IRS claims "breastfeeding does not have enough health benefits to qualify - Mothering Forums

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#1 of 25 Old 10-28-2010, 12:47 AM - Thread Starter
 
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as a form of medical care."

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#2 of 25 Old 10-28-2010, 01:26 AM
 
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I am FURIOUS about this! Does anyone know how to complain to the right government entities about this?!

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#3 of 25 Old 10-28-2010, 07:38 AM
 
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#4 of 25 Old 10-28-2010, 09:32 AM
 
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But breastfeeding is NOT medical care. Breastfeeding is an ideal way of feeding a baby to promote future health. But to me, it's not a medical act. I'm not up in arms over this one. It makes more sense to me to add it to a child tax credit of some kind.
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#5 of 25 Old 10-28-2010, 10:15 AM
 
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Yeah, another vote for... well... duh. Breastfeeding is *feeding* not 'medical care'. Sorry.
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#6 of 25 Old 10-28-2010, 10:55 AM
 
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I guess it depends where you are coming from. I was picturing all the premature babies at much much greater risk of developing NEC if not breastfed/fed breastmilk. I would say that a pump for that mom is a medical expense. Is that covered already? (I'm up here in Canada so I am not familiar with the IRS.)
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#7 of 25 Old 10-28-2010, 11:32 AM
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Of course breastfeeding isn't medical care. It is the normal way of feeding a child. Breast pumping, on the other hand, which is what this article is about, I could consider to be a medical expense. If a mother is unable, for whatever reason (from having a preemie to needing to work), the natural, normal way of feeding her child is inhibited, and therefore, she needs a breast pump to express her milk for her baby.

I would definitely say that a breast pump would be a medical expense if there is a medical reason to use it, such as a preemie baby who cannot latch on or a mother and baby facing forced separation due to hospitalization. In these cases, expressing milk is medically necessary, and the pump is medical equipment. Pumping to increase milk supply if the baby is not getting enough could also fall into this category.

If the mother has to work or wants a pump so that she can leave the baby to go out on a date with her husband, it's harder to argue that a pump is medical equipment. That is just how the mother has arranged to have her baby fed while she is gone. It is certainly a better solution than formula, both for the health of the mother and child and cost-wise. I have a friend who formula fed when she went back to work, and she could have bought a breast pump every week for the amount she paid in formula. Yikes!

ETA: I do think we need to be careful about how we talk about breastfeeding in terms of its "benefits." Breastfeeding is the normal way of feeding a child. Breastfeeding itself is not a medical intervention (though pumping arguably is). Formula feeding is an intervention that carries with it many risks and should only be used when there are extenuating circumstances. I'm uncomfortable talking about breastfeeding in terms of "preventative medicine" because that implies that formula feeding is the standard. As lactivists, we really need to be working to help people understand that all the wonderful things that happen with a mother and baby from breastfeeding are just the way it was designed to work. Interrupting this perfect design shouldn't be considered to be not the best but a perfectly good and normal way of feeding a baby, the way most people do it at least sometimes. It should be considered exactly what it is: a food designed to minimize malnutrition in babies of mothers who cannot or will not breastfeed them.
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#8 of 25 Old 10-28-2010, 03:05 PM
 
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Originally Posted by JMJ View Post
If the mother has to work or wants a pump so that she can leave the baby to go out on a date with her husband, it's harder to argue that a pump is medical equipment. That is just how the mother has arranged to have her baby fed while she is gone.
Your post is wonderful and I agree with a lot of it, except this. I had a pump bought for me by Medicaid so I could pump when I went back to work. I would have had to FF otherwise. I can't afford formula, and can't afford to not work. A pump for the moms who want to pump and need to work is really the best answer to this problem.

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#9 of 25 Old 10-28-2010, 05:09 PM
 
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Your post is wonderful and I agree with a lot of it, except this. I had a pump bought for me by Medicaid so I could pump when I went back to work. I would have had to FF otherwise. I can't afford formula, and can't afford to not work. A pump for the moms who want to pump and need to work is really the best answer to this problem.
Yes of course a pump is the best answer & I believe it should be covered by WIC/foodstamps/etc. in circumstances such as yours. I don't believe it should qualify as a 'medical necessity' though; I really feel that it should fall under 'financial necessity'... To me, 'medical necessity' would be an inability of the child to latch, or mom's low supply, or something of that nature.

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#10 of 25 Old 10-28-2010, 06:55 PM
 
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Happy discussion vibes

If you have certain criteria for medical necessity (hence forth MN) like low supply, failure to latch etc, then you *do* leave the door open for moms like me (with no real issues) to still qualify for MN. Like DS has always sucked in his right cheek when nursing, he doesn't have a problem, it doesn't hurt, he gets plenty of milk, but he did it at 2 weeks old, and he still does it at 18m old. So if I went to my LC or MW and said, "I'm going to work, and I need to pump" and they said, well... you don't have MN, except I don't like the way he's pulling his cheek like that, is that a bad latch? Oh, I think it it, we better get you a pump. Or what is the quantifiable definition of low supply? Because I think I have that too KWIM?

But I don't know how foodstamps would help with a pump. From what I understand, it's only for food, so I could buy formula maybe? So in a year, the government could buy me a $200 pump, have a healthier mom and baby, or $2000 in formula, and no benefits to BFing


I will say that I have gone a bit OT The original article was talking about how you can't use pre-tax $$ from your HCSA to buy a breast pump. I don't understand why you can buy band-aids and condoms, but not a breast pump. ( I did read the have started restricting OTCs like cough syrup and Tylenol)
I can see both sides of this, but a breast pump is a very large purchase for many families, and I am for making them very, very available and affordable for everyone is never a bad thing.

I don't think I would allow bottles, breast pads and the paraphernalia to be included as a MN. Those kinds of things are easier to come buy. We need one less barrier on the road to helping every mom BF full term!

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#11 of 25 Old 10-28-2010, 07:33 PM
 
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If you have certain criteria for medical necessity (hence forth MN) like low supply, failure to latch etc, then you *do* leave the door open for moms like me (with no real issues) to still qualify for MN.
That is EXACTLY what I was thinking

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Originally Posted by kriket View Post
But I don't know how foodstamps would help with a pump. From what I understand, it's only for food, so I could buy formula maybe?
My thought is, when you apply for/renew foodstamps, if you have a baby, they could provide you with a pump. Not only would this get you a free pump, but it would also normalize breastmilk as food. (I'm guessing this is not how it works now?? I'm not sure on this aspect of foodstamps).

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I don't understand why you can buy band-aids and condoms, but not a breast pump. ( I did read the have started restricting OTCs like cough syrup and Tylenol)
I agree the criteria seem a bit arbitrary and I really do think a medically-necessary pump should be covered, I don't even understand how that's debatable but then again I'm a bit ignorant when it comes to understanding other peoples'/gov't views on things like this!!!!

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#12 of 25 Old 10-28-2010, 09:06 PM
 
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My thought is, when you apply for/renew foodstamps, if you have a baby, they could provide you with a pump. Not only would this get you a free pump, but it would also normalize breastmilk as food.
I love this!! Part of the "package" of food stability would be assisting mom with breastfeeding! omg.. This is the best Lactivist idea I have ever heard in my life. You can buy formula with foodstamps. This is the agency that you should talk to for financial assistance for a pump. Get medela and Ameda to work out discount programs with the state like Abbott Labs and crew do with WIC.

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#13 of 25 Old 10-28-2010, 10:27 PM
 
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I like the idea of free breast pumps through WIC........


But I kind of agree with the IRS. Now, I do think in some cases it could be but not automatically a medical care.
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#14 of 25 Old 10-29-2010, 03:04 PM
 
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I like the idea of free breast pumps through WIC........
Ours only offered me a manual, they gave me paperwork to file through insurance to get an electric since I was going back to work FT. I think my hands would have fallen off if I had to use a manual to go back to work.

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#15 of 25 Old 10-29-2010, 03:43 PM
 
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I think if the IRS would have stuck to the "food vs. medical care" issue, people wouldn't be so up in arms. But when they start mouthing off about breastfeeding having no significant health benefits, especially when other government agencies are working hard to promote breastfeeding, that's a huge problem. It isn't their job to interpret health data.

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#16 of 25 Old 11-01-2010, 12:27 PM
 
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As I sit here, pumping at my desk, I wonder what would happen if I didn't pump... I'd get really, really engorged and possibly end up with mastitis. To me, that is enough to make a pump qualify as a medical expense. It's at least as important as condoms (which keep me from getting an STD). Both are preventative medicine.

Not that I think the IRS gives a rip about what I think... but I do wish I could've bought my $300 pump with pre-tax income.

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#17 of 25 Old 11-01-2010, 03:13 PM
 
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I'm going to step in and remind everyone of the purpose of the forum-- breastfeeding advocacy. The window we're looking at this issue through is how it does or does not advance breastfeeing, period. Posts that pass judgment on individuals and their choices rather than discussing the general issue will be removed. You can read more about the purpose of the forum and the forum guidelines here.

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#18 of 25 Old 11-01-2010, 03:26 PM
 
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You know, I had a tube-fed baby and neither WIC nor medicaid would provide a pump after a certain time (medicaid provided it for 6 weeks I think, WIC wouldn't at all since I was staying home with my ill child who was unable to nurse ). So much for "medical need".

I don't really know how I feel about providing pumps to women who don't have a medical need. I mean, it makes sense, but should insurance be the one to provide it? WIC is usually good about providing them to women working outside the home. But that's where it gets iffy. We should *start* by getting them to the women with sick babies, if you ask me.
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#19 of 25 Old 11-01-2010, 03:56 PM
 
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You know, I had a tube-fed baby and neither WIC nor medicaid would provide a pump after a certain time (medicaid provided it for 6 weeks I think, WIC wouldn't at all since I was staying home with my ill child who was unable to nurse ). So much for "medical need".
I got the same spiel when my first son was in the NICU at 31 weeks and unable to eat. I ended up having to rent a Lactina for $60/month out of my own pocket until he was able to nurse.

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#20 of 25 Old 11-01-2010, 04:29 PM
 
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I see a breastpump as part of having a child. I can choose to buy one, or choose not to. Just like I choose to work or choose not to, or choose to have a child, or choose not to. A breast pump is not a necessity, unless there's a true medical need--like the child is unable to latch, has a frenulum problem, etc. Working, IMO, doesn't qualify, because barring a true conception accident, you should weigh your choices carefully before trying to conceive.

A breast pump used specifically to pump for working is an expense just like diapers, breastmilk storage bags, a crib (if using), clothing, food for the mom or the baby, etc. Those are expenses related to babies, expenses that can be anticipated simply by the nature of having a child. A medical situation is something different.
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#21 of 25 Old 11-01-2010, 04:34 PM
 
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I supposed the question is: Is a breast pump a medical device? I could argue that it is. A normal way of feeding a baby is from the breast so when you "can't", a pump is a device to make that normal thing possible.

Am I being logical here?

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#22 of 25 Old 11-01-2010, 04:39 PM
 
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I think if the IRS would have stuck to the "food vs. medical care" issue, people wouldn't be so up in arms. But when they start mouthing off about breastfeeding having no significant health benefits, especially when other government agencies are working hard to promote breastfeeding, that's a huge problem. It isn't their job to interpret health data.
I agree with this. I also agree with PPs that stated that there are no "benefits" to breastfeeding as it is normal. There are, however, RISKS associated with feeding formula and so from the perspective of preventative medicine, I can see how a breastpump should maybe be considered a medical expense.
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#23 of 25 Old 11-01-2010, 08:02 PM
 
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I think it's important to qualify that not every mother who uses a pump is doing so because she's "chosen" to nurse. As a matter of fact, I think that's a bit of a ridiculous assumption. Pumping isn't always a choice, as we've seen in some of the stories here. And do we really want the IRS of all government agencies to be in the position of judging whether a mother's reason for using a pump is good enough?

I also think the whole "well, you chose to be in a situation where you use a pump" argument is a bit of a slippery slope. How many other expenses could that decision be applied to? Who gets to decide what's the norm and what's not? The IRS? That's craziness. What's next-- homebirth? midwives? vitamins? contraception? After all, if people have to be vigilant against choices that lead to a "contraception accident," maybe they just shouldn't be having sex in the first place. That is hyperbole, by the way.

I'd be interest to know if special formulas are covered for babies and children who can't survive without them.

And finally, I just find it really odd that, as a pastor's family with a housing allowance, we can use toilet paper as part of our tax deductable housing allowance (we don't by the way) but they're quibbling over something like a breast pump. It's such a bizarre hill to die on.

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#24 of 25 Old 11-01-2010, 09:57 PM
 
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Hmmm....I have to say that I think that breastmilk is as much of a medical necessity to babies as good, whole, healthy, nutrient-dense foods are to everyone else. Which is the say that it's very necessary for good health...but it is FOOD and not medicine.

Just like people can survive on junk, processed, nutrient-deficient foods, so can babies survive on formula. Will they be in as good health as they could be. Probably not...as least not in the long run. Will, the risks of a poor diet catch up to them eventually...probably. But both formula and processed junk food can provide the necessary calories and minimum nutrient requirements to stay alive.

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#25 of 25 Old 11-01-2010, 10:25 PM
 
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I just got an email from LLLI with some clarification/links and thought I would share.

This is the original IRS publication. Note it doesn't mention breast pumps one way or the other.
http://www.irs.gov/publications/p502/index.html

Aetna tells members breast pumps are an allowable expense IF "recommended by a health care professional for a medical condition with the mother or the infant (or both)..."
http://www.aetna.com/members/fsa/eli...xpenses_B.html

Cigna, on the other hand, says it's not allowed, period:
http://www.cigna.com/our_plans/medic...sa_health.html
http://www.aetna.com/members/fsa/eli...xpenses_B.html

Finally, the IRS response to the AAP's letter asking that breast pumps be an allowable expense says they don't have the authority to change this and it will require Congressional action.

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