IRS Fears Women May “Abuse” Tax Credits for Breastfeeding Supplies

Jodi Jacobson

The IRS has determined that health reform won't cover breast pumps for nursing mothers because "nursing is natural" and women may "abuse the system" if allowed to use their flexible spending accounts to cover nursing supplies and lactation consultants.

In the United States, we have a false love affair with motherhood. Indeed we also have a false love affair with fetal life, not backed up by any commitment to children once they are born.

We love to exalt motherhood, women as mothers, women with 19 children, women who “choose life,” whatever that means.  We just don’t want much to do with the “life after birth” part.

The most recent example of our hypocrisy is the fact that the new health reform bill will not cover breast pumps or the supplies often needed by breastfeeding mothers.  For those who may not be aware, new mothers who breastfeed often need breast pumps.  It may be because they are working outside the home and need to keep up their supply of stored milk so partners or caregivers can feed a baby breast milk even when mom is not there. Perhaps because the new mom is desperate for more sleep, so she pumps and stores milk so that her partner can feed the baby at night.  Perhaps she has other children to tend, so pumping helps ensure she can better juggle everyone’s needs.  Perhaps she is having problems with milk production and therefore needs a pump to increase her supply to adequately nourish her child (something with which I contended with my first baby).  And maybe our societal neurosis about nursing in public leaves some women feeling more comfortable toting breast milk in bottles when out on errands rather than dealing with people who can’t deal with a nursing mom.

No matter the reason, breast pumps are certainly as much a part of “medical care” as are adhesives used by denture wearers to keep false teeth in place.

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Except that denture adhesive is covered as a basic medical expense under the new health care bill, and breast pumps are not.

According to an article in the New York Times yesterday, “Denture wearers will get a tax break on the cost of adhesives to keep their false teeth in place. So will acne sufferers who buy pimple creams.”

And:

People whose children have severe allergies might even be allowed the break for replacing grass with artificial turf since it could be considered a medical expense.

But, notes the Times,nursing mothers will not be allowed to use their tax-sheltered health care accounts to pay for breast pumps and other supplies.”

Why? Because the Internal Revenue Service has ruled that breast-feeding does not have enough health benefits to quality as a form of medical care.  But astro-turf does.

Get this:

Despite a growing body of research indicating that the antibodies passed from mother to child in breast milk could reduce disease among infants — including one recent study that found it could prevent the premature death of 900 babies a year — the I.R.S. has denied a request from the American Academy of Pediatrics to reclassify breast-feeding costs as a medical care expense. [emphasis mine]

Seriously?  Does the IRS now take contributions from Nestles?

Feeding a new infant entails much more than at what hour and how many times you wake up at night. It also intersects with the productivity of women as they work in and outside the home.

In fact, the medical and public health communities in the United States have been trying for decades to reverse the decline in and stigmatization of breastfeeding, with great success in increasing breast feeding rates for at least the first six months of a baby’s life. “According to a survey by the Centers for Disease Control and Prevention,” reports the Times, “about 75 percent of the 4.3 million mothers who gave birth in 2007 started breast-feeding. By the time the baby was 6 months old, the portion dropped to 43 percent, and on the child’s first birthday, to 22 percent.”

Breastfeeding is a commitment that is affected by and affects women’s ability to earn income and work outside the home, which is another reason the intersection of health and economics is so great.  And pumps can make the difference.

To continue breast-feeding once they return to work, many mothers need to use pumps to extract milk, which can be chilled and bottle-fed to the child later. The cost of buying or renting a breast pump and the various accessories needed to store milk runs about $500 to $1,000 for most mothers over the course of a year, according to the United States Breastfeeding Committee, a nonprofit advocacy group.

Lactation consultants, who can cost several hundred dollars, also would not be an eligible expense.  

While breastfeeding equipment and supplies weren’t covered before health reform, one of the main purposes of health reform (please help me out here if I missed the “purpose” of reform) was to improve upon and eliminate disparities in health care, including those disparities based on sex and gender.

And another major goal of the health care overhaul was to control medical costs by encouraging preventive approaches to health. This underscores the nonsensical nature of excluding supplies and support for breastfeeding, one of the most effective preventive “interventions” you can find.  Astro-turf might ameliorate severe allergic reactions, but it does not prevent allergies.

A study released this year by Harvard Medical School concluded that if 90 percent of mothers followed the standard medical advice of feeding infants only breast milk for their first six months, the United States could save $13 billion a year in health care costs and prevent the premature deaths of 900 infants each year from respiratory illness and other infections.

“The old adage that breast-feeding is a child’s first immunization really is true,” said Dr. Robert W. Block, president-elect of the American Academy of Pediatrics. “So we need to do everything we can to remove the barriers that make it difficult.”

Many mothers’ groups and medical experts say that breast milk provides nutrition and natural supplements that prevent disease, and would like to see its use expanded. Hospital accreditation groups have been prodding maternity wards to encourage parents to feed only breast milk until a child is 6 months old.

Let me underscore that figure: the United States could save $13 billion a year by supporting a low-cost preventive intervention: breastfeeding.

Let me also underscore that we spend untold sums of money trying to encourage breastfeeding in developing countries, for example, through international aid for the very reasons articulated above.  But here? It’s not healthy enough.  Somehow the IRS has decided its credentials as a government medical and public health authority supersedes those of AAP and countless other organizations that promote breastfeeding whenever feasible.

The Times suggests two reasons the IRS in all its public health expertise and wisdom has rejected coverage for breastfeeding.

One: It’s considered “natural.”

I.R.S. officials say they consider breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. But because the I.R.S. code considers nutrition a necessity rather than a medical condition, the agency’s analysts view the cost of breast pumps, bottles and pads as no more deserving of a tax break than an orange juicer.

Hmmmm.  I would think teeth would be considered “natural,” and a “necessity,” but when you lose them you get your dental work and your denture adhesive covered.  I would think breathing is considered a “necessity” and not a medical condition, but we cover breathing tubes in the hospital when breathing is compromised.

Yet under health reform American women intending to bear a child, who set aside part of their pretax earnings in flexible spending accounts to pay for un-reimbursed medical expenses will not be using them to pay for breast pumps.  No, no, no.  The men can get Viagra to make the babies.  The women can’t get reimbursed for feeding them.

Two, and here is my favorite “don’t-cover-the-pumps” reason: the IRS is concerned that if it allows coverage of breastfeeding equipment and supplies, women may abuse the privilege.

Yep. You heard it right.  We now have the advent of the breastfeeding-flexible-spending queen to replace the welfare queen. 

Roy Ramthun, a former Treasury Department official, said that tax officials’ reluctance to classify those costs as medical expenses stemmed from a fear that the program might be abused.

“They get very uneasy about anything that smacks of food because they fear it will open up all sorts of exceptions,” said Mr. Ramthun, who runs a consulting company that specializes in health savings accounts. “It’s a matter of cost and of protecting the integrity of the tax code.”

Yes, I can see it now.  Women using their flexible spending accounts to purchase breast pumps in different colors and sizes.  Women buying designer nursing pads to cover their leaking nipples at work.  Women who are not even mothers buying breast pumps to encourage their own milk production and creating a black market in breast milk on eBay. 

I wonder how I missed this opportunity to cheat the system when I nursed both my kids. If the IRS reverses this decision, I’m seeing a scandal bigger than Madoff.

What this reveals is that misogyny and discrimination in this country is so deeply engrained in our psyche we don’t even know it when we see it.  We create ridiculous barriers for women because they are women and we don’t even realize how ridiculous–indeed unethical, unhealthy and uneconomical–those barriers are.  Or how unjust.

The lack of coverage is not for lack of trying by advocates:

“Everyone says they support breast-feeding, but getting businesses and Congress to act on it has been surprisingly difficult,” said Barbara Emanuel, executive director of the breast-feeding advocacy group La Leche League International. “We get resistance from the formula companies and cultural resistance, so it can be hard to get nursing mothers the support that everyone agrees they deserve.”

Well, when you’ve got Senators like John Kyl telling us he doesn’t want insurance to have to cover maternity care because “he doesn’t need it,” and you’ve got “leading” media analysts like Joe Klein scoffing at the idea that businesses be made to ensure their lactating female workers have a private space to pump, you can imagine why it might be this difficult.

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