Breast Milk Pumps: Not Deductible

An IRS policy presents one more barrier to breastfeeding.

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Thursday, February 03, 2011

You'd think that the IRS is already an unpopular enough agency that it wouldn't court the enmity of America's moms.

What has the Tax Man done to anger that not-to-be-messed-with segment of the population? Last year, the agency decreed that breast milk pumps would not be covered under flexible health spending accounts, which allow individuals to tuck away a portion of their income, pre-tax, to pay for otherwise uncovered medical expenses.

This isn't a new policy; breast pumps, which allow nursing moms to express breast milk while they're at work or otherwise separated from their babies, have never been covered under the IRS rules. But medical groups—notably, the American Academy of Pediatrics—had hoped that would change this year. The AAP had lobbied the IRS to add breast pumps, which cost from around $20 to as much as $1,000, to the list of covered expenses, citing the mountains of evidence showing the many health benefits breastfeeding gives babies and moms alike.

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In its official recommendations on breastfeeding, issued in 2005, the AAP calls for infants to be breastfed exclusively until the age of six months, and for moms to be supported in breastfeeding efforts "for the first year and beyond as long as mutually desired by mother and child." In support of those recommendations, the AAP referenced scientific evidence linking breastfeeding to reductions in rates of ear infections, bacterial meningitis, Sudden Infant Death Syndrome, diabetes, asthma and obesity, "among others."

Mothers who nurse, research shows, are at lower risk for ovarian and breast cancer, and also appear to be at lower risk for hip fractures and osteoporosis after menopause.

"Increased breastfeeding also has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden of disposal of formula cans and bottles, and energy demands for production and transport of formula," the 2005 AAP statement said.

You'd think that the potential savings alone would prompt government officials to try to make breastfeeding as easy as possible for families. And, indeed, some government health agencies have made it a priority to support breastfeeding. The federal healthcare reform passed last year, for instance, includes a requirement that nursing moms who work outside the home get unpaid breaks to express breast milk. The new law requires employers with at least 50 workers to provide nursing mothers, up to a year after giving birth, with "a reasonable break time" and "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public." Companies with fewer than 50 employees would be exempt if the requirement amounted to "an undue hardship."

Of course, to pump breast milk at work, mothers need breast pumps—and they're not cheap. Electric-powered pumps, which are generally regarded as most effective and fastest (key for a mom trying to squeeze in a pumping session during a work break), typically run from $150 to $300. Hospital-grade pumps, which some families rent for short periods, run more than $1,000. Hand-powered pumps cost significantly less, with prices starting at around $20 or $25, although they take more time than electric pumps and are considered less effective by many moms.

Then there are related costs, like the freezer bags and bottles used to store the expressed milk.

Those are costs plenty of families are willing to take on given the health rewards of breastfeeding. So why isn't the IRS willing to cut those families a bit of a break and allow them to at least buy the equipment with pre-tax dollars?

According to an October New York Times article, the IRS considers breastmilk to have nutritional value, but not to be a medical necessity.

"They get very uneasy about anything that smacks of food because they fear it will open up all sorts of exceptions," Roy Ramthun, a tax expert and former Treasury Department official, told the Times. "It's a matter of cost and of protecting the integrity of the tax code."

Breastfeeding advocates, meanwhile, are left questioning the integrity of the IRS' decision to allow certain other expenses to qualify for reimbursement under healthcare accounts. Legally covered expenses include hair transplants and hair-growth drugs like Rogaine (but only when prescribed for a "medical condition" and not for "cosmetic" purposes), ear wax removal kits and treatments for "sexual inadequacy."

"Acne Cream? Tax-Sheltered. Breast Pump? No." read the headline of the Times article.

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The IRS' decision to exclude breast pumps introduces just one more barrier to successful, sustained breastfeeding of babies in the U.S. The federal government's Healthy People 2010 plan calls for 75 percent of new mothers to initiate breastfeeding, 50 percent to continue breastfeeding for six months, and 25 percent to continue for 12 months (goals that some breastfeeding advocates contend are actually too low).

According to 2010 data from the Centers for Disease Control and Prevention, the 75 percent initiation rate has been met. "However, rates of breastfeeding at 6 and 12 months as well as rates of exclusive breastfeeding at 3 and 6 months remain stagnant and low," according to the CDC report.

Nationwide, only 43 percent of babies are still being breastfed at six months, and only 22.4 percent at one year. Thirty-three percent are being breastfed exclusively at three months, and 13.3 percent at six months. The rates vary dramatically from state to state, with babies in the poorest parts of the country least likely to be breastfed. (Massachusetts meets several of the federal goals—77.6 of moms here initiate breastfeeding, 50.1 percent of babies are still nursing at six months, and 20.5 percent of those six-month-olds are breastfeeding exclusively.)

"High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so," the CDC report noted. "However, even from the very start, mothers may not be getting the breastfeeding support they need. Low breastfeeding rates at 3, 6, and 12 months illustrate that mothers continue to face multiple barriers to breastfeeding."

And it doesn't take a genius to figure out that lack of access to an affordable breast pump can be one of those barriers. In truth, a woman is unlikely to base a decision about nursing her baby solely on whether or not she can buy a pump with pre-tax dollars. More crucial are factors like the support she receives from medical professionals, her family and her community, and workplace policies that allow her to pump milk on the job. (And let's not forget the political influence of the powerful, deep-pocketed pharmaceutical lobby, which includes the makers of infant formula.)

Nonetheless, the IRS missed an important opportunity to signal that the federal government takes the health benefits of breastfeeding seriously, and will do what it can to make it a little easier for families to do it—and, indeed, make it that much more likely that the government's own breastfeeding goals are met.

Indeed, the IRS is experiencing some pushback from other government sources. In November, after the new policy was announced, members of the U.S. House of Representatives and Senate wrote to IRS Commissioner Douglas Shulman urging the agency to overturn the decision not to allow breast pumps as a reimbursable expense.

Leading the charge are New York Democratic Congresswoman Carolyn Maloney and Sen. Jeff Merkley, an Oregon Democrat. (U.S. Rep. John Olver, a Democrat from the 1st Congressional district, was the only member of the Massachusetts delegation to sign on to the letter. Neither of Massachusetts' senators signed the letter, although Vermont Sen. Patrick Leahy and New Hampshire Sen. Jeanne Shaheen did, as did Connecticut's Chris Dodd, who has since left the Senate.)

"This decision by the IRS is at odds with the growing body of medical evidence showing that breastfeeding has proven health benefits for both mothers and babies," the legislators' letter read. "The American Academy of Pediatrics encourages mothers to breastfeed their infants for at least the first year of a child's life. However, one major barrier is the high cost of buying or renting a breast pump and related supplies. These tools are essential medical expenses that are vital to improved childhood health and should be tax-deductible and reimbursable through flexible health spending accounts."

In addition, the grassroots MomsRising—a national nonprofit that advocates for family-friendly policies—has organized an online petition calling for a reversal of the IRS rule. "Hundreds of medical studies have shown that breastfeeding has health benefits for children, including reducing a child's risk of Sudden Infant Death Syndrome, asthma, leukemia, type 1 diabetes, and obesity," the petition reads. "IRS regulations should reflect medical opinion, not overturn it."

As of last week, MomsRising said 13,000 people had signed the petition; the organization's goal is get at least 20,000 to do so. The petition can be found at www.momsrising.org; type "IRS" in the search box.

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