Here, in a nutshell, is what I learned last weekend at the great United
States Breastfeeding Committee member meeting, and the Natl Conference of
State Breastfeeding Coalitions that immediately followed it.  International
readers -- skip to the bottom two paragraphs.

USA federal part:  The Patient Protection and Affordable Care Act, often
called "healthcare reform," or the "ACA," was a humongous piece of federal
legislation, designed to figure out ways to provide healthcare coverage to
all Americans.  It will be phased in over time, because the changes in
healthcare delivery and reimbursement are so vast that it can't be done all
at the same time. The provisions guarantee a mother *with private
healthcare insurance* no out-of-pocket expenses for "breastfeeding support"
and "supplies" as part of her basic preventive healthcare rights; read more
at: http://www.hrsa.gov/womensguidelines/.

BUT the definitions, sign-up steps, requirements, payments, opportunties,
yadda yadda yadda are defined *by the private insurer.* The feds said: Here
is what you have to include, now go forth and do this, free market economy.
So, now the free market economy (meaning, the insurance companies) are
figuring out how to do this, and each company is doing it on their own.
 Thus, reimbursement packages will differ state-by-state, ins.
company-by-ins. company, even facility-by-facility.

If IBCLCs want to be reimbursed for the fine work they do, and not be
squeezed out by other-than-IBCLCs who run in and bargain with those
insurance company offices first, it will require a boots-on-the-ground
grassroots effort to reach as many insurers as possible.  Do it alone, do
it with your colleague, do it with the people on Lactnet or your Facebook
and yahoo groups, do it through USLCA/ILCA ... but do it.  Yes, all the
professional organizations are scrambling to provide resource materials,
but don't wait to start the process.  Pick up a phone TODAY and call a
health insurance company in your town and just ask "Who do I talk to about
how your company will define "breastfeeding support" and "supplies?"

A basic premise to *know* and not *argue about* because *it is our world
now* is: the insurance companies are being told they HAVE to offer this
service now to their mother-clients, and they can't even ask for a co-pay
to offset their expenses.  The companies are in business to make a profit,
after paying HCPs to provide healthcare.  They are NOT going to turn around
and offer huge reimbursements to the "breastfeeding supporters" in their
network ... BUT ... they can certainly be bargained with to provide as
large a payout as possible.  They can be convinced that IBCLCs are the only
credible, accountable, disciplinable, self-insurable body out there,
skilled in both clinical care and educational services, on lactation
matters that require an allied healthcare provider (and not a
mother-to-mother helper).

Remember: If you do not want to align yourself with an insurance company as
an IBCLC, you do NOT have to.  You can STILL take private clients, offer
fee-for-service care, and charge them whatever your market will bear.

NOTE that private insurance covers only a fairly small segment of the
population.  Not all mothers work in companies that have private insurance
(they may, for example, get it through their union). And NOTE that more
than 50% of the children born in the USA now are WIC eligible, and
Medicaid-eligible. A huge part of the ACA is designed to expand Medicaid
coverage to more people.  Yet, Medicaid will ONLY reimburse healthcare
providers with a license. Until we get licensure as IBCLCs (again,
accomplished state-by-state ...) , or the feds amend the codes for what is
covered, IBCLCs (without any other HCP license providing a  shoehorn for
reimbursement) *cannot* be reimbursed under the present Medicaid regulatory
scheme.

USA state part:  Read the paragraph directly above.  Getting licensure in
the USA happens state-by-state, and is subject to many political whims and
realities. This is a separate issue, although certainly related in spirit,
to implementation of the federal ACA.   It all depends on your Governor,
your regulatory licensing board set-up, and your state legislature.
 Factors having nothing to do with lactation can scuttle the plan.  Other
healthcare providers will likely fight us, on the (misguided) theory that
IBCLCs will "take away" business from their profession. This absolutely
positively must be a battle waged by boots-on-the-ground, and the more the
merrier.  For an example of some great work being done in this area in the
State of Georgia, see
http://www.hmhbga.org/index.php/breastfeeding-initiative/licensure.

International part:  At the ILCA conference I learned that efforts are
underway in many countries to change their definitions of how IBCLCs are
hired, retained, and paid.  New Zealand, Canada, France, England and I
think Australia all have efforts underway to change, sometimes radically,
the way women's healthcare (and BF support ....) are provided.  The
buzzwords "licensure and reimbursement" are often thought of as a USA
issue.  But the issue of recognition of the value of the IBCLC -- the
essential credential for lactation support -- is global.  Many of the same
advocacy pieces that an American might use in her visit to a state
legislator will be equally persuasive when a German or a Kiwi or a
Brazilian goes to visit her health minister (like, the ILCA Position Paper
on the Role and Impact of the IBCLC,
http://www.ilca.org/files/resources/ilca_publications/Role%20%20Impact%20of%20the%20IBCLC-webFINAL_08-15-11.pdf
).

I urge all IBCLCs: do NOT "tune out" when you see posts about licensure and
reimbursement.  You can skim past the parts that don't affect your
geopolitical region, but often there are nuggets in there, about the public
health applications of providing skilled care by any IBCLC, anywhere.  We
are providers certified by an independently-accredited certifying
organization  (IBLCE), and their charge is to protect the public health
safety and welfare by their rigid certification requirements.  And THAT is
universal.

Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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