who have completed an international examination
to demonstrate competency. According to the author and
sponsor, the majority of breast feeding problems occur
following discharge of a new mother and infant from the
hospital. Almost all of more than 400,000 deliveries with
health coverage addressed by this bill include lactation
consultation at the time of delivery. However, after leaving
the hospital, many women fail to continue breast feeding which
has been shown to have numerous and significant health
benefits for babies. This bill increases access to lactation
support outside of the hospital setting.
2)Health Benefits of Breastfeeding . According to CHBRP and
numerous studies, breast feeding has significant health
benefits for both mother and child. Health benefits for
children include a reduction in risk of acute ear infections,
stomach flu, lower respiratory tract infections, eczema,
asthma, obesity, Type 1 and Type 2 diabetes, childhood
leukemia, and sudden infant death syndrome (SIDS). Health
benefits of breast feeding for mothers include reduced risks
of Type 2 diabetes and reduced incidence of breast and ovarian
cancer.
3)Concerns . Health industry opponents of this bill indicate
legislatively mandated health benefits increase costs and
limit insurer, employer, and individual choices with respect
to a variety of health benefits. Insurers indicate this bill
limits individual, employer, and employee choices with respect
to health care expenditures, without a related health benefit.
When considered together, mandates may also hinder the ability
of insurers and employers to offer a wide range of affordable
products to consumers with a variety of health care needs.
4)Related Legislation . AB 514 (De Leon), pending on the Suspense
File of this committee, requires employers to provide a
20-minute paid rest period during each four-hour work period
to accommodate breast feeding employees.
SB 257 (Pavley), pending in the Senate, requires California
state employees to be notified about current law requirements
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supporting breast feeding for working mothers.
There are more than two dozen current law health mandates,
established over the last two decades, to provide coverage for
specified services such as cancer screenings and treatment.
There are another handful of mandates to offer coverage for a
number of other health services.
5)Other Health Mandates in the Current Session . There are nine
health mandates under legislative consideration this year,
including AB 513. Other proposed health mandates include:
a) AB 56 (Portantino): mammography coverage
b) AB 98 (De La Torre): maternity coverage
c) AB 163 (Emmerson): amino acid elemental formula coverage
d) AB 214 (Chesbro): durable medical equipment coverage
e) AB 244 (Beall): mental health parity
f) AB 259 (Skinner): access to nurse midwives
g) SB 158 (Wiggins): HPV vaccine coverage
h) SB 161 (Wright): chemotherapy treatment
Two other bills address minimum coverage or loosening of
current law mandates in the current session. These two bills
are:
a) AB 786 (Jones): standardization of individual market
products
b) SB 92 (Aanestad): out-of-state carrier coverage
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081