Effect of the affordable care act on disparities in breastfeeding: The case of Maine

Objectives. To evaluate the Affordable Care Act (ACA) breastfeeding provision and test whether changes in coverage affected women differently according to health insurance status. Methods. We used the All-Payer Claims Database from Maine (2012-2014) to compare health insurance claims for lactation classes and breast pumps between women with private insurance and women with Medicaid (1) before the ACA breastfeeding provision, (2) after the provision came into effect, and (3) after health insurance expansion through the Marketplace. Results. We found limited change in claims for lactation classes over the study period. By contrast, the number of claims for breast pumps among women with private insurance increased from 70 claims in the third quarter of 2012 to 629 claims 1 year later and 803 claims in the third quarter of 2014. Women with Medicaid had only 11 claims for breast pumps over the entire study period. Conclusions. This 11-fold rise in claims for breast pumps by women with private insurance suggests that these women will likely increase breastfeeding initiation or duration; however, without additional support for women with Medicaid, disparities in breastfeeding may increase.