Dear Internal Revenue Service Commissioner Douglas H. Shulman:

The National Consumers League has been advocating on behalf of women and children’s health since our founding in 1899. We were therefore very concerned to read about the IRS’ decision [1] to deny nursing mothers the ability to use  their tax-sheltered health care accounts to pay for breast pumps and other supplies. Under IRS regulations, eligible medical expenses under the flex programs.

According to IRS Publication 502, items that can be reimbursed  include those that aid in the  “prevention of disease.” The IRS apparently has inexplicably determined that breast-feeding does not help in the “prevention of disease.” The National Consumers League could not disagree more with this determination. We ask that you review and reverse this misguided decision. Indeed, the medical evidence is overwhelming that far more widespread breastfeeding would not only “prevent disease” in the United States, but would save our health care system billions of dollars.

Consider the following evidence about the myriad health benefits to both mother and child of breastfeeding:

• According to a Harvard study published in April of this year[2], if 90% of US families would comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be among infants ($10.5 billion and 741 deaths at 80% compliance).
• The risk of infant death due to Sudden Infant Death Syndrome (SIDS) is lowered[3], and respiratory infections such as pneumonia, and necrotizing enterocolitis is nearly eliminated if mothers breastfeed their infants until at least six months after birth.
• The US Department of Health and Human Services has found that  breastfed infants have a lower risk of contracting ear infections, stomach viruses, atopic dermatitis, type 1 and 2 diabetes, childhood leukemia, and other health problems.
• Mothers also benefit from breastfeeding because of lower risk of contracting type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression (PPD).
• A former acting Surgeon General, Steven Galson, has noted that for most women, breastfeeding is biologically possible. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections.
• Breastfed infants typically need fewer sick care visits, Congress recently acknowledged the importance of breastfeeding in the landmark health care reform legislation it enacted this year by requiring that workplaces provide women with a private place to nurse or use a breast pump.

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

We agree with Dr. Block. We need to encourage, not discourage, barriers to widespread breastfeeding. Unfortunately, the IRS determination NOT to allow parents to use their tax-sheltered flex accounts to cover the cost of breast pumps has the impact of further discouraging  women  from breast feeding and directly undermines what is by every measure a critical practice for improved public health.  We ask that you, as IRS Commissioner, review this decision and, in light of the overwhelming evidence, reverse it. We believe the cost of breast pumps should and must be a covered cost in these flex plans.

Thank you for your attention to our concerns.

Sincerely,

Sally Greenberg
Executive Director, National Consumers League

Cc:      Senate HELP Committee Chairman Tom Harkin, Treasury Secretary Timothy Geithner, Surgeon General Regina Benjamin and House Energy and Commerce Chairman Henry Waxman

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[1] http://www.nytimes.com/2010/10/27/business/27breast.html?_r=1&scp=1&sq=IRS%20wont%20reimburse%20for%20breastfeeding%20&st=cse

[2] http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1

[3] http://www.monash.edu.au/news/newsline/story/200

As Robin illustrated in her post, poor medication adherence results in poor health outcomes for millions of Americans, and costs billions of dollars in increased medical costs.  When three-quarters of Americans concede they don’t take their prescription medications as directed, we are faced with a public health problem that demands a broad, multi-faceted response.

As the nation’s oldest consumer organization, the National Consumers League has long worked to improve medication safety, patient education, and consumer education in the health community.  With planning funds from the Agency for Healthcare Research and Quality (AHRQ), NCL is spearheading a first-of-its-kind national education campaign to raise consumer awareness of the importance of good medication adherence.  As called for in the 2007 NCPIE report, a public-private education campaign to motivate patients to improve their medication-taking behavior should be a national health priority.

Since the campaign planning phase got under way just a little more than a year ago, we have worked around the clock to bring together a diverse and committed group of stakeholders interested in improving medication adherence.  From government agencies to health care practitioner professional associations, community health plans to national health plans, pharmaceutical manufacturers to consumer advocates, the list of supporting organizations tops 100 and continues to grow.

The campaign, which NCL anticipates launching publicly in the third quarter of 2010, aims to educate consumers through mass media, including many new social media tools.  The depth and breadth of involvement from stakeholders will help reinforce the messages to ensure that consumers are educated, engaged, and empowered as they manage their health.  The campaign has involved health care practitioners (HCP) from the start, and HCPs will play an active role in improving adherence as they engage their patients.

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As the nation’s oldest consumer organization, the National Consumers League has been working toward health reform for decades.  Our former President, Josephine Roche, drafted the first piece of universal health care legislation for President Franklin D. Roosevelt in the 1930s.  Like so many others, we are pleased to see that today our foremothers’ determination to provide health coverage for all Americans is coming to fruition.

The League appreciates the hard work of those in the HELP and Finance Committees in the Senate and in the House Committees in providing affordable and quality health care for all Americans.

At this moment in history, more Americans than ever before agree that health reform must happen now and can’t be put off for another day. 85% of Americans think the system needs to change, according to a recent New York Times / CBS News poll.  Consumers need access to health care that is high quality and is  centered around their needs.  The places where Americans  live, work, and go to school must be involved, and each must be part of the national goal of living healthier lives.

All of this must be accomplished while keeping health care affordable. Right now, it is not. Sponsored health insurance premiums have nearly doubled in the last decade, rising three times faster than wages.  No longer will health insurance companies be able to discriminate against consumers because of their health status.

NCL also supports a public option, which will give us  transparency and competition between public and private insurers.  If we provide health care coverage to all Americans, we can also save hundreds of billions of dollars previously used to care for the uninsured.

With 75% of health spending going towards care for the chronically ill, we must refocus our system on prevention and health promotion. We can no longer tolerate a system dominated by treating problems; it’s time to provide Americans the necessary resources and tools to attain a healthy lifestyle.

The lack of comprehensive health care coverage is  America’s albatross – it makes our businesses less competitive and our workers less healthy.

Regardless of political ideology or special interest, we need to ensure that the system is reformed.  The cost of doing nothing is unthinkable.

As HHS Secretary Sebelius has said,  it’s the one of the most personal issues to so many Americans.  It is, after all, one of the only pieces of legislation that will truly affect EVERY American.