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As of this year, a new part of the Affordable Care Act went into effect. It requires most insurance plans to provide support for breast-feeding. In most cases, that the cost of a breast pump will be covered. But what the law does not say is what kind of pump - and that's leading to some confusion.

Kristian Foden-Vencil of Oregon Public Broadcasting, reports.

KRISTIAN FODEN-VENCI, BYLINE: 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 works full time, so she needs a breast pump. Since she wants to breast-feed for at least a year, she was pleased to learn about the new federal health care law.

MEGAN LOPEZ: I was excited because I said this is perfect. I can get a new breast pump and I need one.

FODEN-VENCI: A friend loaned her one, then promptly got pregnant and needed it back. Lopez learned about the free pump from a co-worker, whose wife has Providence Insurance.

LOPEZ: He said: Yeah, she's able to get an electric pump. No problem. They're paying for the whole thing. Like, that's awesome. So I called Kaiser, who I have, and they said: We're providing a manual pump. And I said, really?

(LAUGHTER)

LOPEZ: 'Cause that's not even possible if you're working full-time. So I just said, OK, whatever, I'm not going to get that. 'Cause it's not really going to work for me. So I was pretty bummed out.

FODEN-VENCI: She says electric pumps are high powered and supposed to simulate a nursing child, whereas, she finds manual pumps weak and clumsy.

LOPEZ: It already takes my whole break to pump as it is with an electric pump on both breasts. So it's - to do a hand pump and do it each side, I couldn't even imagine it'd be convenient.

FODEN-VENCI: A high-end electric-powered pump can cost $300, whereas a manual one can be $35. Different health plans are providing different pumps.

Dr. Kim Luft is a pediatrician with Kaiser Permanente. She says manual pumps meet the basic needs of moms, but...

DR. KIM LUFT: 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 with her employer about the Oregon law that allows time for breast-feeding, so she could get the time she needed.

FODEN-VENCI: Lopez has no problem with her employer, OnPoint. She says she doesn't want to take extra time and leave her workmates to cover for her.

OnPoint issued a statement saying it supports nursing mothers and is committed to making it easy and comfortable to pump during the work day - consistent with wage and hour laws.

Meanwhile, Kaiser says helping new mothers breast feed is one of its priorities, too. But its own literature says manual pumps don't increase milk supply for most women.

Kaiser pediatrician, Dr. Kim Luft, says essentially it comes down to money.

LUFT: 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.

FODEN-VENCI: The confusion comes from the fact the law isn't specific about what insurers need to cover. Judy Waxman, of the National Women's Law Center, says the U.S. Department of Health and Human Services needs to step in.

JUDY WAXMAN: 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.

FODEN-VENCI: Myra Alvarez is with the U.S. Department of Health and Human Services. In a statement recorded by the agency in response to NPR's questions, she says 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.

MYRA ALVAREZ: 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.

FODEN-VENCI: 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.

ALVAREZ: Health plans must cover what doctors find to be medically appropriate for his or her patient.

FODEN-VENCI: The Department of Health and Human Services says breast-feeding is important since it helps reduce the risk of some illnesses, such as ear infections and asthma.

For NPR News, I'm Kristian Foden-Vencil in Portland.

MONTAGNE: And this story is part of a reporting partnership between NPR, Oregon Public Broadcasting, and Kaiser Health News.

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