VSP: Allow Stand-Alones Into Exchanges
As part of the Obama administration’s health care reform initiative, the Patient Protection and Affordable Care Act was signed into law in 2010. Since then, we’ve all been working to understand the implications of this new health care model. The really great thing is that it will expand health care coverage, which will allow more people to get the care they need. As an optometrist for over 30 years, this is something I care a great deal about—making sure people have access to health care. I’ve seen the devastating consequences associated with receiving care late or not at all.
With all of the good things that are associated with health care reform, there are still some unintended consequences that need to be fixed before we move into this new health care model. Under the new law, vision insurance will be provided through Exchanges, which will act as a central marketplace where insurance can be purchased. Although stand-alone vision plans (vision plans which specialize in and provide eye care benefits directly to their members) currently provide 90% of the vision insurance in the U.S., under the current plan they will not be authorized to provide care in the Exchanges. Only medical health care plans will be able to compete for the vision coverage. Ironically, stand-alone dental plans are allowed to offer dental care through the Exchanges.
If the Exchanges move forward as structured, I’ll have to provide care to my patients through their health plans. In theory, this sounds great. I’m a doctor and should be treated equal to my medical doctor colleagues. However, there are still a lot of hurdles that have to be overcome before we get to even ground. Medical doctors are at the core of the treatment models called for in the law. Although health plans may decide to allow optometrists on their panel, it is not mandatory. The Harkin Amendment, which has been touted as providing parity for all health care providers, states that health plans are not required to contract with every health care provider and can provide varying reimbursement rates. The amendment provides no guarantees of being treated equal. With the new health care model, I will have to rely on health plans to change their practices and begin treating me the same as their network of medical doctors. While the Harkin Amendment is a good first step, it needs to be strengthened before it has any real meaning.
After caring for my patients all these years, I’m now concerned about the risk of losing them simply because of the way the Exchanges are structured. Stand-alone vision plans have a much higher impact on the number of patients I’m seeing than medical plans do. There are several reasons for this. Not only are there 100 million people in the U.S. relying on vision benefits from stand-alone vision plans, but research shows that these individuals get vision care much more frequently than those who have a benefit through a medical plan. Stand-alone vision plans have more patients and higher utilization than medical plans, and they also direct patients to me. Health plans rarely have a referral model that supports the optometric profession.
If stand-alone vision plans are not allowed to provide care in the Exchanges, this creates an issue for my practice and countless other practices around the country. I completely support optometrists being integrated into the medical health care model. But until I have a guarantee that I will be included on the health plan panels—and treated equal to medical doctors for the same services rendered and have equal access to patients—I can’t risk losing the patients that I currently have through stand-alone vision plans. It just makes sense to allow the vision plans to compete for business in the Exchanges the same way medical and dental plans are allowed to do so.
—Tim Jankowski, O.D.
Chairman, VSP Global Board of Directors
AOA: Optometry Should Be Defined By Optometrists
Thanks to several visionary leaders in Congress and the AOA’s relentless lobbying efforts, the 2010 health care law is making healthy vision for America’s children a new national health care priority. The legislation specifically recognizes pediatric vision care as essential and requires that health plans cover it starting in 2014.
This means that millions more children who now lack health insurance or whose families struggle with plans with insufficient or segmented benefits will soon be closer than ever to having a range of vision problems diagnosed and treated by their local optometrist.
Throughout the Washington, D.C., battles over health care, the AOA’s mission has been to expand patient access to optometric care. We have fought to gain and to hold our profession’s seat at the table whenever and wherever health care policy issues are decided. From my trips to the nation’s capital for meetings at the White House, the Capitol and the Department of Health and Human Services, I’ve seen our hard work make the difference.
In fact, the bill that became law two years ago not only makes pediatric vision care essential in health plans, but also includes AOA-backed provisions telling insurers that they can no longer discriminate against us or confuse our patients by covering vision but not all of the medical services we provide.
The battles rage on though, and it will take a Supreme Court decision later this year to begin to cut through some of the uncertainties. No matter what happens, we will need to be vigilant and prepared to do whatever it takes to again defeat organized medicine and insurers who continue their scheming to undo every one of our gains.
As AOA president, I’m committed to ensuring that neither medicine nor insurers gain the ability to define optometry. Medicine continues to try to tell us and our patients what we are not, while insurers seek to use reimbursement to tell us how and when to provide care. The former is overt and the latter more covert, but both are equally dangerous to our profession.
That is why we must take a stand when health plans try to impose artificial and anti-patient restrictions on our services. This includes the stand-alone plans whose outdated business models result in the isolation of the profession of optometry from the rest of health care, as if somehow vision care must always “stand alone” from primary health care.
Under the new pediatric vision essential benefit, which should be based on a comprehensive eye exam and all necessary follow-up care, the law is aimed at allowing O.D.s to provide our full range of eye health care services while stopping insurers from limiting us to only vision care. This is an important new recognition in Federal law of full-scope optometric eye health care, included to assure the seamless delivery of care for millions of our newest patients as well as to deliver opportunities for optometrists to become providers on the medical plans’ health panel.
I still do hear from insurance executives who, while claiming to have our best interests in mind, want a special loophole that would allow them to go back to segregating optometry from the mainstream of health care, requiring us to refer patients when medical eye care is needed. I’ve let them know that preserving forever a very broken status quo may be very good for their corporate bottom line, but it won’t be good for our patients or our practices.
Although there are many uncertainties in the era of health care reform, the integration of vision and eye health care coverage for currently uninsured and under-insured children is a certain step toward expanded access to the full range of care that we provide. It’s an advancement that builds on decades of our access and scope of practice gains, and the hard work and visionary thinking of optometric leaders from every state that have made them a reality.
Let’s continue looking ahead and continue doing everything necessary to ensure that only optometrists define optometry. For more information on what you can do to help advance our profession, please don’t hesitate to contact me or the AOA’s Washington, D.C., office.
—Dori M. Carlson, O.D.
President, American Optometric Association
