BILL ANALYSIS
AB 513
Page 1
ASSEMBLY THIRD READING
AB 513 (De Leon)
As Amended May 5, 2009
Majority vote
HEALTH 12-3 APPROPRIATIONS 12-5
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|Ayes:|Jones, Block, Carter, De |Ayes:|De Leon, Ammiano, Charles |
| |La Torre, De Leon, Hall, | |Calderon, Davis, Fuentes, |
| |Hayashi, Hernandez, | |Hall, John A. Perez, |
| |Bonnie Lowenthal, Nava, | |Price, Skinner, Solorio, |
| | V. Manuel | |Torlakson, Krekorian |
| |Perez, Salas | | |
| | | | |
|-----+--------------------------+-----+---------------------------|
|Nays:|Fletcher, Gaines, Audra |Nays:|Nielsen, Duvall, Harkey, |
| |Strickland | |Miller, |
| | | |Audra Strickland |
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SUMMARY : Requires health plans and those health insurers that
provide maternity benefits to cover the rental of breast pumps
and lactation consultation with an international board certified
lactation consultant (IBCLC). Specifically, this bill :
1)Requires every health plan contract, except a specialized
health plan contract, and every health insurance policy that
provides maternity benefits that is issued, amended, renewed,
or delivered on or after January 1, 2010, to provide coverage
for the rental of breast pumps and lactation consultation (LC)
with an IBCLC.
2)Makes various legislative findings and declarations relating
to the benefits of LC and breast-feeding.
EXISTING LAW :
1)Provides for the regulation of health plans by the Department
of Managed Health Care and health insurers by the California
Department of Insurance (CDI).
2)Requires full-service health plans licensed under the
Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene)
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to cover all medically necessary basic health care services,
including physician services; hospital inpatient and
outpatient services; diagnostic services; preventive and
routine care; emergency and urgent care services; medically
appropriate home health services; and, rehabilitation therapy.
There is no requirement for health insurers subject to
regulation by CDI to cover medically necessary basic services
or any specific minimum basic benefits.
3)Provides, under Knox-Keene, that health plans must provide all
medically necessary basic health care services, including
maternity services necessary to prevent serious deterioration
of the health of the enrollee or the enrollee's fetus, and
preventive health care services, specifically including
prenatal care.
4)Defines health plans that cover only certain kinds of care,
such as dental and vision care plans, behavioral or mental
health plans, and chiropractic plans, as specialized plans.
5)Defines a policy of health insurance for covered benefits in a
single specialized area of health care, including dental-only,
vision-only, and behavioral health-only policies, as a
specialized health insurance policy.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, based on findings of the California Health Benefits
Review Program (CHBRP) of the University of California, this
bill will result in increased annual costs of $178,000 (60%
General Fund) to the California Public Employees' Retirement
System. Annual increased premium costs across the private
insurance market of $3 million. 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 : The author points out that breast-feeding has been
well established as a low-cost, low-tech preventive intervention
with far-reaching benefits for mothers and babies and
significant cost savings for health providers. 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, LC
provided by an IBCLC has been shown to help women address the
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difficulties with initial and continued breast-feeding. The
author asserts that the coverage of LC and breast pump rentals
required by this bill will provide breast-feeding mothers with
the support and skilled assistance they need to ensure that
feeding gets off to a good start.
IBCLCs are health care professionals who specialize in the
clinical management of breast-feeding and have demonstrated
their competence to practice by passing an internationally
recognized criterion-reference examination. IBCLCs provide
skilled breast-feeding assistance to mothers and children, work
as part of a health care team to prevent and solve
breast-feeding problems, and encourage a social environment that
supports breast-feeding families. IBCLCs work in a variety of
settings including hospitals, neonatal intensive care units and
special care nurseries, lactation clinics, maternal and child
health services, and in private practice.
In its analysis of this bill, CHBRP reports that it was unable
to identify any studies that compared the effectiveness of LC
provided by IBCLCs to the effectiveness of LC provided by other
health professionals, such as nurses or midwives. Furthermore,
according to CHBRP, the preponderance of evidence found no
effect of extra LC on the cessation of exclusive breast-feeding
before four to six weeks after delivery. With regard to breast
pumps, CHBRP indicated that literature on breast pumps is
limited in terms of number of studies and the populations
studied. However, CHBRP states that findings from a single
study suggest that for low-income women returning to work who
had delayed or immediate access to renting a breast pump, the
odds of not using formula at six months were three to five times
as large as the odds for women who did not rent a breast pump.
According to CHBRP, about 20.5 million people are enrolled in
privately and publicly funded health plans and policies subject
to this bill, of which 416,000 are delivering women who would be
directly impacted by the services included in this bill. Among
the estimated 416,000 delivering women with coverage subject to
this bill, about 103,000 would gain coverage for outpatient LC
provided after discharge from the hospital and approximately
27,000 would gain coverage for breast pump rental. CHBRP
reports that there would be no change in utilization rates as a
result of this bill for LC during delivery admission, outpatient
LC, or breast pump rental because LC during delivery admission
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is already fully covered for 96.2% of enrollees.
Total annual expenditures as a result of this bill are estimated
to increase by $607,000 and premiums are estimated to increase
by about $4.1 million. CHBRP states that the overall consensus
from the medical community is that breast-feeding has
substantial health benefits to both infants and mothers.
However, this bill is not expected to generate health benefits
associated with breast-feeding since CHBRP indicates this bill
is not expected to result in an increase in utilization of LC or
use of electric breast pumps. CHBRP does note that this bill is
expected to reduce out-of-pocket costs for the current 6,000
users of outpatient LC and 2,000 users of electric breast pumps.
Furthermore, CHBRP states that since this bill is not expected
to result in an increase in LC or use of electric breast pumps,
it is not expected to decrease racial health disparities,
decrease the economic burden associated with health conditions
that could be prevented by increased breast-feeding, or result
in long-term health benefits.
The sponsor of this bill, the California Women, Infants and
Children (WIC) Association, notes in support that 87% of
California mothers initiate breast-feeding in the hospital and
this bill will ensure that, in the early days and weeks after
birth, mothers will receive the help they need to solve normal
and expected problems so they can continue breast-feeding,
exclusively, without the need for formula. Supporters,
representing health providers, public health groups, and
breast-feeding advocacy groups, assert that mothers should have
access to the support and tools they need to ensure that
breast-feeding is successful. Supporters add that the minimal
costs associated with these services should be more than offset
by the reduction of medical conditions in infants needing
medical treatment.
Health plans, health insurers, and business groups generally
object to all benefit mandates because, while they sympathize
with the intent to meet a need, mandates increase the already
high cost of care for everyone and hinder a carrier's ability to
offer a wider range of affordable products, which together may
lead individuals and employers to drop coverage. Health Net
contends that it already provides coverage for breast pumps as
part of durable medical equipment when there is a demonstrated
medical necessity and opposes this bill because it requires
coverage of pumps when they are not needed for medical reasons
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but to assist the mother in expressing milk on a schedule that
is suitable for her. Health Net also notes that most enrollees
receive LC, primarily from nurses, during delivery admission,
and it is not aware of any evidence that challenges the
competence of nurses to provide this assistance to new mothers.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097
FN: 0001205