IRS Reverses Stance on Breast Pumps

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The Internal Revenue Service has done a turnaround on the deductibility of breast pumps as medical expenses.

The IRS issued Announcement 2011-14 on Thursday, advising the public that expenses for breast pumps and other supplies that assist lactation may be deducted as medical expenses or reimbursed under a flexible spending arrangement or similar plan.

The agency came in for considerable criticism last fall when it decided that breast pumps and other breast-feeding supplies could not be paid for with money from mothers’ tax-exempt flexible spending accounts and health reimbursement accounts (see IRS Denies Tax Break for Breast Pumps).

The American Academy of Pediatrics had requested that breast-feeding costs be reclassified as medical care expenses that would qualify for reimbursement with the accounts, and media coverage of the IRS’s decision provoked outrage among women’s groups.

The health care reform law that was approved last year placed strict limits on the types of pharmaceuticals and medical expenses that could be paid for with health reimbursement accounts and flexible spending accounts.

According to the IRS announcement on Thursday, the IRS has concluded that breast pumps and supplies that assist lactation are medical care under Section 213(d) of the Tax Code because, like obstetric care, they are for the purpose of affecting a structure or function of the body of the lactating woman. Therefore, if the remaining requirements of Section 213(a) are met (for example, the taxpayer’s total medical expenses exceed 7.5 percent of adjusted gross income), expenses paid for breast pumps and supplies that assist lactation are considered to be deductible medical expenses. 

Amounts reimbursed for these expenses under flexible spending arrangements, Archer medical savings accounts, health reimbursement arrangements, or health savings accounts are not considered to be income to the taxpayer, according to the IRS.

The IRS plans to revise Publication 502, Medical and Dental Expenses, to include this information.

The decision was hailed by a group of four lawmakers who had written to IRS Commissioner Doug Shulman last November along with 41 other lawmakers, urging him to reverse the IRS decision.

“Today’s decision is a huge victory for nursing mothers everywhere,” said Rep. Sander Levin, D-Mich., Carolyn B. Maloney, D-N.Y., Sen. Jeff Merkley, D-Ore., and Tom Harkin, D-Iowa, in a statement. “Modern medicine has documented numerous health benefits linked to breastfeeding, including a reduced risk of illness in infants and a reduced risk of cancer in mothers. And because breastfeeding is so effective in preventing disease, it also happens to save billions in health care costs. We thank the IRS for their careful consideration and quick response.”

Pediatricians were also enthusiastic about the IRS decision. “It’s fabulous,” said Dr. Richard J. Schanler, chair of the American Academy of Pediatrics Section on Breastfeeding. “I take care of premature babies in neonatal intensive care units, and the mothers have to pump with an electric breast pump to maintain their milk supply, sometimes for several months, because their babies are too small to suckle at the breasts, so this is a tremendous help for them. Also it’s an even bigger help, in terms of numbers, for mothers who are trying to return to work who need to maintain their milk supply."

Dr. Schanler noted that exclusive breast milk feeding should be continued for at least six months and then it should be the major milk source for the baby thererafter. "We’re talking about a year or more that if the mother is returning to work she will need to have a breast pump, and an electric breast pump is the way to get the best milk volume without hurting her breasts," he said. "It really is medical equipment when you think of the premature babies and the babies in hospitals in intensive care units. But then when you think about the full-term baby, the benefits of breastfeeding and the risks of not breastfeeding are so great that we are talking about medical care to provide that milk for them to keep them from developing infections and chronic diseases."

American Academy of Pediatrics president O. Marion Burton also praised the IRS decision.

"The American Academy of Pediatrics hails the Internal Revenue Service ruling today that recognizes breast pumps and breastfeeding supplies as medical expenses worthy of reimbursement through flexible spending accounts," said Dr. Burton in a statement. "Today’s IRS ruling providing favorable tax treatment for the purchase of breast pumps and breastfeeding equipment marks an important victory for the health of women and children across the country by making breastfeeding a more practical option for new and working mothers. For years, the AAP has been urging the IRS to recognize that breast milk is not just the best and most natural food for infants; it confers well-documented health benefits on both baby and mother that cannot be obtained any other way. The IRS has finally acknowledged this medical fact, and we applaud them for changing their regulations accordingly."

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