{"database": "press", "table": "releases", "rows": [["https://www.duckworth.senate.gov/news/press-releases/duckworth-merkley-push-to-ensure-health-insurers-cover-and-provide-lactation-care-for-pregnant-and-nursing-parents", "Duckworth, Merkley Push to Ensure Health Insurers Cover and Provide Lactation Care for Pregnant and Nursing Parents", "2024-09-25", "2024", "2024-09", "Democrat", "Senate", "IL", "Tammy Duckworth", "D000622", "www.duckworth.senate.gov", "duckworth", "https://www.duckworth.senate.gov/news/press-releases", "scraper", "Under the Patient Protection and Affordable Care Act, health insurance plans are required to cover lactation services\u2014but many still fail to comply\n\n[WASHINGTON, D.C.] \u2013 Today, U.S. Senators Tammy Duckworth (D-IL) and Jeff Merkley (D-OR) called on the U.S. Department of Labor\u2019s (DOL) Employee Benefits and Security Administration (EBSA) to issue strong recommended guidance for private health insurance plans and insurers to comply with federal law by covering in-person lactation support, supplies and counseling for pregnant and nursing parents across the country. Most health plans are required to cover lactation services under the Patient Protection and Affordable Care Act (ACA). The Senators\u2019 letter expresses concerns that many still fail to comply with federal law, making it harder for pregnant and nursing parents to access quality lactation care.\n\nIn their letter, the Senators wrote: \u201cEnsuring that new mothers and the more than 10,000 babies born each day in the United States receive critical preventive care, including comprehensive lactation care, is one of our top priorities\u2026 We respectfully request that the Department of Labor\u2019s (DOL) Employee Benefits and Security Administration (EBSA) utilize its existing authority to issue strong, recommended guidance for the legally required coverage of in-person lactation support, supplies and counseling from trained providers for pregnant and nursing parents across the country, as outlined in the Patient Protection and Affordable Care Act (ACA).\u201d\n\nThe Senators continued: \u201c\u2026 the ACA mandated that all non-grandfathered, fully insured and self-insured plans in individual, small group and large group markets are required to cover certain preventive health services without cost-sharing for enrollees. These preventive health services include lactation support, supplies and counseling from trained providers. Despite this mandate, many plans fail to cover and provide adequate access to lactation care.\u201d\n\nAlong with Duckworth and Merkley, the letter was cosigned by U.S. Senators Richard Blumenthal (D-CT), Cory Booker (D-NJ), Bob Casey (D-PA), Chris Van Hollen (D-MD), Amy Klobuchar (D-MN) and Martin Heinrich (D-NM).\n\nA full copy of the letter is available below and on Senator Duckworth\u2019s website:\n\nDear Assistant Secretary Gomez:\n\nWe write to express our concerns regarding coverage for lactation services by group health plans and health insurance issuers covered under the Employee Retirement Income Security Act (ERISA). We respectfully request that the Department of Labor\u2019s (DOL) Employee Benefits and Security Administration (EBSA) utilize its existing authority to issue strong, recommended guidance for the legally required coverage of in-person lactation support, supplies and counseling from trained providers for pregnant and nursing parents across the country, as outlined in the Patient Protection and Affordable Care Act (ACA).\n\nOn November 18, 2022, Senator Duckworth wrote to the EBSA to voice concerns that insurers were failing to comply with the ACA\u2019s requirements. In response to that correspondence, on December 22, 2022, the EBSA stated they, \u201cshare your concern about consumer-reported denials of coverage for lactation care by group health plans and health insurance issuers,\u201d and noted that the EBSA, \u201cwork[s] diligently to ensure that coverage of breastfeeding services and supplies is available as required by the ACA and its implementing regulations, and we take the enforcement of these requirements very seriously.\u201d\n\nAs you know, the ACA mandated that all non-grandfathered, fully insured and self-insured plans in individual, small group and large group markets are required to cover certain preventive health services without cost-sharing for enrollees. These preventive health services include lactation support, supplies and counseling from trained providers.\n\nDespite this mandate, many plans fail to cover and provide adequate access to lactation care. Our constituents have experienced several barriers to accessing quality lactation care imposed by their health plans or insurers that violate the ERISA and ACA, including:\n\nInadequate Provider Networks: Some plans do not have enough in-network lactation care providers to cover the needs of enrollees, demonstrating an unwillingness to provide adequate access to such care, as mandated by the ACA;\n\nFailure to Cover Out-of-Network Provider Services: Some plans require cost-sharing or do not pay for claims from out-of-network lactation care providers, despite their own network\u2019s inadequate coverage. This is in direct conflict with applicable regulations that require plans to cover items or services rendered by an out-of-network provider when the plan does not have an in-network provider that can furnish the item or service;\n\nLack of In-Person Service Coverage: Though lactation care can be provided in person or via telemedicine, there are distinct advantages that come with each type of visit and therefore should be covered equally. From our understanding, some plan\u2019s in-network lactation care providers primarily offer services via telemedicine and do not cover in-person visits in a similar manner. Given their small number of in-network providers, inability to offer adequate in-person services and refusal to pay claims from out-of-network providers who offer in-person services, these plans have effectively created a de facto telemedicine-only network for lactation care. While plans may engage in \u201creasonable medical management\u201d of lactation care under the ACA, de facto prohibitions on the modality used to provide care are contrary to the law. In a 2015 guidance document, DOL addressed a similar situation, finding that plans limiting coverage of lactation care to services provided during an inpatient hospital admission did not constitute \u201creasonable medical management.\u201d Similarly, limiting the availability of in-person lactation care by creating a telemedicine-only network is equally problematic under the ACA.\n\nPlans have also imposed referral requirements and have failed to create directories of in-network providers, which also curtail the ACA\u2019s mandate and inhibit access to crucial preventive care for new and expecting mothers and their babies.\n\nAs such, we respectfully request that the EBSA utilize its oversight powers to engage with plans about the concerns described above, including potential violations of the ERISA. We also request that the EBSA provide further sub-regulatory guidance to clarify that plans must demonstrate sufficient coverage for all lactation care modalities, including in-person lactation care. Such guidance should provide information on how plans should form and demonstrate a sufficient network of lactation care providers, and, in the absence of a sufficient network, reimburse out-of-network claims.\n\nEnsuring that new mothers and the more than 10,000 babies born each day in the United States receive critical preventive care, including comprehensive lactation care, is one of our top priorities. With our joint commitment to the health and well-being of new mothers and babies in mind, we look forward to your response.\n\nSincerely,\n\n-30-", 1, "2026-03-30T01:40:41Z", "2026-04-06T18:46:43Z"]], "columns": ["url", "title", "date", "year", "month", "party", "chamber", "state", "member_name", "bioguide_id", "domain", "scraper", "source", "date_source", "text", "has_text", "collected_at", "updated_at"], "primary_keys": ["url"], "primary_key_values": ["https://www.duckworth.senate.gov/news/press-releases/duckworth-merkley-push-to-ensure-health-insurers-cover-and-provide-lactation-care-for-pregnant-and-nursing-parents"], "units": {}, "query_ms": 2.010718919336796, "source": "dwillis/congress-press", "source_url": "https://github.com/dwillis/congress-press", "license": "MIT", "license_url": "https://github.com/dwillis/congress-press/blob/main/LICENSE"}