New mothers may be pleased to learn the Affordable Care Act requires most insurance plans to give them equipment and services to enable them to breast feed.
What that means in practical terms for most moms is a free breast pump.
What the act doesn't say, however, is what kind of pump has to be provided.
Some mothers are getting fast electric ones, while others are left with the cheaper, manual version.
Megan Lopez grew up in Portland and works at the OnPoint Credit Union.
It's her job to take phone calls and help customers with their finances.
She has a nine-month old and she works full time, so she needs a breast pump.
She was pleased to learn recently that the new federal health care law requires most insurers to provide new mothers with one.
"I was excited. Because I said this is perfect. I can get a new breast pump and I need one, because I have to give mine back."
She got the information from a co-worker, whose wife has Providence insurance.
"He said: 'Yeah, she's able to get an electric pump. No problem. They're paying for the whole thing.' That's awesome. So I called Kaiser, who I have and I said: 'I heard they have this new law. How does this work? What do I do?' She said: 'Oh yeah they have a new law, but we're providing a manual pump.' And I said: 'Really?' 'Cause that's not even possible if you're working full-time. So I just said: 'Okay, whatever, I'm not going to get that.' 'Cause it's not really going to work for me.' So I was pretty bummed out."
She says electric pumps are high powered and supposed to simulate a nursing child, whereas she finds manual pumps weak and clumsy.
But, she says, the main problem is that she only gets a short break.
"It already takes my whole break to pump as it is with an electric pump on both breasts. So to do a hand pump and do it each side, I couldn't even imagine it'd be convenient."
A high-end electric-powered double breast pump can cost $300, whereas an inexpensive manual one can be as little as $35.
The Affordable Care Act isn't specific, so different health plans are providing different pumps.
Doctor Kim Luft is a pediatrician with Kaiser Permanente. She says manual pumps meet the basic needs of moms, but....
"If there's any medical issues going on where a electric pump would be a medical necessity, then we would order it. And if she's having an issue of not having enough time at work then seeing if she could talk to her employer about the Oregon law that allows time for breast feeding, so she could get the time she needed."
Lopez has no problem with her employer, OnPoint.
She says she doesn't want to take extra time and leave her work mates to cover for her.
And OnPoint issued a statement saying it supports nursing mothers and is committed to making it easy and comfortable to pump during the work day. For example OnPoint says it provides a private dedicated break room and up to 30 minute breaks for nursing mothers -- which it says, is consistent with wage and hour laws.
Meanwhile, Kaiser says helping new mothers breast feed is one of its priorities, too. 14 months ago, Kaiser signed a commitment with the Partnership for a Healthier America to support breast feeding and reduce childhood obesity.
And Kaiser's own literature says manual pumps don't provide enough stimulation to increase milk supply for most women.
Kaiser pediatrician, Dr. Kim Luft, says essentially it comes down to money.
"We have limited resources and we have to be good stewards with those resources so that people's premiums or taxes don't go high. But we're still giving everyone the basic medical care that they need and it's a balancing act. And it's hard."
And the law isn't specific about what insurers need to cover.
Judy Waxman, of the National Women’s Law Center, says that's the problem. She says the U.S. Department of Health and Human Services needs to tell insurance companies exactly what is required of them.
"We are looking to the agency to clarify what it actually means so that women will be able to get the kinds of equipment that they actually need and will actually work for them."
Myra Alvarez is with the U.S. Department of Health and Human Services. In a statement recorded by in the agency in response to OPB's questions, she said the Affordable Care Act is helping take medical decisions out of the hands of insurance companies and putting them in the hands of women and their doctors.
"The regulations give health plans the flexibility to decide whether to pay for women to purchase or simply rent a breast pump and plans are allowed to use reasonable strategies to manage their costs."
Meaning they can provide a manual pump instead of an electric one if it saves money. But she says, it's doctors who have the final say.
"Health plans must cover what doctors find to be medically appropriate for his or her patient."
The bottom line she says is that breast feeding is good for both mothers and their babies. The Department of Health and Human Services says it reduces the risk of many diseases including: leukemia; asthma; ear infections; sudden infant death syndrome and diabetes.